To the extent an individual or entity wishes to rely upon information contained in this resource, such reliance should be based upon an independent legal review and analysis of applicable law. This resource was prepared for informational purposes only and is not offered or intended, nor should it be relied upon, for legal advice for any specific set of circumstances. Additional legal doctrines, federal and state statutes, and case law not set forth herein may apply to your situation and such laws, rules and regulations can vary from state to state. You should consult with your own attorney to obtain specific legal advice on your particular facts and circumstances and applicable laws, rules, and regulations.

Key Resources and Links

Agency

• Workers' Compensation Administration (WCA)

Contact Information

• New Mexico WCA contacts

News and Updates

• See "News and Announcements" on the WCA home page

Other

• Health Care Provider's Guide
• New Mexico WC Statutes (Chapter 52)

Therapy Regulations

• What is the conversion factor for outpatient therapy services?
  • Response: Not applicable
  • Detail: Schedule of maximum fees provided
  • Citation: www.workerscomp.state.nm.us/hcp_fee.php
• What is the basis of the fee schedule for outpatient therapy services?
  • Response: Other
  • Detail: Maximum rates within 60th and 80th percentile of current rates
  • Citation: New Mexico Statutes Chapter 52 - Workers' Compensation Section 4-5
• Are there limits on the number of physical therapy visits allowed?
  • Response: No
  • Detail: §52-1-49 requires employer to provide worker with timely, reasonable and necessary health care services…as long as treatment is necessary. Use left navigation in website to locate statute
  • Citation: New Mexico Statutes 52-1-49
• Are there limits on payment per visit for outpatient therapy services?
  • Response: No
  • Detail: 2026 HCP Fee Schedule and Billing Instructions: Physical therapy bills may include all codes which are reasonable and necessary for the evaluation and treatment of a worker in a single day
  • Citation: https://www.workerscomp.nm.gov/wp-content/uploads/2025/12/NewMexicoPFS2026.pdf
• Do regulations require use of treatment guidelines?
  • Response: Yes
  • Detail: Official Disability Guidelines, effective 1/1/2013
    See 11.4.7.8(F) of Title 11, Chapter 4, Part 7 | Treatment rendered pursuant to ODG is presumed reasonable and necessary
  • Citation: https://www.workerscomp.nm.gov/wp-content/uploads/2026/04/11.4.4_NMAC_Effective_4.7.2026.pdf
    www.workerscomp.nm.gov/wp-content/uploads/2026/04/11.4.7_NMAC_Effective_4.7.2026.pdf
• Is a referral required in order to see a physical therapist?
  • Response: Yes
  • Detail: Physical therapy requires pre-authorization.
  • Citation: https://www.workerscomp.nm.gov/wp-content/uploads/2025/06/11.4.7-NMAC.pdf
• Can outpatient fees be negotiated above or below the fee schedule? ¹
  • Response: Yes
  • Detail: 11.4.7.8 General Provisions (C) of WCA Rules "Nothing in these rules shall preclude the separate negotiation of fees between a practitioner and a payer within the health care provider fee schedule for any health care service as set forth in these rules."
  • Citation: https://www.workerscomp.nm.gov/wp-content/uploads/2025/06/11.4.7-NMAC.pdf
• Can the injured worker be charged for any claim-related services?
  • Response: No
  • Detail: 11.4.7.8: The worker shall not be billed for health care services provided by an authorized HCP as treatment for a valid workers' compensation claim unless payer denies compensability of a claim or payer does not respond to a bill within the time limit set forth in Paragraph (2) of subsection D of 11.4.7.8 NMAC.
  • Citation: https://www.workerscomp.nm.gov/wp-content/uploads/2025/06/11.4.7-NMAC.pdf
• Are there workers' compensation regulations about who can provide services under the direction and supervision of a physical therapist?
  • Response: No
  • Detail: Defaults to state practice act
• Are there provider network and/or managed care regulations in place?
  • Response: No
• Are there regulations that address which fee schedule applies if an injured worker from this state seeks treatment in another state?
  • Response: Yes
  • Detail: NMAC 11.4.7.10 addresses qualification of out of state providers
  • Citation: https://www.workerscomp.nm.gov/wp-content/uploads/2025/06/11.4.7-NMAC.pdf
• Are there regulations regarding Functional Capacity Evaluations (FCEs)?
  • Response: Yes
  • Detail: NMAC 11.4.7.8 (B)
  • Citation: https://www.workerscomp.nm.gov/wp-content/uploads/2025/06/11.4.7-NMAC.pdf

¹ While some states use a mandatory fee schedule, many states have provisions for fees to be negotiated above or below the published fee schedule. "Yes + / - " indicates that fees can be negotiated above or below the fee schedule. "Yes -" indicates that fees can only be negotiated below the fee schedule.

The following payer types conduct business in this state.

• Private Carriers: Yes
• Self-insured Employers or Groups: Yes
• Competitive State Fund: Yes
• Exclusive State Fund: No
• State Comp Fund (last resort): No

The Workers' Compensation resources have been updated as of 2026.