---
title: "Cook Children's Health Plan ABA coverage (Texas Medicaid MCO)."
url: "https://carelu.com/payers/cook-childrens-health-plan"
markdown_url: "https://carelu.com/payers/cook-childrens-health-plan.md"
state: TX (Texas)
payer: "Cook Children's Health Plan"
kind: Medicaid managed care plan (MCO)
parent_program: Texas Medicaid (THSteps-CCP)
description: "How Cook Children's Health Plan administers Texas Medicaid ABA across its six-county Fort Worth-area service area — its dedicated 123-page ABA provider training, code/modifier table, telehealth rules, and EpicCare Link submission process."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Cook Children's Health Plan ABA coverage (Texas Medicaid MCO).

_Payer Guide · Cook Children's Health Plan · Last updated September 2026 · 7 primary sources_

> Dedicated 123-page ABA training deck; 6-county Fort Worth-area STAR + STAR Kids; EpicCare Link portal.

Cook Children's Health Plan — the pediatric-focused plan affiliated with Cook Children's Health Care System, serving STAR and STAR Kids across six North Texas counties (Wise, Denton, Parker, Tarrant, Hood, and Johnson) — publishes an unusually deep ABA provider-education footprint for a Texas MCO: a dedicated 123-page "Applied Behavior Analysis" training deck plus a separate acute-PA training covering ABA mechanics in detail. Read closely, it's a faithful restatement of TMPPM §2.3 rather than a distinct plan overlay — the value here is the clarity and depth of the restatement, not a different rulebook. We found no ABA process that differs between STAR and STAR Kids in the plan's own materials.

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 — 97151 capped 6 hrs/24 units, HO modifier only, 30-day authorization window; signed referral + 3-yr dx recency [1][2]
- **Prior auth for treatment**: Required — TMPPM 90/90/180 cadence via the CCP PA form; 97155/97156/97158 need HO or HN modifier [1][5]
- **Autism diagnosis required?**: Yes — ASD per TMPPM criteria, restated in Cook Children's own ABA provider training materials [1][5]

## At a glance

- **Plan type:** Texas Medicaid MCO (pediatric-focused) — STAR, STAR Kids, CHIP, CHIP Perinatal (Wise/Denton/Parker/Tarrant/Hood/Johnson)
- **Clinical rules:** TMPPM Autism Services criteria, restated in a dedicated 123-page ABA provider training deck
- **Prior auth:** Required — evaluation, treatment, recerts, and re-evaluations, per TMPPM §2.3.7.x
- **Submission:** EpicCare Link secure provider portal; fax only if portal access is pending (STAR/CHIP 682-885-8402)
- **PA turnaround:** Routine 3 business days; urgent 1 business day; life-threatening 1 hour (plan's own figures)
- **Rates:** Not published — plan states it follows the TMHP fee schedule

## The code and modifier table, restated in detail

Cook Children's own training confirms the statewide code set with granular billing notes: 97151 (evaluation/re-evaluation) caps at 6 hours/24 units with a 30-day authorization window and takes the HO modifier only; 97153 and 97154 (direct and group treatment) take no required modifier (HO/HN/HM are informational); 97155, 97156, and 97158 require an HO or HN modifier; and 99366 (interdisciplinary team meetings) takes no modifier, is reimbursable only against an F84.0 autism diagnosis, is capped at twice per year, and requires at least three licensed professionals — one of them the LBA — meeting for a minimum of 30 minutes. Direct treatment caps at 8 hours/day combined across 97153, 97154, 97155, and 97158. Telehealth (modifier 95) is allowed for 97151, 97155, 97156, 97158, and 99366; the plan's materials specifically note LaBAs and RBTs may not deliver any service remotely. [1][2]

## Submitting through EpicCare Link

Cook Children's runs authorization through an EpicCare Link secure provider portal, and its determination letters are delivered only through the portal's In Basket — the plan states explicitly that PA determination letters will not be faxed. Fax submission (STAR/CHIP: 682-885-8402; STAR Kids: 682-303-0005 or 844-843-0005) is offered only for providers whose portal access is still pending. The plan uses the statewide-style CCP Prior Authorization Request Form with a dedicated ABA checkbox and section. One inconsistency to route around: the plan's own materials print at least three different variants of its PA-inquiry email address across different documents — call Provider Support Services at 1-888-243-3312 to confirm the current address rather than guessing from a specific PDF. [3][4]

## Intake gates

The questions that decide whether a family can start with Cook Children's Health Plan, and what they have to bring.

- **Age limit**: 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. [5][1]
- **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][1]
- **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][1]
- **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][1]
- **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][1][7]
- **Telehealth**: Cook Children's own ABA training restates the state rule: telehealth (modifier 95) is allowed for 97151, 97155, 97156, 97158 and 99366, and its materials specifically note that LaBAs and RBTs may not deliver any service remotely. [1][5]
- **Prior-auth decision time**: Cook Children's own table: "Routine — Within 3 business days after receiving the request / Urgent — Within 1 business day after receiving the request / Inpatient (Concurrent) — Within 1 business day … / Emergent/Life Threatening — Within 1 hour after receiving the request"; a request with no priority marked defaults to routine, and "Requests submitted that are not urgent in nature, but rather submitted as urgent based on the delay in Provider submission will be processed as routine." Incomplete requests are returned listing the missing elements; the plan "must receive the requested information within three business days from the date of the letter," after which it decides "based solely on the information that we have." Cook's ABA training restates the TMPPM windows: evaluation PA "within 60 days prior to or on the requested evaluation date"; initial treatment "within 3 business days of the start of care (SOC) date"; the 90-day request is timely "within 30 days prior to the end of the current authorization period"; and a 180-day recertification "must be received no earlier than 60 days before the current authorization period expires." Late requests are denied for dates before receipt. [8][2][1]
- **Other insurance (who pays first)**: "Medicaid is secondary when coordinating benefits with all other insurance coverage, unless an exception applies under federal law … Providers must submit claims to other health insurers for consideration prior to billing Cook Children's Health Plan"; if the plan knows of other coverage the provider did not bill, the claim denies. The secondary claim "Must be received by the health plan within ninety-five days of the disposition date on the primary insurance Explanation of Benefits (EOB)." Cook's materials do not say whether its ABA PA is still needed when it pays second — request it. [8][1][9]

## Delivery and billing rules

Coverage decides whether Cook Children's Health Plan 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][1][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][1]
- **Daily limits / MUEs**: Cook Children's training restates the state caps and adds code-level detail: direct treatment is capped at 8 hours/day combined across 97153, 97154, 97155 and 97158; 97151 caps at 6 hours / 24 units with a 30-day authorization window; and 99366 is reimbursable only against an F84.0 diagnosis, twice per year, requiring at least three licensed professionals (one the LBA) meeting for a minimum of 30 minutes. [1][5]
- **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][1]
- **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][1]
- **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. Cook Children's training spells the modifier rules out: 97151 takes the HO modifier only; 97155, 97156 and 97158 require HO or HN; 97153 and 97154 take no required modifier (HO/HN/HM are informational); 99366 takes no modifier. [1][5]

## What intake should collect for Cook Children's Health Plan

- **Service area check:** Six counties, not Tarrant alone: Wise, Denton, Parker, Tarrant, Hood, Johnson.
- **ASD dx + recency:** TMPPM baseline: qualified diagnoser, DSM severity, within 3 years.
- **Modifier discipline:** 97155/97156/97158 need HO or HN; 97151 takes HO only — align billing staff to the plan's table.
- **Portal access first:** Get EpicCare Link access set up before your first case — determination letters aren't faxed.

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

## Verification of benefits (VOB) data

How Cook Children's Health Plan ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 01077 — pVerify's payer-list page shows a single 01077 "Cook Children's Health Plan" entry (Eligibility: Yes), no CHIP/STAR split — confirmed via repeated matching queries, not an independent raw-HTML grep.
- **Payer ID (Availity):** CCHP1 (CHIP) / CCHP9 (STAR, STAR Kids) — Availity's own master list independently confirms both codes, matching Cook Children's own EDI page verbatim ("CHIP Payor ID is CCHP1 and STAR/STAR Kids Payor ID is CCHP9") — strong agreement between two independent sources.
- **Supports 270/271 eligibility:** Yes — Confirmed via Availity's master payer list; also rides the centralized TMHP 270/271 feed as every other MCO in this file.
- **Behavioral health administrator:** none — Cook Children's own 123-page ABA provider training and Acute PA training describe the plan's own EpicCare Link authorization pipeline throughout, with no external BH vendor named anywhere.
- **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:** Cook Children's own ABA training adds a detail not stated in the statewide TMPPM baseline: the evaluation authorization carries a 30-day window. Submit through the EpicCare Link secure provider portal (fax 682-885-8402 for STAR/CHIP, or 682-303-0005 / 844-843-0005 for STAR Kids, only while portal access is pending) — determination letters are delivered via the portal only, never faxed.
- **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. Cook Children's own training restates the statewide 99366 rule in more detail: F84.0-only reimbursement, capped twice per year, requiring at least 3 licensed professionals (one the LBA) meeting a minimum of 30 minutes.
- **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:** 1-888-243-3312 (Provider Relations — credentialing, contracting, demographics)
- **Phone menu path:** General Member Services: 1-800-964-2247 — determination letters are delivered via the EpicCare Link In Basket only, never faxed; fax is for submission while portal access is pending.
- **Hours:** Monday-Friday, 8:00 a.m.-5:00 p.m. (excluding state holidays)
- **Portal:** [Cook Children's EpicCare Link](https://www.cookchp.org/providers/prior-authorization-search/)
- **Fax:** 682-885-8402 (STAR/CHIP PA); 682-303-0005 or 844-843-0005 (STAR Kids PA, portal-access-pending only)

Questions to ask on a verification call:

- Confirm the correct Availity payer ID split — CCHP1 for CHIP vs. CCHP9 for STAR/STAR Kids — for 270/271 eligibility checks.
- Does Cook Children's Health Plan support real-time (vs. batch) 270/271 eligibility for these payer IDs?
- 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 beyond the F84.0-only, twice-per-year, 3-licensed-professional-minimum rule already confirmed in Cook Children's own ABA training?
- Does the 8-hour/day combined direct-treatment cap across 97153/97154/97155/97158 confirmed in Cook Children's own training match the statewide TMPPM cap exactly, or does the plan apply a stricter overlay?

### VOB data sources

- https://www.cookchp.org/siteassets/documents/pdfs/provider-relations/applied-behavior-analysis-011525-.pdf (accessed 2026-07-23)
- https://www.cookchp.org/siteassets/documents/pdfs/electronic-visit/acute-prior-authorization-including-pdn--aba-062426.pdf (accessed 2026-07-23)
- https://www.cookchp.org/providers/prior-authorization-search/ (accessed 2026-07-23)
- https://www.cookchp.org/siteassets/documents/pdfs/provider-manual/comprehensive-care-program-prior-authorization-request-form-2024.pdf (accessed 2026-07-23)
- https://pverify.com/payer-list/ (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23)
- https://www.cookchp.org/providers/electronic-submission-services/ (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.cookchp.org/join/contact-us/ (accessed 2026-07-23)

## Common questions

### Does Cook Children's Health Plan cover ABA?

Yes — the Texas Medicaid Autism Services benefit across STAR and STAR Kids in its six-county North Texas service area, on TMPPM criteria, with a dedicated 123-page ABA provider training restating the requirements in detail.

### Does STAR Kids have different ABA rules than STAR at Cook Children's?

We found no distinguishing STAR Kids ABA process in the plan's own materials — the ABA policy applies uniformly across Medicaid, CHIP, and STAR Kids.

### How do I submit an ABA PA to Cook Children's?

Through the EpicCare Link secure provider portal, using the Comprehensive Care Program PA form. Fax (682-885-8402 for STAR/CHIP) is available only while portal access is pending — determination letters are delivered via the portal only, not by fax.

## Primary sources

1. [Cook Children's Health Plan — Applied Behavior Analysis provider training (rev. 1/15/2025, PDF)](https://www.cookchp.org/siteassets/documents/pdfs/provider-relations/applied-behavior-analysis-011525-.pdf)
2. [Cook Children's Health Plan — Acute Prior Authorization (Including PDN & ABA) provider training (rev. 6/24/2026, PDF)](https://www.cookchp.org/siteassets/documents/pdfs/electronic-visit/acute-prior-authorization-including-pdn--aba-062426.pdf)
3. [Cook Children's Health Plan — Prior Authorization Search & Submission](https://www.cookchp.org/providers/prior-authorization-search/)
4. [Cook Children's Health Plan — Comprehensive Care Program Prior Authorization Request Form (PDF)](https://www.cookchp.org/siteassets/documents/pdfs/provider-manual/comprehensive-care-program-prior-authorization-request-form-2024.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. [Cook Children's Health Plan — STAR/CHIP/CHIP Perinatal Provider Manual (rev. 02/13/26) (PDF)](https://www.cookchp.org/siteassets/documents/pdfs/provider-manual/star-chip-chip-perinatal-provider-manual-021326.pdf)
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)

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.