---
title: "Dell Children's Health Plan ABA coverage (Texas Medicaid MCO)."
url: "https://carelu.com/payers/dell-childrens-health-plan"
markdown_url: "https://carelu.com/payers/dell-childrens-health-plan.md"
state: TX (Texas)
payer: "Dell Children's Health Plan"
kind: Medicaid managed care plan (MCO)
parent_program: Texas Medicaid (THSteps-CCP)
description: "How Dell Children's Health Plan — the Ascension Seton-affiliated STAR/CHIP plan for the Travis service area — covers ABA: Magellan Healthcare's behavioral-health delegation, the plan's own PA list, and the GoManda autism-app member benefit."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

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

_Payer Guide · Dell Children's Health Plan · Last updated September 2026 · 9 primary sources_

> Established pediatric plan (STAR since 2012), Travis SDA (8 counties); ABA delegated to Magellan BH.

Dell Children's Health Plan is not a new entrant — it has administered CHIP in Central Texas since 2000 and was selected to run STAR and CHIP Perinatal in the Travis service area starting March 1, 2012, and it currently serves 40,000+ members across 8 counties. The plan is affiliated with Dell Children's Medical Center and Ascension Seton (its provider manual and staff correspondence run through @seton.org and @ascension.org addresses), giving it a pediatric-hospital-system orientation. For ABA specifically, the plan delegates behavioral-health prior authorization to Magellan Healthcare rather than administering it in-house, and it publishes its own current PA code list confirming ABA as a covered STAR benefit.

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 on the plan's Medicaid/CHIP PA list (Yes); route through Magellan Healthcare for BH prior auth [3]
- **Prior auth for treatment**: Required — 97153, 97154, 97155, 97156, 97158, 99366 all PA=Yes on the 6/1/2026 PA list; 97157 also listed PA=Yes (see note below) [3]
- **Autism diagnosis required?**: Yes — ASD diagnostic testing by a developmental pediatrician, neurologist, psychiatrist, licensed psychologist, or autism diagnosis team [2]

## At a glance

- **Plan history:** CHIP administrator since 2000; STAR + CHIP Perinatal in Travis SDA since 3/1/2012 — an established plan, not new
- **Service area:** Travis SDA — Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, Williamson counties
- **Affiliation:** Dell Children's Medical Center / Ascension Seton
- **ABA covered?:** Yes — explicitly listed for STAR; CHIP-specific coverage of ABA is not explicitly confirmed (see below)
- **BH administration:** Delegated to Magellan Healthcare — phone 1-800-424-1764
- **Prior auth:** Required — 97151, 97153–97156, 97158, 99366 (and 97157 — see note) all PA-required
- **Value-added benefit:** GoManda learning app (ages 2–8, autism/speech delay), free 1-year subscription with referral

## An established pediatric plan, not a startup

Dell Children's Health Plan's own provider manual states it plainly: "Dell Children's Health Plan has been an administrator of CHIP since 2000 and was selected to administer the CHIP Perinatal and STAR programs in Central Texas beginning March 1, 2012." It currently publishes actively-maintained documents dated into 2026 (a Prior Authorization list effective 6/1/2026, provider directories dated 3/2026), and independent reporting describes it as serving 40,000+ lives across 8 counties. The plan's email domains (@seton.org, @ascension.org) and homepage both tie it to the Seton/Ascension health system that also runs Dell Children's Medical Center — though we could not locate a single primary-source document stating the exact legal entity structure (e.g., a specific "Seton Health Plan d/b/a" formulation), so treat the precise corporate relationship as indicative rather than a verbatim-confirmed fact. [1]

## ABA coverage and prior authorization

The plan's STAR Member Handbook and provider manual both explicitly list "Applied Behavior Analysis (ABA) therapy" as a covered STAR behavioral-health service, and the member-facing behavioral-health page states ABA "is now a benefit for STAR members as a covered benefit through Texas Medicaid," requiring prior ASD diagnostic testing "by a developmental pediatrician, a neurologist, a psychiatrist, a licensed psychologist, or an autism diagnosis team." The plan's Prior Authorization List (effective 6/1/2026) confirms PA is required (marked "Yes") for 97151, 97153, 97154, 97155, 97156, 97158, and 99366, each cross-referenced to the TMPPM Children's Services Handbook. One discrepancy worth flagging rather than silently resolving: the same PA list also shows code 97157 with PA=Yes, even though 97157 is confirmed absent from Texas Medicaid's actual THSteps-CCP Autism Services billable code set per TMHP's own fee schedule and handbook — treat 97157's status with this plan as needing direct confirmation. Separately, the provider manual's STAR-covered-services list explicitly names ABA, but the CHIP-specific covered-behavioral-health-services bullet list in the same manual does not repeat ABA by name (it lists inpatient/outpatient mental health and substance-use-disorder services only) — this is genuinely ambiguous in the plan's own document, so confirm ABA coverage for standard CHIP (non-STAR, non-Perinatal) members directly with the plan rather than assuming either way. [1][2][3]

## Behavioral health rides on Magellan

Unlike some Texas MCOs that handle BH in-house, Dell Children's Health Plan delegates behavioral-health services — including ABA-related prior authorization and referrals — to Magellan Healthcare. The member-facing behavioral-health page tells families to "self-refer directly by calling Magellan toll-free at 1-800-424-1764," and the provider manual lists dedicated Magellan-branded forms (Behavioral Health Prior Auth Form, Initial Review Form, Concurrent Review Form, Discharge Assistance, Provider Search) accessed through the Magellan member/provider portal. The dedicated BH PA fax is (866) 354-8758, distinct from the plan's general medical PA fax (844-981-3329). General Provider Services runs at 1-844-781-2343; the plan's provider portal for eligibility, PA status, and claims is the HealthX Provider Portal. [2][1][4]

## A pediatric-specific extra: the GoManda benefit

Dell Children's Health Plan lists a value-added benefit directly relevant to autism families: the GoManda learning app, free for one year to CHIP/STAR members ages 2 to 8 with autism or speech delay, available with a referral. It's not a substitute for ABA, but it's worth mentioning at intake as a no-cost supplement families may not know they have access to. No dedicated autism specialty clinic or autism-specific clinical program beyond the standard ABA benefit and GoManda was found in the plan's published materials. No plan-specific ABA fee schedule is published — the PA list's references point back to the TMPPM/TMHP baseline already covered in our Texas Medicaid guide. [5]

## Intake gates

The questions that decide whether a family can start with Dell 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. [9][3]
- **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. [9][3]
- **Who may diagnose**: The plan states it on its own member-facing behavioral-health page: ABA requires prior ASD diagnostic testing by a developmental pediatrician, a neurologist, a psychiatrist, a licensed psychologist, or an autism diagnosis team — the same set the TMPPM names. [2][9]
- **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. [9][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. [9][3][8]
- **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. [9][3]
- **Prior-auth decision time**: Dell Children's timeliness standards: "Non-urgent pre-service: … a decision will be made within three business days. Urgent pre-service: … within one business day but not later than 72 hours or three calendar days"; urgent concurrent within 24 hours; standard timeframes may be extended when information is insufficient. Incomplete requests are not approved; the reviewer asks for the missing documentation, and "If no additional information is received within the designated time frame, the … medical director will make a determination based on the information previously received." The September 2025 manual sets no submission or reauthorization lead time and nothing ABA-specific. [10][11][12]
- **Other insurance (who pays first)**: "Federal and state laws require Medicaid, including the STAR program, be the payer of last resort … Providers must submit claims to other health insurers for consideration prior to billing us. A copy of the other health insurer's EOB/EOP or rejection letter should be submitted with the claim." Deadline: "submit clean claims within 95 calendar days of receiving a response from the third-party payer." The manual does not say whether Dell Children's ABA PA is still needed when it pays second — request it. [10][13]

## Delivery and billing rules

Coverage decides whether Dell 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. [9][3][7]
- **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. [9][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. [9][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. [9][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. [9][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. Behavioral health, including ABA prior authorization, is delegated to Magellan Healthcare (1-800-424-1764) rather than administered by the plan, so authorizations use Magellan's forms and portal even though the claim still follows the state's enrolled-LBA structure. [2][9]

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

- **STAR vs. CHIP vs. CHIP Perinatal:** ABA is explicitly covered for STAR; CHIP-specific ABA coverage isn't explicitly confirmed in the plan's own materials — verify for CHIP-only members.
- **ASD diagnostic report + diagnosing provider credentials:** The plan names specific qualifying diagnosers (developmental pediatrician, neurologist, psychiatrist, licensed psychologist, or autism diagnosis team).
- **Route through Magellan for BH:** Behavioral health — including ABA — is delegated to Magellan Healthcare, not handled by the plan directly; use Magellan's forms and portal.
- **County of residence:** Confirm coverage in the Travis SDA's 8 counties (Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, Williamson).
- **GoManda eligibility:** Ages 2–8 with autism or speech delay qualify for a free 1-year subscription with referral — flag for families as a no-cost extra.

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

## Verification of benefits (VOB) data

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

### EDI routing

- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Magellan Healthcare
- **ABA rides on:** behavioral health benefit
- **Two-hop verification required:** Yes — Inferred true because ABA prior authorization demonstrably requires contacting Magellan separately from the plan's general medical PA channel — but whether the 270/271 ELIGIBILITY check itself requires a second EDI hop to Magellan (vs. only the PA/UM step) was not independently confirmed.

### 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 | Yes, per Dell Children's own PA list (eff. 6/1/2026, PA=Yes) — contradicts the "not on Texas's billable ABA code set" finding shipped for 97157 elsewhere in this file (texas-medicaid and the other Medicaid MCO guides); the plan's own list gives no code-level detail beyond a PA=Yes/No flag, so treat as a confirmed Dell-specific discrepancy needing direct confirmation, not a resolved fact either way. | Required, per Dell Children's PA list (eff. 6/1/2026) — flagged PA=Yes for 97157 with no further code-level detail given. | — | — | — | — |
| 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:** Dell Children's own PA list (eff. 6/1/2026) confirms 97151 PA=Yes, matching the TMPPM baseline. Behavioral health (ABA included) is delegated to Magellan Healthcare, not administered in-house — route PA through Magellan's own form/portal, not the plan's general medical channel.
- **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:** DISCREPANCY: Dell Children's own PA list (eff. 6/1/2026) shows 97157 as PA=Yes, even though 97157 is confirmed absent from Texas Medicaid's actual THSteps-CCP Autism Services billable code set per TMHP's own fee schedule and handbook (independently confirmed this pass). Verify directly with Dell Children's/Magellan before assuming this applies to any other Texas Medicaid plan.
- **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:** 1-844-781-2343 (General Provider/Customer Services) or 1-800-424-1764 (Magellan Behavioral Health — 24/7)
- **Hours:** General Provider Services: Mon-Fri 8am-5pm CT. Magellan BH hotline: 24/7.
- **Portal:** [HealthX Provider Portal (medical) / magellanhealth.com (behavioral health)](https://dellchildrenshealthplan.com/for-providers/manuals-forms/)
- **Fax:** (866) 354-8758 (Magellan BH PA); 844-981-3329 (general medical PA)

Questions to ask on a verification call:

- Confirm ABA prior authorization routes through Magellan Healthcare (1-800-424-1764 / magellanhealth.com) and not the plan's general medical PA channel — use the Magellan-branded BH Prior Auth Form.
- PA list shows 97157 as PA=Yes even though it is absent from the statewide THSteps-CCP Autism Services code set — is 97157 actually billable under this plan's ABA benefit?
- Is ABA an explicitly covered benefit for standard CHIP (non-STAR, non-Perinatal) members, or only for STAR members as the provider manual's STAR-specific list states?
- What EDI payer ID should be used for this member's 270/271 eligibility check, given the plan's stated use of Change Healthcare as its EDI Gateway?
- Is the ABA copay or coinsurance charged per visit or per day, and does the plan's out-of-pocket maximum apply?

### VOB data sources

- https://dellchildrenshealthplan.com/wp-content/uploads/2024/11/Provider-Manual-102024_web.pdf (accessed 2026-07-23)
- https://dellchildrenshealthplan.com/manage-your-health/behavioral-health/ (accessed 2026-07-23)
- https://www.magellanprovider.com/news-publications/state-plan-eap-specific-information/texas.aspx (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.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://dellchildrenshealthplan.com/wp-content/uploads/2026/04/Dell-Childrens-Prior-Authorization-List-Final-Effective-6_1_2026.xlsx-DCHP-PA-List-2.pdf (accessed 2026-07-23)
- https://dellchildrenshealthplan.com/for-providers/manuals-forms/ (accessed 2026-07-23)

## Common questions

### Is Dell Children's Health Plan a new Texas Medicaid plan?

No — despite sometimes being described as newly launched, the plan's own provider manual confirms it has administered CHIP since 2000 and STAR/CHIP Perinatal in the Travis service area since March 1, 2012.

### Does Dell Children's Health Plan cover ABA therapy?

Yes for STAR members — explicitly listed as a covered behavioral-health benefit, with prior authorization required on assessment and treatment codes. CHIP-specific (non-STAR) coverage of ABA is not explicitly confirmed in the plan's own materials — verify directly for CHIP-only members.

### Who handles ABA prior authorization at Dell Children's Health Plan?

Magellan Healthcare, under delegation — call 1-800-424-1764 or use the Magellan provider portal, not the plan's general medical PA line.

### What areas does Dell Children's Health Plan cover?

The Travis service delivery area: Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, and Williamson counties.

## Primary sources

1. [Dell Children's Health Plan — STAR Medicaid and CHIP Provider Manual (Oct 2024)](https://dellchildrenshealthplan.com/wp-content/uploads/2024/11/Provider-Manual-102024_web.pdf)
2. [Dell Children's Health Plan — Behavioral Health (member page)](https://dellchildrenshealthplan.com/manage-your-health/behavioral-health/)
3. [Dell Children's Health Plan — STAR/CHIP Prior Authorization List (eff. 6/1/2026)](https://dellchildrenshealthplan.com/wp-content/uploads/2026/04/Dell-Childrens-Prior-Authorization-List-Final-Effective-6_1_2026.xlsx-DCHP-PA-List-2.pdf)
4. [Dell Children's Health Plan — Manuals & Forms](https://dellchildrenshealthplan.com/for-providers/manuals-forms/)
5. [Dell Children's Health Plan — Value-Added Services](https://dellchildrenshealthplan.com/for-members/value-added-services/)
6. [Dell Children's Health Plan — STAR Member Handbook (May 2023)](https://dellchildrenshealthplan.com/wp-content/uploads/2023/05/STAR-Handbook-ENG-052023_web.pdf)
7. [BACB RBT Handbook (updated 06/2026)](https://www.bacb.com/rbt-handbook)
8. [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)
9. [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)
10. [Dell Children's Health Plan — Provider Manual, CHIP and STAR (September 2025) (PDF)](https://dellchildrenshealthplan.com/wp-content/uploads/2025/09/FY26-Provider-Manual-1.pdf)
11. [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)
12. [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)
13. [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.