MedicaidBilling CodesHigh impact
Supplement 26-02: Early and Periodic Screening, Diagnostic, and Treatment EPSDT / Tot to Teen Healthcheck Updated Screening Services Requirements
New Mexico Medicaid·NM · Pediatrics, Family Medicine·Specialty Services
Effective date
May 27, 2026
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid has updated EPSDT (Tot to Teen Healthcheck) requirements with specific billing codes and documentation standards for well-child visits, children in state custody, blood lead screening, and maternal depression screening. The policy adds new CPT codes for maternal depression screening and requires specific diagnosis codes for children in welfare custody.
Action Required
By May 27, 2026: Billing teams must update systems to include new diagnosis code Z62.21 for children in welfare custody alongside standard EPSDT codes. Add CPT codes 96161, 96127, and 96160 for maternal depression screening billed under infant's Medicaid ID. Update encounter forms to remind providers of required lead screening at 12 and 24 months using CPT 83655. Train staff on comprehensive WCV documentation requirements including trauma screening for children in state custody within 30 days of placement.