MedicaidCoverageMedium impact
Supplement 24-15: Coverage of Gender Affirming Healthcare Medications and Procedures
New Mexico Medicaid·NM · Endocrinology, Plastic Surgery, General Surgery +3 more·Medical Policy
Effective date
Oct 1, 2024
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid now covers gender affirming healthcare services effective October 1, 2024, including hormone therapy, surgeries, and other procedures. Claims must include specific diagnosis codes (F64.2 or F64.9), condition code 45 for UB-04 claims, and modifier KX for all gender affirming procedure codes.
Action Required
By January 9, 2025: Billing team must update systems to recognize gender affirming procedure codes with required modifier KX and appropriate diagnosis codes (F64.2 for ages 12-17, F64.9 for ages 18+). For UB-04 claims, add condition code 45 (Gender incongruence). Verify age-based eligibility requirements are documented in medical records. Submit backdated claims within 90 days to avoid timely filing denials.