Health care providers (HCPs)play a key role in New Mexico's workers' compensation system. Authorized HCPs are any medical care providers licensed in New Mexico or otherwise approved by the WCA Director, including surgeons, psychologists and physical therapists. In addition to helping injured workers recover from injuries to return to work, the HCP also offers opinions that affect claims and benefits.
Find out more in our Health Care Provider Guide.
The annual New Mexico Workers’ Compensation Administration Director's Medical Advisory Committee (DMAC) to discuss possible revisions to the 2023 Health Care Provider Fee Schedule and other medical workers' compensation topics will be held on at 1 p.m., (MDT), Thursday, Oct 6, 2022. This year, the DMAC meeting will be held virtually as a webinar viewable by the public. The Zoom link to view the meeting can be found below.
Download the meeting agenda
Following the DMAC meeting, the New Mexico Workers’ Compensation Administration will make the proposed 2023 fee schedule/billing instructions, 2022 revision available on this page and accept written comments from 8 a.m., Wednesday, October 12 through close of business, Monday, November 14, 2022. Send comments to the attention of the WCA Office of General Counsel by email to firstname.lastname@example.org; by fax to 505-841-6813; or by U.S. mail to WCA Office of General Counsel, PO Box 27198, Albuquerque, NM 87125-7198. The Director will take all comments into consideration.
The NM WCA will hold a public hearing on the proposal at 10 a.m., Thursday, November 3, 2022, virtually via the Zoom platform. The Zoom link to join will be made public on this page at the start of public comment.
You are invited to a Zoom webinar.
When: Oct 6, 2022, 1 PM Mountain Time (US and Canada)
Topic: Director’s Medical Advisory Committee (DMAC)
Please click the link below to join the webinar:
Or One tap mobile : US: +16699006833,,87418356127#,,,,*174286# or +17193594580,,87418356127#,,,,*174286#
Dial( for higher quality, dial a number based on your current location):
US: +1 669 900 6833 or +1 719 359 4580 or +1 253 215 8782 or +1 346 248 7799 or +1 669 444 9171 or +1 386 347 5053 or +1 564 217 2000 or +1 646 876 9923 or +1 646 931 3860 or +1 301 715 8592 or +1 309 205 3325 or +1 312 626 6799
Webinar ID: 874 1835 6127
International numbers available: https://us02web.zoom.us/u/kcGf3fXnNQ
Interested in Becoming an Independent Medical Examiner (IME) on the WCA List?
Independent Medical Examinations (IMEs) are neutral medical exams provided in certain workers' compensation cases when parties dispute a worker's medical treatment or medical issues need clarification. IMEs can be performed by a single physician or a panel of physicians and specialists.
Either party may petition a workers' compensation judge for the worker to be examined by an independent physician(s) who has not previously treated the worker. IMEs can also occur by agreement of the parties. The judge then considers the opinion of that examination in determining the case. IME providers in New Mexico must be licensed health care providers in good standing and must use the most recent American Medical Association's (AMA) Guide (the Guides) to the Evaluation of Permanent Impairment.
IME providers used by a judge must be on the WCA IME provider list, which is approved by the IME Provider Selection Committee. The committee members represent both labor and industry and are appointed by the WCA Advisory Council.
The IME Provider Selection Committee approves providers for independent medical examinations (IMEs) through a process. The application process is open March 1 through May 31 each year and is now closed.
Find the current list of IME providers.
For questions, contact the WCA Medical Cost Containment Bureau at WCA-MCC@state.nm.us.
Health Care Provider (HCP) Fee Schedules
The WCA's Medical Cost Containment Bureau implements various cost-saving measures for medical services provided to injured or disabled workers. The MCC Bureau, in conjunction with the Economic Research and Policy Bureau, publishes the Health Care Provider Fee Schedule (HCPFS) to set costs for medical procedures. Health care providers are normally limited to receiving payments within the range of the HCPFS. Hospital stays require pre-authorization.
In the 2019 Health Care Provider Fee Schedule and Billing Instructions, there was an omission of text on page 14, under "Materials and Supplies." The last statement in that section should read:
"Materials and supplies provided during a hospital inpatient stay, hospital outpatient treatment or surgery, or emergency room visit shall be reimbursed based on the appropriate hospital ratio."
The correction is retroactive to January 1, 2019.
Provider's Report of Physical Ability (PROPA)
Download the WCA Provider's Report of Physical Ability (PROPA) 2022 revision.
Helpful guidelines for the HCPs filling out the form can be found on the back of the form.
Purpose of the form: Because a prolonged workplace absence is detrimental to a worker's well-being, the WCA asks HCPs to facilitate the recovering worker's safe, efficient return to work by providing interested parties a clear, quantitative description of current claim-related physical restrictions. In this way, you help employers identify suitable work and assign safe work activities.
When/who fills the PROPA out: Based on a reasonable medical probability, the primary treating HCP is encouraged to fill out the PROPA at each appointment. However, reimbursement for the form can only be obtained as indicated in the current HCP Fee Schedule and Billing Instruction page 22, summarized below:
- The PROPA shall be billed for reimbursement if pre-authorization is obtained AND if it is completed at the provider's initial visit or if there is a change in Work Status (section 2 of the PROPA) or Activity Restrictions (section 3 of the PROPA).
- Completion of the PROPA shall be billed as a separate line item along with the appropriate evaluation code for the appointment.
- The PROPA shall be billed using CPT code 99080 and shall be reimbursed $25.00
- For the initial visit, the medical notes must indicate "WCA Provider's Report of Physical Ability Change."
After the HCP fills the PROPA out: The HCP is asked to provide a copy to the worker immediately after each visit. Note -- the PROPA is not intended to substitute a Functional Capacity Evaluation (FCE).
Please note that the PROPA 2022 version replaces all previous version of the PROPA, including the one dated 2018.
For any questions on this form, contact the WCA Medical Cost Containment Bureau at WCA-MCC@state.nm.us.
For the method of payment for Freestanding Ambulatory Surgery Centers, please see page 10 of the Fee Schedule and Billing Instructions.
Ratios Effective January 1, 2019 can be found on page 11 of the Fee Schedule and Billing Instructions document.
Release for Health Care Records
In a workers' compensation case, it may be necessary for a worker to allow a HCP to disclose medical records for the purposes of facilitating and evaluating a workers' compensation claim.
Find the form for Authorization for Use and Disclosure of Health Records.
Approval of Out of State Health Care Provider Forms and Letter
As indicated in NMAC 184.108.40.206 QUALIFICATION OF OUT OF STATE HEALTH CARE PROVIDERS
A. An HCP that is not licensed in the state of New Mexico must be approved by the director to qualify as an HCP under the act.
B. No party shall have recourse to the billing and payment dispute resolution provisions of these rules with respect to the services of an HCP who is not licensed in New Mexico or approved by the director.
C. The director's approval may be obtained by submitting an application to the director and proposed order, supported by an original affidavit of the HCP seeking approval. Nothing in this rule shall prevent the director from entering into agreements with any party or HCP to provide for simplified and expeditious qualification of HCPs in individual cases, provided, however, that all such arrangements shall be considered public records.
D. The director's approval of a health care provider in a particular case, pursuant to the provisions of Section 52-4-1 NMSA 1978 will be deemed given when an out of state health care provider provides services to that injured worker and the employer/insurer pays for those services. Unless otherwise provided, the approval obtained by this method will not apply to the provision of health care by that provider to any other worker, except by obtaining separate approval as provided in these rules.
To seek the WCA Director's approval, you may submit the following forms which are downloadable by clicking on the corresponding document.
The forms are also available on our forms page.
Official Disability Guidelines
On July 1, 2013, the Official Disability Guidelines (ODG)* went into effect in New Mexico for the treatment of workers' compensation injuries. All medical services rendered for recommended treatment contained in the most recent edition of the Official Disability Guidelines (ODG) are presumed reasonable and necessary.
Read more about the Official Disability Guidelines.
Return to Work
The goal after a workplace illness or injury is getting back to work as quickly as possible. Even if an immediate return to the job isn't possible, light or flex duty may be possible, provided the treating health care provider recommends it and the employer has such work available. The longer a worker is out of work, the greater the chance of never returning to the job.
Find out more about Return to Work.