---
title: Molina Healthcare of New Mexico ABA coverage (Turquoise Care MCO).
url: "https://carelu.com/payers/molina-healthcare-new-mexico"
markdown_url: "https://carelu.com/payers/molina-healthcare-new-mexico.md"
state: NM (New Mexico)
payer: Molina Healthcare of New Mexico (Turquoise Care)
kind: Medicaid managed care plan (MCO)
parent_program: New Mexico Medicaid (Turquoise Care)
description: "How Molina Healthcare administers New Mexico Medicaid ABA under Turquoise Care — the July 2024 market entry, mandatory electronic PA submission through Availity Essentials, the state-criteria baseline and LOD #53 rate floor, and the ABA policy gaps to verify in the portal."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Molina Healthcare of New Mexico ABA coverage (Turquoise Care MCO).

_Payer Guide · Molina Healthcare (NM) · Last updated September 2026 · 6 primary sources_

> New to NM 7/2024; PA via Availity Essentials; no published ABA policy — verify in portal.

Molina Healthcare is new to New Mexico: it entered with the Turquoise Care launch on July 1, 2024 (alongside UnitedHealthcare, as Western Sky/Centene exited). As a Turquoise Care MCO it is bound by the shared Behavioral Health Level of Care Guidelines and the LOD #53 rate floor — but unlike the other three plans, Molina has published no New Mexico-specific ABA clinical policy or code-level PA list we could verify. The honest operating posture: assume the state baseline clinically, submit PAs electronically through Availity Essentials as Molina requires, and confirm ABA code-level requirements in the portal before the first request.

This plan administers the **New Mexico Medicaid (Turquoise Care)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [New Mexico Medicaid (Turquoise Care) guide](https://carelu.com/payers/new-mexico-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: Molina Healthcare of New Mexico's Medicaid prior-authorization code list — not published publicly and molinahealthcare.com 403s to automated retrieval. Run the ABA codes through Availity Essentials and keep the dated result, or request the PA code matrix via carelu.com/sources. The state floor (LOD #53: 97151/97152/0362T ‘Prior Auth: NO’) is the fallback. [4]
- **Prior auth for treatment:** Not published / unverified. Verify via: Molina Healthcare of New Mexico's Medicaid prior-authorization code list, via Availity Essentials (its mandated PA channel) or carelu.com/sources. The state floor puts PA on 97153 only; Molina publishes no New Mexico ABA code-level list of its own. [4]
- **Autism diagnosis required?**: State rule — ASD dx within 3 years, or the documented at-risk-for-ASD pathway (NMAC 8.321.2.13) [5]

## At a glance

- **Plan type:** Turquoise Care MCO — entered New Mexico 7/1/2024
- **Clinical rules:** State baseline (shared Turquoise Care LOC guidelines); no distinct ABA policy published
- **PA submission:** Electronic, via Availity Essentials — Molina's mandated primary channel
- **ABA code-level PA list:** Not published — verify 97151/97153 handling in Availity before submitting
- **Rates:** Must pay at least the state FFS ABA fee schedule (LOD #53)

## What's verified — and what to check in the portal

Verified: Molina is a Turquoise Care MCO bound by the state's ABA criteria and the LOD #53 rate floor, its provider manual requires electronic PA submission, and Availity Essentials is the mandated primary channel (a contract-compliance item, not a preference). Not verified: any Molina-specific ABA clinical policy, PA form, or code-level PA list for New Mexico — we found none published. That gap cuts both ways: the state baseline (no PA on 97151, PA on 97153, the under-20-hrs quirk) should govern via the shared Level of Care Guidelines, but until Molina publishes its ABA mechanics, run a code-level PA check in Availity for each new case and get the answer in writing. As the newest plan alongside UHC, expect member churn from the Western Sky exit — verify plan identity on any card that predates July 2024. [1][2]

## The state floor still holds

Whatever Molina's internal mechanics turn out to be, two things are anchored at the state level and enforceable: the clinical criteria (NMAC 8.321.2.13 and Supplement 24-13 — the ASD-or-at-risk eligibility, adult benefit, stage model, and authorization cadence) and the rates. Letter of Direction #53 directs every Turquoise Care MCO to pay providers no less than the Medicaid FFS ABA fee schedule, retroactive to 1/1/2025, and it binds sub-vendors too. If a Molina contract or remittance comes in under the published schedule, LOD #53 is the citation to raise. [4][3]

## Intake gates

The questions that decide whether a family can start with Molina Healthcare of New Mexico (Turquoise Care), and what they have to bring.

- **Age limit**: Follows the New Mexico Medicaid rule: NMAC 8.321.2.13 imposes no upper age limit and covers Medicaid-enrolled adults, with under-21s served through EPSDT and the at-risk pathway bounded at 12–36 months. One drafting trap: the shared Turquoise Care Level of Care Guidelines (July 2024) describe ABA for members 12 months up to 21 years, because the adult expansion arrived later in NMAC 8.321.2.13 (12/10/2024) and Supplement 24-13 — cite those, not the LOC document, on an adult request. [5][6][4]
- **Diagnosis recency**: Follows the New Mexico Medicaid rule: a presumptive ASD diagnosis from a licensed practitioner within scope must have been received within three years of the referral to stage two or three; a recipient who already carries an ASD diagnosis needs no re-evaluation but does need an ISP and a medical-necessity determination; and the at-risk pathway requires no diagnosis at all. [5][6][4]
- **Who may diagnose**: Follows the New Mexico Medicaid rule: an approved Autism Evaluation Provider confirms the presence of or risk for ASD through a comprehensive diagnostic, targeted or ASD risk evaluation, or the recipient is referred on a presumptive diagnosis from any licensed practitioner whose scope of practice allows an ASD diagnosis, received within three years of referral. [5][6][4]
- **Referral required?**: Follows the New Mexico Medicaid rule — Autism Evaluation Provider evaluation, ISP and referral to an approved ABA provider agency, with the ISP and evaluation accompanying the stage-three PA request. Molina publishes no New Mexico-specific ABA clinical policy, PA form or code-level PA list, and its provider manual requires electronic prior authorization submission through Availity Essentials as the mandated primary channel — run a code-level PA check there for each new case and keep the answer in writing. [5][6][4][1]
- **Prior-auth decision time**: Molina’s manual publishes no day count of its own: it decides “as promptly as the Member’s health requires and no later than contractual and regulatory requirements”, expedited when a standard timeframe “could jeopardize a Member’s life or health”. So its HCA contract governs: it requires the plan to “adjudicate standard prior authorization requests within seven (7) Business Days after receipt of all necessary and relevant documentation”, and requests are “deemed granted for determinations not made within the seven (7) Business Day turn-around time” (extension up to 14 calendar days on request or with justification); expedited decisions come “no later than twenty-four (24) hours after the receipt of all necessary and relevant documentation”, also deemed granted if missed. Federal floor on top: for rating periods that start on or after January 1, 2026, 42 CFR 438.210(d) caps standard decisions at “7 calendar days after receiving the request for service” (extendable up to 14 more calendar days), and expedited at 72 hours. The contract binds the plan to “the most rigorous standards” of the NM Prior Authorization Act, NCQA, HCA regulation or 438.210(d), so plan against 7 calendar days from receipt and the 24-hour state expedited clock. Reauthorization: Supplement 24-13 sets no day count, only that the ABA Treatment Plan Update and Progress Report “must be prepared and submitted to the MCO or TPA prior to the end of the recipient’s Prior Authorization period”. [1][7][8][3]
- **Other insurance (who pays first)**: Molina’s manual: “Medicaid is always the payer of last resort”; “If third-party liability can be established, Providers must bill the primary payer and submit a primary explanation of benefits (EOB) to Molina for secondary claim processing”, reimbursed “based on the state regulatory COB methodology”. Timely filing for a secondary claim: “Other carrier’s EOB when Molina is the secondary payer” — one year from the date of service. Molina “will pay claims for prenatal care and preventive pediatric care and then” seek reimbursement from third parties. The HCA contract makes Medicaid “the payer of last resort” and adds the trap: the plan “shall deny payment on a Claim that has been denied by a third-party payer when the reason for denial is the Provider’s or Member’s failure to follow prescribed procedures, including but not limited to failure to obtain prior authorization” — so secure the commercial plan’s ABA authorization first. The same contract says “Claims for EPSDT shall be paid at the time presented for payment by the Provider and the CONTRACTOR shall bill the responsible third party”; whether an ABA claim is handled under that EPSDT pay-and-chase exception is not spelled out, so confirm with the plan before skipping the primary. TRICARE also pays ahead of Medicaid: its own secondary-payer rule exempts “a plan administered under title XIX”. The manual does not say whether Molina’s own ABA prior authorization is required while it is secondary — confirm with Molina UM. [1][7][9][10]
- **Diagnostic tools required** _(ask the plan)_: Follows the New Mexico Medicaid rule, which names none: NMAC 8.321.2.13 requires the diagnosis be made against the latest DSM or ICD and the at-risk criteria be measured by standardized assessments, without naming instruments. No plan-specific instrument list was found for this MCO either. [5][6][4]
  - Ask the plan: MAD Behavioral Health Policy and Billing Manual / Supplement 24-13 — hca.nm.gov blocked automated retrieval this cycle (CloudFront geo-block), so pull the MAD Behavioral Health Policy and Billing Manual and Supplement 24-13 from the HCA ABA provider page by hand, or ask the MAD ABA Manager.
- **Telehealth** _(ask the plan)_: No verified rule. NMAC 8.321.2.13 carries no telehealth provision for ABA and the shared Turquoise Care Level of Care Guidelines set none for ABA Stage 3, and no plan-specific ABA telehealth policy was found for this MCO. [5][6][4]
  - Ask the plan: The plan’s provider portal or behavioral health UM line, plus the MAD Behavioral Health Policy and Billing Manual — hca.nm.gov blocked automated retrieval this cycle (CloudFront geo-block), so pull the MAD Behavioral Health Policy and Billing Manual and Supplement 24-13 from the HCA ABA provider page by hand, or ask the MAD ABA Manager.

## Delivery and billing rules

Coverage decides whether Molina Healthcare of New Mexico (Turquoise Care) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Follows the New Mexico Medicaid rule: every stage-three service requires clinical management, a BCaBA or technician implementing the plan requires case supervision from their BA or supervising BAA, and prior authorization is triggered where more than two hours of case supervision, or two hours of clinical management, per 10 hours of intervention is requested. Certification-maintenance supervision is not MAD-reimbursable. [5][6][4]
- **Daily limits / MUEs**: Follows the New Mexico Medicaid rule: no per-day unit ceiling, with authorization-gated intensity thresholds instead — including the inverted quirk that comprehensive treatment averaging under 20 hours a week requires prior authorization — and PA on supervision or clinical management above two hours per 10 hours of stage-three service. No plan-specific hour caps were found for this MCO. [5][6][4]
- **Place of service**: Follows the New Mexico Medicaid rule: school-setting activities with the potential to supplant educational services are excluded; a residential facility that is not itself an ABA provider must contract a MAD-enrolled ABA provider to render on site; treatment foster care is not treated as out-of-home placement; and out-of-home placement is otherwise an exclusion under the shared Turquoise Care Level of Care Guidelines apart from time-limited transition services. [5][6][4]
- **Bill as provider**: Follows the New Mexico Medicaid rule: reimbursement goes to the MAD-enrolled ABA provider, behavior analysts enrol as Provider Type 445 / Specialty 099 and technicians as Provider Type 430 / Specialty 098 on the MAD-877 and MAD-878 attestations, and every practitioner must clear a New Mexico criminal background registry check before rendering. Letter of Direction #53 makes the state fee-for-service ABA fee schedule the contractual minimum this MCO and its sub-vendors must pay. [5][6][4]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: The plan’s provider portal or claims line, plus the MAD Behavioral Health Policy and Billing Manual — hca.nm.gov blocked automated retrieval this cycle (CloudFront geo-block), so pull the MAD Behavioral Health Policy and Billing Manual and Supplement 24-13 from the HCA ABA provider page by hand, or ask the MAD ABA Manager. [5][6][4]

## What intake should collect for Molina Healthcare of New Mexico (Turquoise Care)

- **Availity Essentials access:** Molina mandates electronic PA submission — confirm your organization's Availity registration covers Molina NM before the first case.
- **Code-level PA answers, in writing:** No published ABA PA list — run 97151/97153/0373T through Availity's auth-check and save the response per case.
- **Diagnosis or at-risk documentation:** State rule: ASD dx within 3 years of referral, or the at-risk pathway documentation.
- **Plan identity:** Molina is new as of 7/2024 — cards or records referencing Western Sky/Centene are stale; verify current enrollment.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Molina Healthcare of New Mexico (Turquoise Care) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00247 — pVerify 00247 = "Molina Healthcare of New Mexico" (Elig Y / Claim Y).
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none (integrated Turquoise Care)
- **ABA rides on:** medical benefit — Integrated Turquoise Care; ABA rides the Molina NM Medicaid payer ID, no two-hop. Verify against the Molina NM provider manual.
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Not required (LOD #53 fee schedule: "Prior Auth: NO") | — | home, clinic / office, community, school, telehealth (modality allowed; NM ABA-specific POS numbers not published in the fee schedule/Supplement) | — | U5 (Qualifying Psychologist), U4 (BCBA-D), U3 (BCBA), U9 (BCaBA), U1 (Behavior Technician), UA/UB group size (97154/97158) |
| 97152 | Yes | Not required (LOD #53 fee schedule: "Prior Auth: NO") | — | home, clinic / office, community, school, telehealth (modality allowed; NM ABA-specific POS numbers not published in the fee schedule/Supplement) | — | U5 (Qualifying Psychologist), U4 (BCBA-D), U3 (BCBA), U9 (BCaBA), U1 (Behavior Technician), UA/UB group size (97154/97158) |
| 97153 | Yes | Required (LOD #53 fee schedule: "Prior Auth: YES") | — | home, clinic / office, community, school, telehealth (modality allowed; NM ABA-specific POS numbers not published in the fee schedule/Supplement) | — | U5 (Qualifying Psychologist), U4 (BCBA-D), U3 (BCBA), U9 (BCaBA), U1 (Behavior Technician), UA/UB group size (97154/97158) |
| 97154 | Yes | Not required (LOD #53 fee schedule: "Prior Auth: NO") | — | home, clinic / office, community, school, telehealth (modality allowed; NM ABA-specific POS numbers not published in the fee schedule/Supplement) | — | U5 (Qualifying Psychologist), U4 (BCBA-D), U3 (BCBA), U9 (BCaBA), U1 (Behavior Technician), UA/UB group size (97154/97158) |
| 97155 | Yes | Not required (LOD #53 fee schedule: "Prior Auth: NO") | — | home, clinic / office, community, school, telehealth (modality allowed; NM ABA-specific POS numbers not published in the fee schedule/Supplement) | — | U5 (Qualifying Psychologist), U4 (BCBA-D), U3 (BCBA), U9 (BCaBA), U1 (Behavior Technician), UA/UB group size (97154/97158) |
| 97156 | Yes | Not required (LOD #53 fee schedule: "Prior Auth: NO") | — | home, clinic / office, community, school, telehealth (modality allowed; NM ABA-specific POS numbers not published in the fee schedule/Supplement) | — | U5 (Qualifying Psychologist), U4 (BCBA-D), U3 (BCBA), U9 (BCaBA), U1 (Behavior Technician), UA/UB group size (97154/97158) |
| 97157 | Yes | Not required (LOD #53 fee schedule: "Prior Auth: NO") | — | home, clinic / office, community, school, telehealth (modality allowed; NM ABA-specific POS numbers not published in the fee schedule/Supplement) | — | U5 (Qualifying Psychologist), U4 (BCBA-D), U3 (BCBA), U9 (BCaBA), U1 (Behavior Technician), UA/UB group size (97154/97158) |
| 97158 | Yes | Not required (LOD #53 fee schedule: "Prior Auth: NO") | — | home, clinic / office, community, school, telehealth (modality allowed; NM ABA-specific POS numbers not published in the fee schedule/Supplement) | — | U5 (Qualifying Psychologist), U4 (BCBA-D), U3 (BCBA), U9 (BCaBA), U1 (Behavior Technician), UA/UB group size (97154/97158) |
| 0362T | Yes | Not required (LOD #53 fee schedule: "Prior Auth: NO") | — | home, clinic / office, community, school, telehealth (modality allowed; NM ABA-specific POS numbers not published in the fee schedule/Supplement) | — | U5 (Qualifying Psychologist), U4 (BCBA-D), U3 (BCBA), U9 (BCaBA), U1 (Behavior Technician), UA/UB group size (97154/97158) |
| 0373T | Yes | Required (LOD #53 fee schedule: "Prior Auth: YES") | — | home, clinic / office, community, school, telehealth (modality allowed; NM ABA-specific POS numbers not published in the fee schedule/Supplement) | — | U5 (Qualifying Psychologist), U4 (BCBA-D), U3 (BCBA), U9 (BCaBA), U1 (Behavior Technician), UA/UB group size (97154/97158) |

Code notes:

- **97151:** State baseline; Molina publishes no NM-specific ABA policy — submit PAs via Availity Essentials and confirm code-level PA in the portal per case. Stage 2 BCBA assessment; done annually. Verify via: HCA/MCO — per-code daily unit caps are not published in NM primary sources (limits are program-level: comprehensive 30–40 hrs/wk, focused 10–25, the <20-hrs/wk PA quirk).
- **97152, 97157, 0362T:** State baseline; Molina publishes no NM-specific ABA policy — submit PAs via Availity Essentials and confirm code-level PA in the portal per case. Verify via: HCA/MCO — per-code daily unit caps are not published in NM primary sources (limits are program-level: comprehensive 30–40 hrs/wk, focused 10–25, the <20-hrs/wk PA quirk).
- **97153:** State baseline; Molina publishes no NM-specific ABA policy — submit PAs via Availity Essentials and confirm code-level PA in the portal per case. Adaptive behavior treatment by protocol — the primary PA-gated code. State PA quirk (Supplement 24-13 §3.17.1(A)): comprehensive treatment averaging UNDER 20 hrs/week requires PA regardless. Also PA-gated: >2 hrs T1026 UC/UD supervision per 10 hrs Stage 3. Verify via: HCA/MCO — per-code daily unit caps are not published in NM primary sources (limits are program-level: comprehensive 30–40 hrs/wk, focused 10–25, the <20-hrs/wk PA quirk).
- **97154:** State baseline; Molina publishes no NM-specific ABA policy — submit PAs via Availity Essentials and confirm code-level PA in the portal per case. Group adaptive behavior treatment; UA (group 2–4) / UB (group 5–8) size modifiers. Verify via: HCA/MCO — per-code daily unit caps are not published in NM primary sources (limits are program-level: comprehensive 30–40 hrs/wk, focused 10–25, the <20-hrs/wk PA quirk).
- **97155:** State baseline; Molina publishes no NM-specific ABA policy — submit PAs via Availity Essentials and confirm code-level PA in the portal per case. Protocol modification / supervision; ≥1 hr per 20 hrs of Stage 3 (97153/97154/97156) required with the recipient present. Verify via: HCA/MCO — per-code daily unit caps are not published in NM primary sources (limits are program-level: comprehensive 30–40 hrs/wk, focused 10–25, the <20-hrs/wk PA quirk).
- **97156:** State baseline; Molina publishes no NM-specific ABA policy — submit PAs via Availity Essentials and confirm code-level PA in the portal per case. Family adaptive behavior treatment guidance. Verify via: HCA/MCO — per-code daily unit caps are not published in NM primary sources (limits are program-level: comprehensive 30–40 hrs/wk, focused 10–25, the <20-hrs/wk PA quirk).
- **97158:** State baseline; Molina publishes no NM-specific ABA policy — submit PAs via Availity Essentials and confirm code-level PA in the portal per case. Group family guidance; UA/UB size modifiers. Verify via: HCA/MCO — per-code daily unit caps are not published in NM primary sources (limits are program-level: comprehensive 30–40 hrs/wk, focused 10–25, the <20-hrs/wk PA quirk).
- **0373T:** State baseline; Molina publishes no NM-specific ABA policy — submit PAs via Availity Essentials and confirm code-level PA in the portal per case. Extra-technician / intensifying protocol. State PA quirk (Supplement 24-13 §3.17.1(A)): comprehensive treatment averaging UNDER 20 hrs/week requires PA regardless. Also PA-gated: >2 hrs T1026 UC/UD supervision per 10 hrs Stage 3. Verify via: HCA/MCO — per-code daily unit caps are not published in NM primary sources (limits are program-level: comprehensive 30–40 hrs/wk, focused 10–25, the <20-hrs/wk PA quirk).

### Medicaid rates

Source: Not separately published by Molina Healthcare of New Mexico. Under LOD #53 the NM Medicaid FFS ABA fee schedule (see new-mexico-medicaid rates) is the ENFORCEABLE MINIMUM Molina Healthcare of New Mexico and its sub-vendors must pay, retroactive to 1/1/2025 — so the floor is verified even though Molina Healthcare of New Mexico's actual contracted/paid rate at or above it is not published. Effective 2025-01-01 (floor).

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | ≥ $112.65 (U3) / $130.94 (U5/U4) — LOD #53 floor | 15min | — |
| 97152 | ≥ $58.33 (U3) / $65.47 (U5/U4) — LOD #53 floor | 15min | — |
| 97153 | ≥ $19.85 (U1) / $23.35 (U9) / $32.31 (U3) — LOD #53 floor | 15min | — |
| 97154 | ≥ $11.43 (U1) / $18.59 (U3) — LOD #53 floor | 15min | — |
| 97155 | ≥ $39.69 (U3) / $55.55 (U5/U4) — LOD #53 floor | 15min | — |
| 97156 | ≥ $25.78 (U3) / $35.79 (U5/U4) — LOD #53 floor | 15min | — |
| 97157 | ≥ $51.59 (U3) / $71.43 (U5/U4) — LOD #53 floor | 15min | — |
| 97158 | ≥ $12.69 (U3) / $15.88 (U5/U4) — LOD #53 floor | 15min | — |
| 0362T | ≥ $112.29 (U3) / $130.94 (U5/U4) — LOD #53 floor | 15min | — |
| 0373T | ≥ $107.13 (U3) / $119.05 (U5/U4) — LOD #53 floor | 15min | — |

### Contacts

- **Provider services phone:** (855) 322-4078
- **Hours:** Mon–Fri 8:00 a.m.–5:00 p.m. MT
- **Portal:** [Availity Essentials](https://www.availity.com)

Questions to ask on a verification call:

- Which ABA codes currently require prior authorization under Molina's Turquoise Care plan — does the state baseline (PA only on 97153 & 0373T) apply, or does Molina run its own list?
- Confirm whether Molina supports real-time 270/271 eligibility verification.
- What is the current Availity/Change Healthcare payer ID for Molina NM Medicaid claims?
- Are ABA-specific telehealth POS codes or modifiers used for Molina Turquoise Care billing?
- Is there a published per-code daily unit cap, or only the state's program-level weekly-hour guidance?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://downloads.conduent.com/content/usa/en/document/270-payer-guide-medicaid-5010.pdf (accessed 2026-07-23)
- https://downloads.conduent.com/content/usa/en/document/eligibility-gateway-companion-guide.pdf (accessed 2026-07-23)
- https://www.hca.nm.gov/wp-content/uploads/FInal-LOD-53-Applied-Behavioral-Analysis-ABA-Fee-Schedule-Rates.pdf (accessed 2026-07-23)
- https://www.hca.nm.gov/wp-content/uploads/24-13-Supplement-ABA-Guidance.pdf (accessed 2026-07-23)
- https://www.molinahealthcare.com/providers/nm/medicaid/contacts/contact_info.aspx (accessed 2026-07-23)

## Common questions

### Does Molina Healthcare of New Mexico cover ABA?

Yes — as a Turquoise Care MCO it administers the state ABA benefit under the shared Level of Care Guidelines and NMAC criteria. Molina has published no NM-specific ABA policy, so verify code-level PA requirements in Availity Essentials.

### How do I submit an ABA prior authorization to Molina NM?

Electronically through Availity Essentials — Molina's mandated primary submission channel. Since no ABA-specific PA list is published, confirm which codes require authorization in the portal and keep the answer on file.

### What does Molina pay for ABA in New Mexico?

At least the state FFS ABA fee schedule — LOD #53 makes the published rates a minimum for all Turquoise Care MCOs and their sub-vendors, retroactive to January 1, 2025.

## Primary sources

1. [Molina Healthcare of New Mexico Provider Manual (Medicaid 2025)](https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/NM_2024/Medicaid/communications/MCAIDNM-Provider-Manual-2025-EN-508.pdf)
2. [Molina NM Medicaid Authorizations page](https://www.molinahealthcare.com/providers/nm/medicaid/resource/priorauth.aspx)
3. [MAD Supplement 24-13 — ABA Guidance (state criteria)](https://www.hca.nm.gov/wp-content/uploads/24-13-Supplement-ABA-Guidance.pdf)
4. [Letter of Direction #53 — ABA Fee Schedule Rates (MCO rate floor)](https://www.hca.nm.gov/wp-content/uploads/FInal-LOD-53-Applied-Behavioral-Analysis-ABA-Fee-Schedule-Rates.pdf)
5. [NMAC 8.321.2.13 Applied Behavior Analysis (Cornell LII)](https://www.law.cornell.edu/regulations/new-mexico/N-M-Admin-Code-SS-8.321.2.13)
6. [Turquoise Care BH Level of Care Guidelines (ABA Stage 3, defers to NMAC 8.321.2)](https://www.bcbsnm.com/turquoise-care/pdf/tc-bh-level-care-guidelines-nm.pdf)
7. [Turquoise Care Medicaid Managed Care Services Agreement — Molina, Amendment 5 (signed 12/2025), §§ 4.5.19.8, 4.19.11](https://www.hca.nm.gov/wp-content/uploads/TCMHC_24-630-8000-0032_CA5_Signed.pdf)
8. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes](https://www.ecfr.gov/current/title-42/section-438.210)
9. [8.302.3 NMAC — Third Party Liability Provider Responsibilities](https://www.srca.nm.gov/parts/title08/08.302.0003.html)
10. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.