MedicaidReimbursementMedium impact
Supplement 23-04: Suspension of Prior Authorization Requirements for Skilled Nursing, Long-Term Care, and Home Health Facilities/Agencies
New Mexico Medicaid·NM · Pulmonology, Critical Care·Prior Authorization
Effective date
Mar 14, 2022
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid has implemented a $305.66 per diem add-on rate for ventilator services in long-term and skilled nursing facilities, effective March 14, 2022. Facilities must use specific billing codes (revenue code 0947 with CPT 94004) and ICD-10 diagnosis code Z99.11 for ventilator-dependent residents who meet detailed clinical criteria.
Action Required
Immediately: Long-term and skilled nursing facilities in New Mexico must update billing systems to use revenue code 0947 with CPT 94004 and ICD-10 diagnosis code Z99.11 for ventilator-dependent residents. Ensure facility is DOH-certified for ventilator services and staff are trained in respiratory care. Implement 90-day clinical reviews to verify continued ventilator dependency. Maintain separate cost reporting for ventilator services beginning March 14, 2022.