New Mexico Medicaid transportation rates: the HCA fee schedule, tariff caps, and Turquoise Care trips

Three ceilings on every claim

A New Mexico fee-for-service transportation claim pays the lowest of three numbers. Section 8.324.7.16 of the New Mexico Administrative Code sets the rule, and the state plan’s payment page for transportation says the same thing.

1. Your usual and customary charge. What you charge the general public in most cases for the same service.
2. Your approved tariff. For a provider with a tariff, the billed charge cannot be higher than the tariff allows.
3. The HCA fee schedule. The Medicaid amount for the code, including any per-trip limit.

The state plan page, Attachment 4.19-B page 15, was last approved under amendment NM-24-0009. CMS approved it September 18, 2025, effective January 1, 2025. It still refers to tariff rates approved by the state corporation commission. Motor carrier regulation now sits with the NMDOT Transportation Regulation Bureau, which posts the tariff of each non-emergency medical transport company on its website. HCA’s payment to a transportation provider already includes gross receipts and other taxes, so the rate is the whole amount you collect.

The New Mexico state guide covers getting operating authority and filing a tariff. The rest of this page is about what the codes pay.

Ground trip rates on the January 2025 schedule

HCA pays ground non-emergency trips per loaded mile on the schedule that took effect January 1, 2025. There is no separate base fee. Every one-way trip has its own cap, and a mile counts only with the member aboard.

The first family member carried to a member’s therapy bills the base code with UK at the same rate as the member. Every family-member line needs the physician’s written attestation that family therapy is needed. T2001 needs a written physician attestation of the need for an attendant. Lodging and meals need written attestation from the physician that the member needs care outside the home community.

Some arithmetic at these rates, using hypothetical trips:

• A 40-mile wheelchair van trip. 40 x $1.78 = $71.20. With an escort, T2001 adds 40 x $0.71 = $28.40.
• Where the caps start. A wheelchair van trip reaches the $300 cap at about 169 miles, and a taxi trip at about 146 miles. Every mile past that is unpaid.
• A long taxi trip. A 200-mile one-way taxi trip would come to $412.00 at $2.06, so it pays $300.00.

Because there is no base fee, a short trip earns very little. A 4-mile wheelchair van ride pays $7.12.

What HB2 2024 changed on the modifier lines

The current amounts came out of the 2024 House Bill 2 rate update. HCA posted a table of the changes for specialized pricing, labeled proposed, and CMS approved NM-24-0009 effective January 1, 2025. Every line from that table that appears on the transportation schedule now in force carries the new amount.

The table shows taxi and wheelchair van mileage paying the same $1.76 on the UK lines before 2025. After the update, the taxi line pays 28 cents a mile more than the wheelchair van line. On the current schedule the UK lines match the member rates, $2.06 for A0100 and $1.78 for A0130.

Modifiers that ride on every line

The taxi, wheelchair van, and attendant codes each take a pair of letters, following the national ambulance pattern. The first letter names where the trip began and the second where it ended. The schedule defines the letters:

• R. Residence.
• D. Diagnostic or therapeutic site other than P or H.
• P. Physician’s office.
• H. Hospital.
• N. Skilled nursing facility.
• E. Residential, domiciliary, or custodial facility other than a skilled nursing facility.
• G and J. Hospital-based and freestanding dialysis facilities.
• I and S. A transfer point between ambulance modes, and the scene of an accident or acute event.

A taxi trip from a member’s home to a diagnostic or therapeutic site bills A0100 RD, the pairing HCA named in its September 2026 audit notice. The origin and destination modifiers entry explains the national version.

The rule also limits who can be paid for in the vehicle. An additional passenger transport, meaning two or more members picked up at one location and taken to the same provider, is not covered, and Medicaid pays for one member. One attendant is covered for a child 10 or younger when the child’s provider justifies it in writing for each transport.

Rule changes that took effect September 1, 2026

8.324.7 NMAC was amended effective September 1, 2026, following its adoption on August 6, 2026. The changes that touch billing are:

• Long trips. For travel over 120 miles from the home community, your billing records must hold a written statement from the provider who referred the member or the one giving the care. The statement identifies the service and the outside provider, explains that the member cannot get that care in the home community, and is refreshed every 12 months for continuing trips.
• New provider type. Transportation network companies holding an NMDOT permit under the Transportation Network Company Services Act are eligible providers.
• Pharmacy trips. HCA no longer pays for a ride to a pharmacy. The one exception is a member released from a correctional facility no more than seven days earlier.

The long-trip terms were already in use for fee-for-service billing. Supplement 23-09, dated September 5, 2023, raised the threshold from 65 to 120 miles and the referral renewal from six to 12 months for trips from July 1, 2023, and the amendment wrote them into the rule.

Other rules in the same part decide when the lodging and meal codes apply. Lodging is covered when a one-way trip to care takes over four hours and the member has to stay overnight. It is first approved for up to five days, re-evaluated by day five for up to 15 more, and re-evaluated every 15 days after that. Meals are covered when the member must be away from the home community for eight hours or more. Border cities, those within 100 miles of the state line with Mexico excluded, count as in-state.

Codes held for plan trips and ambulances

The bottom of the schedule is a group HCA calls alternate transportation codes, open to accept encounter data:

• A0090, member mileage. $0.34 a mile, paid to the member only when care is outside the home community, with the physician’s written attestation.
• A0140, air travel. Individually priced, one unit per ticket.
• A0110, A0120, A0170, T2002, and T2004. Bus, mini-bus, parking and tolls, per diem, and commercial multi-pass. Individually priced and currently an MCO benefit only.

Ambulance codes follow different math. The ground ambulance base includes the first 15 miles, oxygen, disposable supplies, and medications. A scheduled non-emergency basic life support transport (A0428) pays $389.99, mileage (A0425) pays $13.41 a mile, and a second or third patient on the same run pays 50 or 33 percent of the base. Non-emergency ambulance needs a primary care provider’s order certifying that other transportation is contraindicated.

Turquoise Care trips pay through the plan’s vendor

A member enrolled in a Turquoise Care plan rides through that plan’s transportation vendor, and the vendor pays at the rate in your agreement with it, not at the HCA schedule. The fee-for-service schedule itself marks several codes as plan benefits only. One vendor change lands this fall. Blue Cross and Blue Shield of New Mexico (BCBSNM) switches its Medicaid ride vendor from Modivcare to MTM Health effective November 1, 2026, in a provider notice first posted July 15, 2026 and revised September 9. MTM Health takes over recurring rides and any trip already booked for a date after November 1.

The New Mexico state guide lists each plan’s transportation vendor, and how to apply to MTM’s network is in the MTM Health guide.

What the PERM audit found

HCA’s Supplement 26-05, dated September 3, 2026, describes two flagged fee-for-service NEMT claims from the federal Payment Error Rate Measurement review:

1. An escort with no record. On a T2001 RD claim, the transportation log had a box for an attendant or escort, and it was not checked, with nothing else naming one.
2. Units that did not match. On an A0100 RD taxi claim, the units billed were fewer than the units in the record.

HCA made a virtual training on September 15, 2026 mandatory, and every NEMT manager and biller had to attend. The rule behind both findings is in 8.324.7.11: a provider must keep records sufficient to fully disclose the extent and nature of the services. The national code meanings are in NEMT billing codes.

Matching New Mexico miles to the claim in HealthRide

A New Mexico ride is paid mile by mile, and an escort line only holds up if the record shows the escort was there. In HealthRide, escorts are set on the trip when it is booked, and the driver app stores each leg’s GPS-recorded miles along with the signature the rider gives on screen. When HCA or a plan’s vendor pays, invoicing records the payment and keeps fee-for-service and plan money in one ledger.