MedicaidCoverageMedium impact
Supplement 24-23: Billing and Guidance for Lactation Care Providers in the Outpatient Setting
New Mexico Medicaid·NM · OB-GYN, Family Medicine, Pediatrics·Claims & Billing
Effective date
Oct 1, 2024
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid now covers lactation care services provided by certified Lactation Care Providers (LCPs) effective October 1, 2024. LCPs can bill up to 6 visits per calendar year using HCPCS code S9443 with specific modifiers for individual ($110) or group sessions ($56.44 per individual), with no prior authorization required.
Action Required
By March 20, 2025: Billing team must enroll eligible Lactation Care Providers as Provider Type 406 with Specialty Code 207 and taxonomy 174N00000X. Update billing system to accept HCPCS code S9443 with modifiers U1 ($110 for individual sessions) and U2 ($56.44 per individual for group sessions) for New Mexico Medicaid. Submit claims using CMS 1500 form. Claims for services provided since October 1, 2024 can be submitted within 90 days of this supplement to avoid timely filing denials.