MedicaidCoverageMedium impact
Supplement Special COVID -19 Supplement #16: COVID-19 Vaccine Coverage, Billing and Reimbursement
New Mexico Medicaid·NM · Pharmacy·Claims & Billing
Effective date
Dec 1, 2020
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid established comprehensive COVID-19 vaccine coverage and billing guidelines, retroactive to December 1, 2020. The policy outlines specific billing procedures for different provider types (UB-04 vs CMS-1500), pharmacy point-of-sale billing requirements, and reimbursement rates following Medicare methodology with approximately $40 per dose administration fee effective March 15, 2021.
Action Required
Immediately: New Mexico providers administering COVID-19 vaccines must use specific revenue codes based on facility type (FQHCs use 0529, IHS/Tribal use 0519, RHCs use 0521/0510, others use 0779) and append appropriate HCPCS COVID-19 vaccine administration codes. Pharmacy providers must bill COVID-19 vaccine at $0.01 with specific NCPDP field requirements including Professional Service Code MA and Basis of Cost Determination value 15. All providers have up to one year from date of service to file COVID-19 vaccine claims and should resubmit previously denied claims.