CurrentBlue Cross Blue Shield - New MexicoPolicy N/A

Electronic Visit Verification (EVV) policy overview

Governance and implementation guidance for EVV for Medicaid personal care services (PCS) and home health care services (HHCS) in New Mexico, including verification requirements, implementation timeline, verification methods, covered services, and stakeholder roles.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyElectronic Visit Verification (EVV) policy overview

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionIntegrate EVV systems with prior authorization so providers can only bill for services at the planned time and in the specified type, scope, amount, duration, and frequency identified in the approved person-centered service plan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6verification elements

Jan 1, 2023CMS HHCS compliance date

Up to 1%/qtrfederal match risk

7home health service categories

3verification methods allowed

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EVV Applicability and Covered Services

EVV applicability and covered Home Health services

EVV is required for Medicaid personal care services (PCS) and home health care services (HHCS) that involve in‑home visits. The following criteria specify which services and procedure codes are included in New Mexico’s EVV implementation.

EVV required for PCS and HHCS requiring an in‑home visit as mandated by the 21st Century Cures Act; non‑compliance may result in federal match reductions (up to 1% per quarter).

Covered service categories

Skilled Nursing Visits
Physical Therapy Visits
Home Health Aides
Occupational Therapy Visits
Clinical Social Worker (Social Worker Visit)
Speech Therapy Visits

Service–procedure code mappings (EVV applies to services billed with these codes)

G0151 — Physical Therapy Visit
G0159 — Physical Therapy Evaluation or re‑evaluation
G0157 — Physical Therapy Assistant
G0153 — Speech Language Therapy Visit
G0161 — Speech Language Therapy Evaluation or re‑evaluation
G0152 — Occupational Therapy Visit

EVV applies to PT/OT/speech when those services are delivered in the home; EVV does not apply to delivery, set‑up, or instruction on the use of medical supplies, equipment, or appliances.

Procedure Codes and Compliance Deadlines

Home Health EVV procedure codesCPTCovered

G0151	Physical Therapy Visit
G0159	Physical Therapy Evaluation or re-evaluation
G0157	Physical Therapy Assistant
G0153	Speech Language Therapy Visit
G0161	Speech Language Therapy Evaluation or re-evaluation
G0152	Occupational Therapy Visit
G0160	Occupational Therapy Evaluation or re-evaluation
G0158	Occupational Therapy Assistant
G0156	Home Health Aide
G0300	Skilled Nursing LPN

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HHCS compliance deadline

CMS compliance effective dateJanuary 1, 2023

Applicability noteThe Cures Act required states to implement compliant EVV solutions for HHCS by this date to avoid federal match reductions.

Local timeline contextNew Mexico listed Home Health Services implementation in 2023 on its EVV timeline.

Provider Responsibilities and Prior Authorization Integration

Prior Authorization

Integrate EVV with Prior Authorizations

Integrate EVV with prior authorization and service-plan systems to ensure billing is limited to approved services. EVV data should interface with authorization records so providers can only bill for services that match the individual's approved person-centered service plan in time, type, scope, amount, duration, and frequency. When EVV is linked to prior authorization: providers must verify that scheduled visits and billed services correspond to the active authorization; deviations (time, service type, units, or frequency) may trigger automated claim edits, manual review, or denial. States and payers may subject manually entered EVV data to additional review as part of fraud, waste, and abuse controls. Operationally, implement automated checks that compare EVV timestamps and service codes to the authorization window and authorized codes before claims payment.

Verify scheduled visits against active prior authorizations before billing
Automated edits or denials may occur when EVV records do not match authorization details
Manually-entered EVV data may be subject to additional review for FWA
Compare EVV timestamps and service codes to authorization windows and authorized codes

Key Terms

Electronic Visit Verification (EVV)

DefinitionElectronic Visit Verification (EVV) is a technological solution used to electronically verify whether personal care and home health providers delivered services as billed.

Core verification elementsType of service; Individual receiving the service; Date of service; Location of service delivery; Individual providing the service; Time the service begins and ends.

Primary purposeImprove fiscal integrity, program integrity, and quality monitoring by electronically confirming delivered services.

PCS and HHCS

Personal Care Services (PCS)Services supporting Activities of Daily Living (ADLs) or both ADLs and Instrumental Activities of Daily Living (IADLs).

Home Health Care Services (HHCS)Nursing services and/or home health aide services delivered in the home; at the state's option, may include in‑home physical therapy, occupational therapy, and speech pathology/audiology services.