---
title: Blue Cross Blue Shield of Texas Medicaid ABA coverage (Texas Medicaid MCO).
url: "https://carelu.com/payers/bcbs-texas-medicaid"
markdown_url: "https://carelu.com/payers/bcbs-texas-medicaid.md"
state: TX (Texas)
payer: Blue Cross Blue Shield of Texas (Medicaid)
kind: Medicaid managed care plan (MCO)
parent_program: Texas Medicaid (THSteps-CCP)
description: "How Blue Cross Blue Shield of Texas administers Medicaid ABA in the Travis/Austin service area — the 2024 insourcing of behavioral health from Magellan, the current PA procedure code grid, and submission mechanics via fax and Availity."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Blue Cross Blue Shield of Texas Medicaid ABA coverage (Texas Medicaid MCO).

_Payer Guide · BCBSTX Medicaid · Last updated September 2026 · 7 primary sources_

> STAR/STAR Kids in Travis; insourced BH from Magellan in 2024; PA code grid confirms 97151-97158.

Blue Cross Blue Shield of Texas (BCBSTX), a Division of Health Care Service Corporation, runs STAR and STAR Kids in the Travis service area — distinct from BCBSTX's commercial and Federal Employee Program lines, which follow different rules entirely (see our BCBSTX commercial guide for those). BCBSTX publishes no dedicated Autism Services chapter in its combined STAR/CHIP/STAR Kids provider manual; ABA policy instead lives in a standalone PA checklist and a periodically updated PA procedure code grid. The operationally important fact for intake: BCBSTX carved Medicaid behavioral health out to Magellan as recently as mid-2023, then "insourced" it in 2024 — older documents referencing Magellan are stale.

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**: Required — per the statewide TMPPM benefit; submit via fax 1-888-530-9809 or the Availity provider portal [3][2]
- **Prior auth for treatment**: Required — same fax/portal; BCBSTX brought behavioral health/ABA administration in-house in 2024, ending its Magellan carve-out [3][2]
- **Autism diagnosis required?**: Yes — ASD per the statewide TMPPM criteria (no distinct BCBSTX Medicaid ABA policy found) [5]

## At a glance

- **Plan type:** Texas Medicaid MCO (HCSC) — STAR, STAR Kids (Travis service area; STAR Kids adds MRSA Central)
- **Clinical rules:** TMPPM Autism Services criteria (no distinct BCBSTX Medicaid ABA policy found)
- **Prior auth:** Required on 97151, 97153, 97154, 97155, 97156, 97158 (confirmed on BCBSTX's own PA code grid, eff. 1/1/2024)
- **Behavioral health:** Insourced from Magellan in 2024 — BCBSTX now administers BH/ABA PA directly, not via a vendor carve-out
- **Submission:** BH intake fax 1-888-530-9809, or the Availity Essentials provider portal
- **Rates:** Not published — contract-specific

## The 2024 end of the Magellan carve-out

As late as a 7/5/2023-dated PA summary, BCBSTX directed providers to "contact Magellan for authorization requirements" for Texas Medicaid behavioral health — a classic BH carve-out. On May 10, 2024, BCBSTX announced the "insourcing of Behavioral Health Services for Medicaid," and every current-generation document we could find (the ABA PA Requirement Checklist, revised 4/26/2024, and a September 2024 UM provider training deck) makes no mention of Magellan and instead routes ABA authorization to BCBSTX's own behavioral-health intake fax, 1-888-530-9809, or the Availity Essentials portal. We found no document stating explicitly that the Magellan relationship has fully ended for every BH service line — if a legacy document you're working from still references Magellan, treat it as superseded and confirm current routing with BCBSTX's Medicaid Provider Network Representative before submitting. [1][2]

## What the current PA code grid confirms

BCBSTX's Texas Medicaid Benefit Prior Authorization Procedure Code List lists 97151, 97153, 97154, 97155, 97156, and 97158 each as "Applied Behavioral Health (Allowable only for members 20 years of age or younger)," PA-required, effective 1/1/2024 — matching the statewide code set. We could not find 0362T or 99366 on this list or any other BCBSTX Medicaid document; treat their handling as unconfirmed and rely on TMPPM baseline expectations rather than a BCBSTX-specific rule. General PA turnaround per BCBSTX's own UM training material is 3 business days for routine requests — we found no ABA-specific SLA distinct from that standard. [3][4]

## Intake gates

The questions that decide whether a family can start with Blue Cross Blue Shield of Texas (Medicaid), and what they have to bring.

- **Age limit**: Follows the Texas Medicaid rule, and BCBSTX states it on its own PA code grid: 97151 and 97153-97158 are each listed as Applied Behavioral Health allowable only for members 20 years of age or younger. [3][5]
- **Diagnosis recency**: 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. [5][3]
- **Who may diagnose**: 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). [5][3]
- **Diagnostic tools required**: 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. [5][3]
- **Referral required?**: 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. [5][3][7]
- **Telehealth**: 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. [5][3]
- **Prior-auth decision time**: BCBSTX's Medicaid manual publishes no decision clock (only that "Faxes received after hours will be processed the next business day"), and its ABA checklist lists what makes a request complete without timing — so the Texas rule governs: a Medicaid MCO must decide a nonhospitalized PA "within three business days after the organization receives the request" (Tex. Gov't Code § 540.0303), with the 1 TAC § 353.425 incomplete-request process (written notice of what is missing within 3 business days; a final decision within 3 business days after it arrives). The federal ceiling is 7 calendar days standard and 72 hours expedited (42 CFR 438.210(d)); Texas's 3 business days is stricter. No ABA reauthorization lead time is published. [8][9][10][11]
- **Other insurance (who pays first)**: Bill the other carrier first: "Providers should submit the claim to the other carrier first," then send BCBSTX the COB claim with the other carrier's remittance advice, denial letter or member EOB — "We deny Coordination of Benefits claims received without at least one of the above three items." Filing deadline: "BCBSTX must receive Coordination of Benefit claims within 95 days from the date on the other carrier's or program's PRA or letter of denial of coverage." The manual's option to bill Medicaid without billing other insurance is written for "Texas Health Steps providers" (checkups), not ABA. It does not say whether BCBSTX's ABA PA is still required when it pays second — request it. [8][12]

## Delivery and billing rules

Coverage decides whether Blue Cross Blue Shield of Texas (Medicaid) 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.

- **Supervision**: 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. [5][3][6]
- **Concurrent billing (97153 + 97155)**: 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. [5][3]
- **Daily limits / MUEs**: 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. [5][3]
- **Session-note signature**: 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. [5][3]
- **Place of service**: 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. [5][3]
- **Bill as provider**: 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. [5][3]

## What intake should collect for Blue Cross Blue Shield of Texas (Medicaid)

- **Line of business:** Confirm the card is BCBSTX Medicaid (STAR/STAR Kids), not commercial or FEP — different guides, different rules.
- **ASD dx + recency:** State baseline: qualified diagnoser, DSM severity, within 3 years.
- **Current routing, not legacy Magellan:** If an older document or contact points to Magellan, confirm with BCBSTX provider relations — BH/ABA was insourced in 2024.
- **Prescriber referral:** The state's signed-referral requirement applies unchanged for the evaluation PA.

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

## Verification of benefits (VOB) data

How Blue Cross Blue Shield of Texas (Medicaid) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 01017 (STAR/CHIP) / 01352 (STAR Kids) — pVerify's payer-list page shows TWO distinct Medicaid-specific entries, separate from the commercial BCBSTX code (00220): 01017 "BCBS Texas Medicaid STAR CHIP" and 01352 "BCBS TEXAS MEDICAID STAR Kids." Confirmed via repeated matching queries, not an independent raw-HTML grep.
- **Payer ID (Availity):** 66002 — 66002 is stated on BCBSTX's own Medicaid eligibility page (covering STAR/CHIP/STAR Kids together, no per-program split) — but this exact code could NOT be found in Availity's own master payer-list PDF (only commercial BCBSTX-family codes appear there), so it's sourced from the payer's own site pointing at Availity, not independently cross-validated against Availity's published list. Confirm via Availity Essentials onboarding before routing.
- **Payer ID (Change Healthcare / Optum):** HCSVC — HCSVC per Optum's official Real-Time Eligibility Payer List, labeled "BCBS Texas Medicaid Star CHIP" — explicitly STAR/CHIP scope; whether it also covers STAR Kids (which has its own distinct pVerify code, 01352) is unconfirmed.
- **Supports 270/271 eligibility:** Yes — Rides the same centralized TMHP 270/271 feed as every other MCO in this file; also has distinct clearinghouse-side codes across all three networks researched (see payerId fields).
- **Behavioral health administrator:** none — As recently as a 7/5/2023-dated PA summary, BCBSTX directed providers to Magellan for Texas Medicaid behavioral health — a carve-out. BCBSTX announced 'insourcing' of Medicaid behavioral health on 5/10/2024, and every current-generation document found (PA checklist rev. 4/26/2024, Sept. 2024 UM training) routes ABA to BCBSTX's own BH intake fax/Availity, with no Magellan reference. Shipped 'none' for the CURRENT state; if a legacy document still references Magellan, treat it as superseded per BCBSTX's own 2024 announcement.
- **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:** BCBSTX's own PA code grid (eff. 1/1/2024) confirms 97151 as PA-required, 'Allowable only for members 20 years of age or younger.' Submit to BCBSTX's BH intake fax 1-888-530-9809 or the Availity Essentials portal — NOT Magellan, which BCBSTX insourced away from in 2024.
- **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. Not found on BCBSTX's own PA code grid or provider manual — rely on the statewide TMPPM baseline rather than a BCBSTX-specific rule.
- **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:** 1-877-560-8055 (STAR/CHIP) / 1-877-784-6802 (STAR Kids)
- **Phone menu path:** Provider Relations/Network line (credentialing, contracting): 1-855-212-1615 — separate from the member-services numbers above.
- **Hours:** 8:00 a.m.-5:00 p.m. Central Time
- **Portal:** [Availity Essentials](https://www.availity.com/)
- **Fax:** 1-888-530-9809 (Behavioral Health/ABA PA intake, per BCBSTX's own PA Requirement Checklist)

Questions to ask on a verification call:

- Confirm 66002 is the correct Availity payer ID for STAR/CHIP/STAR Kids eligibility, and whether STAR Kids (which has its own distinct pVerify code, 01352) is also covered by that single Availity ID.
- Does BCBSTX 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?
- Is CPT 99366 billable under this plan's Autism Services benefit — it does not appear on BCBSTX's own PA code grid or provider manual?
- Since BCBSTX insourced Medicaid behavioral health from Magellan in 2024, confirm ABA PA still routes to the 1-888-530-9809 BH intake fax or Availity, not a Magellan channel.

### VOB data sources

- https://www.bcbstx.com/provider/medicaid/education-and-reference/news/2024/05-10-2024-md-behavioral-health-aba-forms (accessed 2026-07-23)
- https://www.bcbstx.com/docs/provider/tx/provider-medicaid/um/applied-behavioral-analysis-pa-requirement-checklist.pdf (accessed 2026-07-23)
- https://www.bcbstx.com/content/dam/hcsc/docs/provider/tx/provider-medicaid/education/2067877-758408-0324-TX-Medicaid-STAR-CHIP-STARKids-Provider-Manual-Handbook.pdf (accessed 2026-07-23)
- https://www.bcbstx.com/docs/provider/tx/provider-medicaid/um/prior-auth-proc-code-grid-06012026.pdf (accessed 2026-07-23)
- https://pverify.com/payer-list/ (accessed 2026-07-23)
- https://www.bcbstx.com/provider/medicaid/claims-and-eligibility/eligibility (accessed 2026-07-23)
- https://www.optum.com/content/dam/o4-dam/resources/pdfs/guides/optuminsight-rt-eligibility-payer-list.pdf (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.bcbstx.com/provider/medicaid/contact (accessed 2026-07-23)

## Common questions

### Does Blue Cross Blue Shield of Texas Medicaid cover ABA?

Yes — the Texas Medicaid Autism Services benefit for STAR and STAR Kids members in the Travis service area, on TMPPM criteria. BCBSTX publishes no distinct clinical policy; its own PA code grid confirms PA is required on the core ABA codes.

### Is ABA carved out to a behavioral health vendor at BCBSTX Medicaid?

Not currently — BCBSTX carved Medicaid BH out to Magellan as recently as mid-2023, but announced "insourcing" of Medicaid behavioral health in May 2024. Current PA documents route ABA to BCBSTX's own fax and portal, not Magellan.

### How do I submit an ABA PA to BCBSTX Medicaid?

Fax to 1-888-530-9809 or submit through the Availity Essentials provider portal, per BCBSTX's current ABA PA Requirement Checklist.

## Primary sources

1. [BCBSTX — Medicaid Behavioral Health / ABA Forms Update (news, 5/10/2024)](https://www.bcbstx.com/provider/medicaid/education-and-reference/news/2024/05-10-2024-md-behavioral-health-aba-forms)
2. [BCBSTX — Applied Behavioral Analysis PA Requirement Checklist (rev. 4/26/2024, PDF)](https://www.bcbstx.com/docs/provider/tx/provider-medicaid/um/applied-behavioral-analysis-pa-requirement-checklist.pdf)
3. [BCBSTX — Texas Medicaid Benefit Prior Authorization Procedure Code List (PDF)](https://www.bcbstx.com/docs/provider/tx/provider-medicaid/um/prior-auth-proc-code-grid-06012026.pdf)
4. [BCBSTX — Texas Medicaid STAR, CHIP, and STAR Kids Provider Manual (PDF)](https://www.bcbstx.com/content/dam/hcsc/docs/provider/tx/provider-medicaid/education/2067877-758408-0324-TX-Medicaid-STAR-CHIP-STARKids-Provider-Manual-Handbook.pdf)
5. [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)
6. [BACB RBT Handbook (updated 06/2026)](https://www.bacb.com/rbt-handbook)
7. [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)
8. [BCBSTX — Texas Medicaid STAR, CHIP, and STAR Kids Provider Manual (June 2025) (PDF)](https://www.bcbstx.com/docs/provider/tx/provider-medicaid/education/tx-medicaid-star-chip-starkids-provider-manual-handbook-2025.pdf)
9. [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)
10. [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)
11. [42 CFR § 438.210(d) — Medicaid managed care authorization timeframes](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
12. [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)

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.