MedicaidCoverageMedium impact
Supplement 24-08: Implementation of Community Health Workers (CHW) and Community Health Representatives (CHR)
New Mexico Medicaid·NM · Family Medicine, General Practice, Internal Medicine +1 more·Medical Policy
Effective date
Jul 1, 2023
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid now covers Community Health Worker (CHW) and Community Health Representative (CHR) services for preventive health, health navigation, and clinical support. CHWs/CHRs can bill specific CPT codes with required standing order forms and must enroll as Provider Type 462.
Action Required
For practices serving New Mexico Medicaid patients: 1) CHWs/CHRs must enroll with New Mexico Medicaid as Provider Type 462, Specialty 230 and obtain DOH attestation, 2) Complete required standing order forms for each service date and attach to claims for auditing, 3) Update billing system to use CPT codes 98960-98962 with taxonomy 172V00000X on CMS-1500 forms, 4) Implement reimbursement limits: maximum 10 units (5 hours) per CHW per day and 16 units (8 hours) per member per 30 days, 5) Claims previously denied from July 1, 2023 to present can be resubmitted within 90 days with waived timely filing requirements.