Behavioral Health Forms get a Facelift

January 16, 2019

Starting, Jan. 8, 2019, you will notice some changes to Blue Cross and Blue Shield of New Mexico's (BCBSNM) behavioral health request forms. The changes may make it easier for you to navigate the forms. The forms also include the new Current Procedural Terminology (CPT®) codes for Applied Behavioral Analysis (ABA).

Please use the CPT codes for 2019 as communicated by the American Psychological Association and the American Medical Association.

The changes include:

  • A new ABA Clinical Service Request Form that replaces the following forms:
    • ABA Initial Treatment Request
    • ABA Managed Care/Concurrent Review
    • ABA Treatment Request Member Schedule forms
  • A new ABA Initial Assessment Request form
  • Updates to the following existing forms:
    • Electroconvulsive Therapy (ECT) Request Form
    • Focused Outpatient Management Program (FOPM)
    • Intensive Outpatient Program (IOP) Request Form
    • Psychological or Neuropsychological Testing Request Form

Find these, and other forms, under the Education and Requirements tab at