New Mexico prices ABA across five credential tiers, with 97153 at $19.85 for technicians and 97155 at $39.69 for BCBAs. The state tells plans not to pay less.
Key Takeaways
- Credentials drive the rate. New Mexico’s fee-for-service schedule prices 97153 at five tiers, from $19.85 for a Behavior Technician to $38.02 for a Qualifying Psychologist, and 97155 at three.
- The state has directed plans not to pay less. Letters of direction since July 2024 have told Turquoise Care plans not to contract below fee-for-service rates, and a March 2025 letter required ABA claims to be adjusted back to January 1, 2025.
- New Mexico leads its region on the analyst code. At the BCBA tier, 97155 pays $39.69, above Utah, Arizona, Colorado, Texas, and Oklahoma, and the technician rate is also near the top.
- Code changes and federal scrutiny are next. The 2027 CPT revisions split 97155 and delete 0373T, and a new CMS toolkit gives states a framework for revisiting ABA payment, credentialing, and oversight.
New Mexico’s Medicaid program pays for applied behavior analysis on a finely tiered fee schedule, and it has directed its managed care plans to treat those rates as a minimum. The fee-for-service ABA schedule effective January 1, 2025 prices the core technician code, 97153, at five different rates depending on who delivers the service, and the analyst code, 97155, at three.
The schedule also matters for managed care. HCA has repeatedly directed its Turquoise Care managed care organizations not to negotiate rates below the fee-for-service schedule, including in arrangements with subcontractors, and a February 2025 letter tied that requirement to the state budget bill, HB2. For ABA, Letter of Direction 53, dated March 21, 2025, applied the minimum to the January 2025 schedule and required eligible claims with service dates on or after January 1, 2025 to be adjusted and paid within 60 days. That letter was written to sunset once the adjustments were complete. The requirement matters because in other states, such as Arizona, managed care rate cuts and contract terminations have disrupted ABA networks.
How New Mexico Medicaid Covers ABA: A Three-Stage Model
New Mexico organizes ABA in three stages under its Medicaid rules at 8.321.2 NMAC. In Stage 1, an Autism Evaluation Practitioner (a licensed psychologist, or a board-certified or board-eligible physician in developmental behavioral pediatrics, pediatric neurology, or child psychiatry) completes a Comprehensive Diagnostic Evaluation and develops an Integrated Service Plan. In Stage 2, a behavior analyst conducts a behavior or functional analytic assessment and writes a treatment plan. In Stage 3, the treatment plan is carried out.
ABA falls under the EPSDT benefit for members under 21, but the rule states that there is no age requirement and that ABA is a covered benefit for Medicaid-enrolled adults, a broader scope than in neighboring Arizona and Oklahoma, where ABA coverage is built primarily around EPSDT for children and young adults. Every ABA provider must pass a criminal background registry check, and HCA publishes separate attestation templates for each practitioner type, from Autism Evaluation Practitioners to technicians who have not yet been certified.
Stage 1 has three evaluation types. The Comprehensive Diagnostic Evaluation determines whether a child has autism spectrum disorder. A Targeted Evaluation follows when a child with a full diagnosis presents with changed behaviors, and a Risk Evaluation applies to children who meet the rule’s at-risk criteria. When a child’s needs exceed what an ABA provider agency can support, the rule allows a referral to an enrolled ABA Specialty Care Practitioner.
Stage 1 evaluations are billed under HCPCS code T1026 at $206.33 per hour, with up to 10 hours per Comprehensive Diagnostic Evaluation. The evaluation is repeated every 36 months, or sooner if medically warranted. The schedule lists no prior authorization for evaluation, assessment, or most treatment codes, but 97153 requires it.
New Mexico’s Credential-Tiered ABA Fee Schedule
The schedule recognizes five practitioner types for direct treatment. For 97153, a Behavior Technician is paid $19.85 per 15-minute unit. The state defines that group to include Registered Behavior Technicians, Board Certified Autism Technicians, and uncertified technicians completing certification on a time-limited basis. A Board Certified Assistant Behavior Analyst is paid $23.35, a Board Certified Behavior Analyst $32.31, a doctoral-level BCBA-D $37.99, and a Qualifying Psychologist $38.02.
For 97155, the BCBA rate is $39.69, and the BCBA-D and Qualifying Psychologist rate is $55.55. Assistant analysts may bill 97155 under their supervising analyst’s modifier and are paid at that analyst’s rate. New Mexico’s schedule defines the Qualifying Psychologist tier as a state-licensed psychologist certified by the American Board of Professional Psychology in behavioral and cognitive psychology and tested in ABA. That level of detail goes further than Missouri’s three credential tiers and further still from Oklahoma’s schedule, which pays one rate per code regardless of credential.
The tiering extends across the code set. Behavior identification assessment under 97151, performed annually or sooner if medically warranted, pays $130.94 per unit at the doctoral and psychologist tiers and $112.65 for a BCBA. Family guidance under 97156 pays $35.79 and $25.78 at the same tiers. Specialty care treatment under 0373T, which CPT describes for patients with destructive behavior and which New Mexico requires to involve two or more staff, pays up to $119.05 and requires prior authorization. One result of the structure: a BCBA delivering 97153 is paid $32.31, not far below the same analyst’s $39.69 rate for 97155.
New Mexico also pays for supervision as a service of its own. Clinical management and case supervision are each billed under T1026 at $142.84 per hour for analysts, or $109.27 for case supervision by a supervising assistant analyst. The schedule expects at least one hour of each for every 10 hours of Stage 3 treatment, and more than two hours per 10 requires prior authorization to confirm medical necessity. Partial hours can be billed in decimal units, and an hour can be split across more than one day.
New Mexico ABA Rates Compared to Neighboring States
Against its five bordering states, New Mexico sits at or near the top on both core codes.
Medicaid 97153 (adaptive behavior treatment by protocol, technician-delivered), rate per 15-minute unit: New Mexico and neighboring states. Arizona appears twice: the first bar is its standard rate and the second its higher home-setting rate. Source: MediRate.
On 97153 at the technician tier, New Mexico’s $19.85 is effectively level with Arizona’s home-setting rate of $19.96 and Utah’s $19.67. It is above Arizona’s standard rate of $17.91, Oklahoma at $17.35, Colorado at $17.20, and Texas at $14.50.
Medicaid 97155 (adaptive behavior treatment with protocol modification, analyst-delivered), rate per 15-minute unit: New Mexico and neighboring states. Arizona appears twice: the first bar is its standard rate and the second its higher home-setting rate. Source: MediRate.
On 97155 at the BCBA tier, New Mexico leads at $39.69, followed by Utah at $37.51, Arizona at $29.82 (and $33.00 in the home), Colorado at $25.80, Texas at $25.10, and Oklahoma at $23.55. The gap between the two codes is wide: New Mexico pays twice as much for a BCBA unit of 97155 as for a technician unit of 97153.
Because most New Mexico Medicaid members are enrolled in Turquoise Care, the published schedule is the rate HCA has told plans not to undercut, not a full picture of what they pay. For granular rate detail across tiers and codes, MediRate maintains the underlying data.
How New Mexico Set Its Current ABA Rates
The current schedule builds on rate increases the New Mexico Legislature funded during its 2023 session. A July 2024 letter of direction told the Turquoise Care plans to implement those increases and, as the 2025 letter later repeated, not to negotiate below the fee-for-service rates.
The January 2025 schedule was posted subject to a 30-day public comment period, and HCA stated that claims already paid would be adjusted if any rates changed. Letter of Direction 53 later confirmed the final rates, noting that they had been built into the managed care capitation rates effective January 1, 2025 and directing the plans to verify that their adjustments matched.
What New Mexico ABA Providers Should Watch
The first issue is coding. In January, the 2027 CPT revisions split 97155, add six adaptive behavior codes, and delete Category III codes 0362T and 0373T. A state that prices 97155 at three credential tiers, and that pays for 0373T today, will need to decide how those rates carry over to the new codes.
The second is federal oversight. On August 4, 2026, CMS released its State Medicaid and CHIP ABA Toolkit, reporting that ABA spending in the two programs rose 421 percent from 2021 to 2025. The agency said the toolkit creates no new federal requirements. It covers clinical standards, benefit design, payment methodology, provider enrollment, credentialing, utilization management, and program integrity, and it arrives as federal auditors have flagged improper ABA payments in several states.
The third is the schedule itself. The January 1, 2025 ABA schedule is still the most recent one posted on HCA’s fee schedule page, now more than 20 months after it took effect. Any revision would reshape the regional comparison above.
Frequently Asked Questions
What does New Mexico Medicaid pay for ABA?
Under the fee-for-service schedule effective January 1, 2025, 97153 pays $19.85 per 15-minute unit for a Behavior Technician, $23.35 for a Board Certified Assistant Behavior Analyst, $32.31 for a Board Certified Behavior Analyst, $37.99 for a BCBA-D, and $38.02 for a Qualifying Psychologist. 97155 pays $39.69 for a BCBA and $55.55 for a BCBA-D or Qualifying Psychologist.
Does New Mexico Medicaid cover ABA for adults?
Yes. ABA is part of the EPSDT benefit for members under 21, but 8.321.2 NMAC states that there is no age requirement and that ABA is a covered benefit for Medicaid-enrolled adults.
Can Turquoise Care plans pay less than the fee-for-service schedule?
HCA has directed them not to. Letters of direction since July 2024, including Letter of Direction 53 for ABA in March 2025, told the managed care organizations and their subcontractors not to negotiate below fee-for-service rates. Letter 53 was written to sunset after the January 2025 adjustments were paid, so providers should confirm current terms with each plan.
How does New Mexico pay for ABA supervision?
Clinical management and case supervision are billed under T1026 at $142.84 per hour for analysts, with $109.27 for case supervision by a supervising assistant analyst. At least one hour of each is expected for every 10 hours of Stage 3 treatment, and more than two hours per 10 requires prior authorization.
Who can provide ABA under New Mexico Medicaid?
An Autism Evaluation Practitioner handles Stage 1 evaluations. Behavior analysts (Board Certified Behavior Analysts, BCBA-Ds, and Qualifying Psychologists) handle assessment, treatment planning, and treatment, alongside Board Certified Assistant Behavior Analysts and Behavior Technicians working through an ABA provider agency.
Sources: MediRate; New Mexico Health Care Authority, Applied Behavior Analysis Fee Schedule for Medicaid Fee for Service (effective January 1, 2025); HCA Letters of Direction 11 (July 1, 2024), 36-2 (February 27, 2025), and 53 (March 21, 2025); 8.321.2 NMAC; HCA ABA Provider Information page; Centers for Medicare and Medicaid Services (August 4, 2026); Council of Autism Service Providers; prior Acuity Media Network reporting.
