Aetna Better Health of Texas serves STAR, STAR Kids, and CHIP in the Bexar and Tarrant service areas — putting it alongside UnitedHealthcare in the DFW/Tarrant STAR Kids market. Like every Texas MCO, it delivers the statewide THSteps-CCP Autism Services benefit and must apply the TMPPM medical-necessity criteria. An honesty note that shapes this guide: Aetna Better Health's Texas provider manual and PA pages block automated retrieval, and we found no distinct TX ABA clinical policy in public sources — so this page gives you the state baseline that verifiably governs, and flags exactly which plan-level mechanics to confirm with the plan before your first submission.
Every fact on the Texas Medicaid guide applies to Aetna Better Health members: PA required on the 97151 evaluation (24-unit cap) with a signed prescriber referral and an ASD diagnosis made or reconfirmed within 3 years; treatment authorized in two 90-day periods then 180-day recertifications, with the prescriber signature no longer required on the 90-day extension since April 1, 2025; the 8-hour daily direct-treatment cap; the HO/HN/HM credential modifiers; and the telehealth ban on BT/LaBA-delivered direct treatment. Build your clinical package to that baseline and it will be substantively correct regardless of Aetna's intake mechanics.[1][2]
We could not verify Aetna Better Health of Texas's ABA-specific submission mechanics from public sources — the plan's provider manual and Medicaid pages return errors to automated retrieval, and no distinct TX ABA policy surfaced elsewhere. Aetna Better Health plans typically run submissions through Availity, but treat that as an assumption, not a fact. Before your first case: confirm the PA submission channel and any plan-specific form (or whether the state CCP PA form is accepted), the UM department's fax/phone, expected turnaround times, and appeals routing. A ten-minute provider-relations call up front beats a bounced authorization later.[3][4]
The questions that decide whether a family can start with Aetna Better Health of Texas, and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the Texas Medicaid (TMPPM) rule: birth through 20 years of age on the date of service, with eligibility ending the day of the 21st birthday. CHIP members are excluded from the ABA benefit. Aetna Better Health publishes no retrievable Texas ABA policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Follows the Texas Medicaid (TMPPM) rule: the ASD diagnosis must be made or reconfirmed within 3 years of initiation or recertification; past 3 years a comprehensive re-evaluation of ASD symptom severity levels per DSM criteria is required first. Aetna Better Health publishes no retrievable Texas ABA policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Follows the Texas Medicaid (TMPPM) rule: a developmental pediatrician, neurologist, psychiatrist, licensed psychologist, or an interdisciplinary diagnostic team (a physician, PA or NP in consultation with qualified child specialists with autism expertise). Aetna Better Health publishes no retrievable Texas ABA policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Follows the Texas Medicaid (TMPPM) rule: a reliable, valid, standardized diagnostic assessment tool or combination of tools — the manual names the ADOS, ADI-R and CARS as examples. Screening instruments alone (STAT, M-CHAT-R) do not substitute. Aetna Better Health publishes no retrievable Texas ABA policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Follows the Texas Medicaid (TMPPM) rule: a signed, dated prescriber referral for the evaluation, signed within 60 calendar days before or on the anticipated evaluation date; and for treatment a signed, dated referral from a physician or allowed practitioner (MD/DO, PA, NP, or CNS with delegated authority) stating frequency and duration, signed on or before the service start date and no more than 3 months old. Since 4/1/2025 the prescriber signature is no longer required on the CCP PA form for the 90-day extension. Aetna Better Health publishes no retrievable Texas ABA policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Follows the Texas Medicaid (TMPPM) rule: synchronous audio-visual only, modifier 95, on 97151, 97155, 97156, 97158 and 99366. One-on-one direct treatment delivered to the child by a behavior technician or LaBA must be in person — telehealth is prohibited for BT/LaBA-delivered direct service. Aetna Better Health publishes no retrievable Texas ABA policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Not confirmed from a current plan document. The statutory ceiling binds the plan regardless: a Texas Medicaid MCO must decide a nonhospitalized PA "within three business days after the organization receives the request" (Tex. Gov't Code § 540.0303), and an incomplete request follows 1 TAC § 353.425 — written notice of what is missing within 3 business days, and a final decision no later than 3 business days after the information arrives. The plan's own prior-authorization page as archived in July 2024 said the same: "Allow at least three business days for a response … The turnaround time begins when we receive all info necessary to make a decision," with concurrent review in one business day. Whether the current manual sets a stricter clock, or any ABA reauthorization lead time, could not be checked.[6][7][8]
Blocked on: Aetna Better Health of Texas provider manual (published 8/6/2026) and live prior-authorization page — aetnabetterhealth.com returns an Akamai "Access Denied" to curl, to a real Chrome session and to r.jina.ai, and the newest Wayback copy of the manual is truncated. Human retrieval via carelu.com/sources, or ask Aetna Better Health provider services using the number on the member card.
Not confirmed from a current plan document. The state rule every Texas Medicaid MCO operates under: Medicaid is the payer of last resort, so bill the commercial plan first and submit its EOB with the Medicaid claim. The plan's September 2022 manual (archived) gave the filing window as "within 95 days of the primary carrier's EOB in the Coordination of Benefits (COB) case." Whether the current manual requires the plan's own ABA prior authorization when it pays second could not be checked — request it.[9][10]
Blocked on: Aetna Better Health of Texas provider manual (published 8/6/2026) and live prior-authorization page — aetnabetterhealth.com returns an Akamai "Access Denied" to curl, to a real Chrome session and to r.jina.ai, and the newest Wayback copy of the manual is truncated. Human retrieval via carelu.com/sources, or ask Aetna Better Health provider services using the number on the member card.
Coverage decides whether Aetna Better Health of Texas pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Follows the Texas Medicaid (TMPPM) rule: the manual sets no numeric ratio of its own, requiring LBAs to directly supervise LaBAs and behavior technicians in accordance with Texas licensure and deferring to the certifying body's minimums — for RBT-credentialed staff the BACB floor of supervision on at least 5% of service hours each month with two face-to-face contacts. Only direct supervision, where the LBA observes the LaBA or BT with the child, is reimbursable (under 97155); indirect supervision is unpaid. Aetna Better Health publishes no retrievable Texas ABA or reimbursement policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Follows the Texas Medicaid (TMPPM) rule: concurrent billing is prohibited — Texas Medicaid will not reimburse multiple ABA providers during one session with the child when more than one provider is present. The single exception is when the family and the child receive separate services and the child is not present in the family session. Total authorized hours may be requested under either 97153 or 97155 and billed as the code matching the service actually delivered — not both for the same clock time with the child present. Aetna Better Health publishes no retrievable Texas ABA or reimbursement policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Follows the Texas Medicaid (TMPPM) rule: direct treatment is capped at 8 hours (32 units) per day combined across 97153, 97154, 97155 and 97158; 97151 is capped at 6 hours (24 units) per evaluation and per re-evaluation; group treatment runs 2 to 8 children. Authorization periods are two consecutive 90-day terms then recertifications of up to 180 days. Aetna Better Health publishes no retrievable Texas ABA or reimbursement policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Follows the Texas Medicaid (TMPPM) rule: rendering ABA providers must sign each entry with full signature and credentials, with additional supervisory signatures per state licensure. Treatment notes carry the child's name, date of service, start and stop times, goals addressed, progress and a summary of interventions; 97155/97158 notes add protocol-modification decision points. The 97151 evaluation and the 90-day progress summary each need a dated signature from the LBA and from the parent or caregiver. Aetna Better Health publishes no retrievable Texas ABA or reimbursement policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Follows the Texas Medicaid (TMPPM) rule: home, clinic, office and community settings are payable. In schools, services delivered by a behavior technician as a shadow, an aide, or as general support are excluded; school personnel participating to coordinate care are not counted as duplicate providers, and interdisciplinary team meetings bill under 99366 against an ABA PA. BT and LaBA direct treatment must be in person in every setting. Aetna Better Health publishes no retrievable Texas ABA or reimbursement policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Follows the Texas Medicaid (TMPPM) rule: only the LBA enrolls in Texas Medicaid and bills. LaBAs and behavior technicians may not enroll — their services go out under the supervising LBA's NPI with the credential modifier identifying who rendered (HO = LBA, HN = LaBA, HM = behavior technician; 97151 takes HO only, 97155/97156/97158 take HO or HN). The LBA must directly employ or contract with every LaBA and BT on the team. Aetna Better Health publishes no retrievable Texas ABA or reimbursement policy of its own, so plan-level deviation could not be ruled out.[1][3]
Blocked on: Aetna Better Health of Texas provider relations — its Texas provider manual and Medicaid PA pages block automated retrieval, so we could not confirm whether the plan publishes anything that deviates from the TMPPM.
Yes — as a Texas Medicaid MCO it delivers the statewide THSteps-CCP Autism Services benefit under TMPPM criteria: PA on evaluation and treatment, ages 0–20, 3-year dx recency. CHIP members are excluded.
None that we could find publicly — and its provider documents block automated retrieval. Texas MCOs must apply TMPPM criteria, so plan clinically against the state baseline and confirm submission mechanics with the plan directly.
Confirm with the plan — the specific channel and forms aren't publicly verifiable. Ask provider relations whether the state CCP PA form is accepted and get the UM fax/portal details in writing before your first submission.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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