---
title: Aetna Better Health of Texas ABA coverage (Texas Medicaid MCO).
url: "https://carelu.com/payers/aetna-better-health-texas"
markdown_url: "https://carelu.com/payers/aetna-better-health-texas.md"
state: TX (Texas)
payer: Aetna Better Health of Texas
kind: Medicaid managed care plan (MCO)
parent_program: Texas Medicaid (THSteps-CCP)
description: "How Aetna Better Health of Texas fits the state Medicaid ABA benefit — the TMPPM baseline that governs it, its Bexar and Tarrant service areas, and which plan-specific details you'll need to confirm directly because they aren't publicly verifiable."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Aetna Better Health of Texas ABA coverage (Texas Medicaid MCO).

_Payer Guide · Aetna Better Health (TX) · Last updated September 2026 · 5 primary sources_

> TMPPM state baseline in Bexar & Tarrant; plan-specific PA mechanics not publicly verifiable.

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.

This plan administers the **Texas Medicaid (THSteps-CCP)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Texas Medicaid (THSteps-CCP) guide](https://carelu.com/payers/texas-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: Aetna Better Health of Texas provider manual and Medicaid PA pages — aetnabetterhealth.com is behind an Akamai bot wall (r.jina.ai returns only the challenge page), so we could not check whether the plan deviates from the TMPPM. The TMPPM rule this value restates is itself verified; what is unverified is that Aetna Better Health applies it unchanged. Human retrieval via carelu.com/sources. [1]
- **Prior auth for treatment:** Not published / unverified. Verify via: Aetna Better Health of Texas provider manual and Medicaid PA pages — aetnabetterhealth.com is behind an Akamai bot wall (r.jina.ai returns only the challenge page), so we could not check whether the plan deviates from the TMPPM. The TMPPM rule this value restates is itself verified; what is unverified is that Aetna Better Health applies it unchanged. Human retrieval via carelu.com/sources. [1]

## At a glance

- **Plan type:** Texas Medicaid MCO (CVS/Aetna) — STAR, STAR Kids, CHIP (Bexar & Tarrant SDAs)
- **Clinical rules:** TMPPM Autism Services criteria (statewide baseline; no distinct TX policy found)
- **Prior auth:** Required on evaluation and treatment, per the state benefit
- **Auth cadence:** State 90/90/180 cadence; 3-year dx recency; 8 hrs/day cap
- **Plan mechanics:** Forms, portal, and UM contacts NOT publicly verified — confirm with the plan
- **Rates:** Not published — contract-specific

## What verifiably governs: the state baseline

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]

## What to confirm with the plan directly

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]

## Delivery and billing rules

Coverage decides whether Aetna Better Health of Texas pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: 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. [1][3]

## What intake should collect for Aetna Better Health of Texas

- **STAR / STAR Kids vs. CHIP:** CHIP is excluded from the ABA benefit — confirm the Medicaid line.
- **ASD dx + recency:** State baseline: qualified diagnoser, DSM severity, within 3 years.
- **Prescriber referral:** The signed referral is a state requirement — it will be needed whatever Aetna's form looks like.
- **Plan mechanics on file:** Call provider relations once, document the submission channel/forms/fax, and template it.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Aetna Better Health of Texas ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 000944 — pVerify separately lists "AETNA BETTER HEALTH (TX) CHIP" (000945) as a distinct product from the Medicaid line (000944) used here — confirm the member's line of business before routing.
- **Payer ID (Availity):** 38692
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### How the 271 reports ABA benefits

- **ABA benefit bucket (service type code):** MH
- **Deductible applies to ABA:** no
- **Cost-share type:** plan-dependent
- **271 response quality for ABA:** high

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes — ABA Initial Evaluation / Re-evaluation, by the LBA | Required — CCP PA form + signed prescriber referral; not reimbursable unless the evaluation was submitted for authorization of payment; must be billed within 30 calendar days of the first date of service | 24 units (6 hours) per evaluation or re-evaluation event per per evaluation event; re-evaluations authorized no more than once every 180 days | office, home, clinic, community | Yes — 95 modifier, synchronous audio-visual only, delivered by the LBA (LaBAs and BTs/RBTs may not deliver any service remotely) | HO (required — LBA only) |
| 97152 | Not confirmed (see code notes) | — | — | — | — | — |
| 97153 | Yes — direct 1:1 ABA treatment (BT-complexity level), delivered per treatment-plan protocol | Required — covered under the treatment authorization (90-day initial + 90-day extension, then 180-day recertifications; no prescriber signature on the 90-day extension since 4/1/2025) | Shares the 8-hour (32-unit) combined daily direct-treatment cap, shared with 97153, 97154, 97155, and 97158 (TMPPM §2.3.12). per day | office, home, clinic, community | No — 1:1 direct treatment must be delivered in person | No modifier required (HO/HN/HM may be reported for information only) |
| 97154 | Yes — direct group ABA treatment (BT-complexity level; group is 2–8 children/youth) | Required — covered under the treatment authorization (90-day initial + 90-day extension, then 180-day recertifications) | Shares the 8-hour (32-unit) combined daily direct-treatment cap, shared with 97153, 97154, 97155, and 97158 (TMPPM §2.3.12). per day | office, home, clinic, community | No — group direct treatment must be delivered in person | No modifier required (HO/HN/HM may be reported for information only) |
| 97155 | Yes — protocol modification / direct 1:1 time by the LBA (or delegated LaBA) | Required — covered under the treatment authorization (90-day initial + 90-day extension, then 180-day recertifications) | Shares the 8-hour (32-unit) combined daily direct-treatment cap, shared with 97153, 97154, 97155, and 97158 (TMPPM §2.3.12). per day | office, home, clinic, community | Yes — 95 modifier, synchronous audio-visual, delivered by the LBA only | HO or HN (one required) |
| 97156 | Yes — parent/caregiver education & training, by the LBA (or delegated LaBA) | Required — covered under the treatment authorization | — | office, home, clinic, community | Yes — 95 modifier, synchronous audio-visual, delivered by the LBA (LaBAs may not deliver this — or any — service via telehealth, even by delegation) | HO or HN (one required) |
| 97157 | Not confirmed (see code notes) | — | — | — | — | — |
| 97158 | Yes — group protocol modification, by the LBA (or delegated LaBA) | Required — covered under the treatment authorization | Shares the 8-hour (32-unit) combined daily direct-treatment cap, shared with 97153, 97154, 97155, and 97158 (TMPPM §2.3.12). per day | office, home, clinic, community | Yes — 95 modifier, synchronous audio-visual, delivered by the LBA only | HO or HN (one required) |
| 99366 | Yes — interdisciplinary team meeting, attended by qualified nonphysician health-care providers | Not separately authorized — reimbursable when a PA for ABA evaluation, re-evaluation, or treatment is already on file; reimbursement limited to primary diagnosis F84 | — | office, home, clinic, community, remote participation for team members (95 modifier) | Yes — 95 modifier for remote participation by team members | No modifier required (95 for remote participation) |
| 0362T | Not confirmed (see code notes) | — | — | — | — | — |
| 0373T | Not confirmed (see code notes) | — | — | — | — | — |

Code notes:

- **97151:** Aetna Better Health of Texas's plan-specific submission mechanics (form, portal, UM fax/phone) are not publicly verifiable — its provider manual and PA pages return errors to automated retrieval. Confirm directly with provider relations before first submission.
- **97152:** 97152 does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.
- **97153:** Either 97153 or 97155 may be billed for direct individual treatment hours — bill the code matching who delivered the session.
- **97154:** Either 97154 or 97158 may be billed for direct group treatment hours.
- **97155:** Also the code used to bill the required progress summary submitted after the first 90 days of treatment. Only DIRECT supervision (LBA observing the LaBA/BT with the client) is reimbursable under this code — indirect supervision (caseload review, data discussion) is not billable.
- **97156:** Continued treatment authorization considers caregiver attendance at ≥85% of planned sessions.
- **97157:** 97157 does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.
- **99366:** School-district personnel may participate and count toward the 3-participant licensed-professional minimum but are not separately reimbursable.
- **0362T:** 0362T does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.
- **0373T:** 0373T does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.

### Contacts

- **Provider services phone:** 1-800-248-7767 (Bexar service area) / 1-800-306-8612 (Tarrant service area)
- **Hours:** 8 a.m.–5 p.m., Monday–Friday
- **Portal:** [Availity](https://apps.availity.com/)

Questions to ask on a verification call:

- Confirm which payer ID routes Aetna Better Health of Texas's Medicaid line eligibility (000944) vs. its CHIP line (000945).
- Does Aetna Better Health of Texas support real-time (vs. batch) 270/271 eligibility for this payer ID?
- Is the ABA copay or coinsurance charged per visit or per day, and does the plan's out-of-pocket maximum apply?
- Are CPT codes 97152, 97157, 0362T, and 0373T billable under this plan's Autism Services benefit?
- Is there a daily/weekly unit cap for 97156 (parent/caregiver training) or 99366 (team meeting)?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23)
- https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/texas/providers/pdf/tx_provider_manual.pdf (accessed 2026-07-23)
- https://www.tmhp.com/news/2021-07-30-hhsc-release-autism-services-benefits-effective-february-1-2022 (accessed 2026-07-23)
- https://www.tmhp.com/sites/default/files/file-library/edi/D00026_270_271_Medicaid_CHIP_Eligibility_Companion_Guide.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/TMPPM/2_04_Childrens_Services/2_04_Childrens_Services.htm (accessed 2026-07-23)
- https://public.tmhp.com/FeeSchedules/StaticFeeSchedule/FeeSchedules.aspx?fn=%5C%5Ctmhp.net%5CFeeSchedule%5CPROD%5CStatic%5CTexas_Medicaid_Fee_Schedule_PRCR615C.pdf (accessed 2026-07-23)
- https://www.aetnabetterhealth.com/texas/providers/contact-us.html (accessed 2026-07-23)

## Common questions

### Does Aetna Better Health of Texas cover ABA?

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.

### Does Aetna Better Health have its own Texas ABA policy?

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.

### How do I submit an ABA PA to Aetna Better Health of Texas?

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.

## Primary sources

1. [TMPPM Children's Services Handbook, § 2.3 Autism Services](https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/TMPPM/2_04_Childrens_Services/2_04_Childrens_Services.htm)
2. [TMHP — Update to a PA Requirement for Autism Services (eff. 4/1/2025)](https://www.tmhp.com/news/2025-02-14-update-prior-authorization-requirement-autism-services-effective-april-1-2025)
3. [Aetna Better Health of Texas — provider manual (access-restricted)](https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/texas/providers/pdf/tx_provider_manual.pdf)
4. [Aetna Better Health of Texas — plan site](https://www.aetnabetterhealth.com/texas/index.html)
5. [BACB RBT Handbook (updated 06/2026)](https://www.bacb.com/rbt-handbook)
6. [Tex. Gov't Code § 540.0303 — MCO PA determinations for nonhospitalized recipients (eff. 4/1/2025)](https://texas.public.law/statutes/tex._gov't_code_section_540.0303)
7. [1 Tex. Admin. Code § 353.425 — MCO processing of incomplete PA requests](https://www.law.cornell.edu/regulations/texas/1-Tex-Admin-Code-SS-353-425)
8. [Aetna Better Health of Texas — Prior Authorization page (Wayback capture 7/22/2024)](https://web.archive.org/web/20240722134910/https://www.aetnabetterhealth.com/texas/providers/prior-authorization.html)
9. [TMPPM Vol. 1, Section 8: Third Party Liability (TPL)](https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/TMPPM/1_08_Third_Party_Liability/1_08_Third_Party_Liability.htm)
10. [Aetna Better Health of Texas — Provider Manual (Sept. 2022, Wayback capture) (PDF)](https://web.archive.org/web/20221006124427id_/https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/texas/providers/pdf/tx_provider_manual.pdf)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.