MedicaidCoverageMedium impact
Supplement 25-03: Qualified Clinical Trials (QTC) Information
New Mexico Medicaid·NM·Medical Policy
Effective date
Feb 4, 2025
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid now covers routine patient care costs for beneficiaries participating in Qualified Clinical Trials (QCT). Providers must submit a new attestation form (MAD 901) with each claim and use specific billing codes and modifiers for both institutional and professional claims.
Action Required
By May 5, 2025: Download MAD form 901 from New Mexico Medicaid provider portal. Train billing staff to complete attestation form for each QCT claim, including NCT identifier and principal investigator attestation. Update billing system to include condition code 30, ICD-10 code Z00.6, and modifiers Q0/Q1 for QCT claims. For UB-04 claims, enter NCT number in value code D4; for CMS-1500 claims, enter 'CT' plus NCT number in field 19. Claims will be denied if attestation form is incomplete or missing required elements.