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New Mexico Providers

Prior authorization requirements


Please verify benefit coverage prior to rendering services. Inpatient services and non-participating providers always require prior authorization.

Services billed with the following revenue codes ALWAYS require prior authorization:

Elective services provided by or arranged at nonparticipating facilities. All services billed with the following revenue codes:

0023 Home health prospective payment system
0240–0249 All-inclusive ancillary psychiatric
0570–0572, 0579 Home health aide
0632 Pharmacy multiple sources
0901, 0905–0907, 0913, 0917 Behavioral health treatment services
0944–0945 Other therapeutic services
0961 Psychiatric professional fees
3101–3109 Adult day and foster care

Behavioral health

Fax all requests for services that require prior authorization to:

Inpatient:

1-877-434-7578

Outpatient:

1-800-505-1193

Pharmacy

Check the latest Formulary for the members’ service area on our Benefits and Pharmacy page.

Prior authorization code look-up

Please note:

  • This tool is for outpatient services only.
  • Inpatient services and non-participating providers always require prior authorization.
  • This tool does not reflect benefits coverage1 nor does it include an exhaustive listing of all noncovered services (for example, experimental procedures, cosmetic surgery, etc.). Refer to your Provider Manual for coverage/limitations.

1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.

To determine coverage of a particular service or procedure for a specific member:

  • Access eligibility and benefits information on the Availity Portal.
  • Use the Prior authorization Lookup Tool accessed through Payer Spaces in Availity.
  • Call Provider Services at 1-866-805-4589 for Amerigroup Amerivantage (Medicare Advantage).

Provider tools & resources

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We look forward to working with you to provide quality service for our members.