New Mexico
This data is meant to be used for educational purposes to inform providers, patients, insurers, and state Medicaid agencies what genetic services may or may not be written into each state’s Medicaid policy. The database is not meant to indicate or imply whether a certain program will cover a specific service, since many decisions are made on a case by case basis. If you have specific questions about whether a service is covered, you should reach out to your plan administrator. Please see this disclaimer below for more information.
Medicaid Coverage Information Published
State Contact Information
Nicole Comeaux, Division Director
The Human Services Department’s Medical Assistance Division (MAD) Medical Assistance Division
P.O. Box 2348
Santa Fe, NM 87504-2348
(505) 827-3100
General Genetic Testing Criteria
Genetic Testing Not Covered
State Specific Definition
Genetic Services for Children
Genetic Counseling Requirement
Metabolic Formula Coverage Legislation
Metabolic Formula Coverage & Criteria
Prior Authorization Requirements
All medicaid services are subject to utilization review for medical necessity and program compliance. Reviews can be performed before services are furnished, after services are furnished and before payment is made, or after payment is made.
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
Coverage is available.
Requirements for BRCA
Cystic Fibrosis Screening
Hereditary Cancer Testing Coverage
Lynch Syndrome Testing Coverage
Microarray Testing
Newborn Screening
Panel Testing
Pharmacogenetic Testing
Prenatal Testing Offered
Whole Exome Sequencing
Other Tests Covered
Other Information
Children’s Medical Services – “We are the go-to for families who have a child or youth with special health care needs (CYSHCN). Children and Youth with Special Health Care Needs means an individual younger than 21 years old, experiencing a moderate to severe medical condition:
- With significant potential or actual impact on long term health and ability to function; and
- Which requires specialized health care services and/or a variety of services from multiple diverse systems.”
Resources
- Managed Care Policy Manual
- https://www.hsd.state.nm.us/providers/managed-care-policy-manual/
- NMAC Program Rules Chapter 324 – Adjunct Services, Vision Appliances, Hearing Appliances, Durable Medical Equipment, Oxygen, Medical Supplies, Prosthetics and Orthotics
- https://www.hsd.state.nm.us/providers/rules-nm-administrative-code/ Children’s Medical Services https://nmhealth.org/about/phd/fhb/cms/
Newborn Screening Reimbursement
On this Page
Disclaimer: The information contained in the database has been obtained from sources believed to be reliable but NCC has not attempted to validate or confirm the information. The database may be updated periodically. However, the accuracy and completeness of the information contained in the database cannot be, and is not, guaranteed. NCC makes no warranty of the accuracy, completeness or timeliness of this information, and shall not be liable for any decision made in reliance on this information. It is the user’s responsibility to verify this information by contacting the state Medicaid agency directly.
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