---
title: Molina Healthcare of Texas ABA coverage (Texas Medicaid MCO).
url: "https://carelu.com/payers/molina-healthcare-texas"
markdown_url: "https://carelu.com/payers/molina-healthcare-texas.md"
state: TX (Texas)
payer: Molina Healthcare of Texas
kind: Medicaid managed care plan (MCO)
parent_program: Texas Medicaid (THSteps-CCP)
description: "How Molina Healthcare of Texas fits the state Medicaid ABA benefit — the TMPPM baseline, where ABA volume actually sits in Molina's book (STAR, not the ex-Cigna STAR+PLUS), and which PA specifics to pull manually from Molina's code matrix."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Molina Healthcare of Texas ABA coverage (Texas Medicaid MCO).

_Payer Guide · Molina Healthcare (TX) · Last updated September 2026 · 4 primary sources_

> TMPPM baseline; verify codes in Molina's PA Code Matrix — its PA guide PDFs sit behind bot walls.

Molina Healthcare of Texas runs STAR, STAR+PLUS, and CHIP — with a book that includes the Cigna Texas Medicaid (STAR+PLUS) membership Molina acquired in 2021. For ABA purposes, keep the programs straight: STAR+PLUS is the adult program, so pediatric ABA volume rides on Molina STAR. Like every Texas MCO, Molina delivers the statewide Autism Services benefit on TMPPM criteria; we found no evidence of distinct Molina ABA criteria. The caveat shaping this guide: Molina's Texas PA guide PDFs are served behind bot protection, so plan-specific PA details below are flagged for manual confirmation rather than asserted.

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: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide — both bot-protected on molinahealthcare.com. The TMPPM rule this value restates is itself verified; what is unverified is that Molina applies it unchanged. Human retrieval via carelu.com/sources. [1]
- **Prior auth for treatment:** Not published / unverified. Verify via: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide — both bot-protected on molinahealthcare.com. The TMPPM rule this value restates is itself verified; what is unverified is that Molina applies it unchanged. Human retrieval via carelu.com/sources. [1]

## At a glance

- **Plan type:** Texas Medicaid MCO — STAR, STAR+PLUS, CHIP
- **Clinical rules:** TMPPM Autism Services criteria (no distinct Molina ABA policy found)
- **Prior auth:** Required on evaluation and treatment, per the state benefit
- **Code-level lookup:** Molina BH & Medical PA Code Matrix / Look-Up Tool — pull it manually
- **Out-of-network:** All OON requests require authorization regardless of service
- **Rates:** Not published — contract-specific

## The state baseline is the rulebook

Molina members get the same benefit as everyone else in Texas Medicaid: PA on the 97151 evaluation with signed prescriber referral and a 3-year-recent ASD diagnosis, the 90/90/180 treatment cadence (no prescriber signature on the 90-day extension since April 2025), the 8-hour daily cap, credential modifiers, and the in-person requirement for BT/LaBA-delivered direct treatment. Build the clinical package to the TMPPM and it travels to Molina intact. One Molina-specific rule surfaced in its PA guidance: out-of-network requests require authorization regardless of the service — relevant while credentialing is in flight. [1][2]

## What to pull manually

Molina directs providers to its Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool for code-level PA handling, and its current-year "MHT Prior Authorization Guide" PDF is the document of record — but those files sit behind bot protection, so we could not verify their ABA specifics for this guide. Before your first Molina submission: download the current PA guide from molinahealthcare.com manually, run the ABA codes (97151–97158, 99366) through the look-up tool, and confirm the submission channel (Molina plans typically use Availity or the Molina Provider Portal, but confirm for Texas ABA specifically). Note also which program the child is on: a family that says "Molina" after the Cigna transition may be a STAR+PLUS adult — not an ABA case profile. [3][2]

## Intake gates

The questions that decide whether a family can start with Molina Healthcare of Texas, and what they have to bring.

- **Prior-auth decision time**: Molina's 2026 manual: "For a standard authorization request, Molina makes the determination and provides notification within three (3) calendar days for CHIP and three (3) business days for Medicaid"; non-urgent pre-service decisions for STAR run "Within 3 business days after receipt of request." Expedited: "as promptly as the member's health requires and no later than seventy-two (72) hours after we receive the initial request," and "Supporting documentation is required to justify the expedited request" — the PA guide adds that requests outside the urgent definition "will be handled as routine or non-urgent." A request to extend an ongoing course of ambulatory treatment counts as concurrent review, decided "Within 24 clock hours of receipt of request" when urgent. ABA is on Molina's PA list; the manual sets no ABA reauthorization lead time and no incomplete-request timeline of its own, so the state process applies (1 TAC § 353.425). [5][3][6][7]
- **Other insurance (who pays first)**: "Medicaid is the payer of last resort. Private and governmental carriers must be billed prior to billing Molina." After the other coverage pays or denies, submit to Molina with the primary's remittance advice — "A copy of the remittance advice from the primary payer must accompany the claim or the claim will be denied" — "within 95 calendar days after final determination by the primary payer." If the primary paid more than Molina's contracted allowable, the claim is paid in full at zero. The manual does not say whether Molina's own ABA PA is still needed when Molina pays second — request it. [5][8]

## Delivery and billing rules

Coverage decides whether Molina Healthcare 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: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com. [1][2]

## What intake should collect for Molina Healthcare of Texas

- **Program line:** STAR (pediatric ABA) vs. STAR+PLUS (adult) vs. CHIP (excluded) — the answer routes everything.
- **ASD dx + recency:** State baseline: qualified diagnoser, DSM severity, within 3 years.
- **Network status:** Out-of-network requests always need authorization at Molina — check credentialing before quoting timelines.
- **Current PA guide on file:** Pull the MHT Prior Authorization Guide manually each year — it's the code-level source of truth.

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

## Verification of benefits (VOB) data

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

### EDI routing

- **Payer ID (pVerify):** 00152
- **Payer ID (Availity):** 20554
- **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:** Molina directs providers to its Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool for code-level PA handling — its PA guide PDFs sit behind bot protection and were not independently verified this pass.
- **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:** (855) 322-4080
- **Phone menu path:** After-hours Nurse Advice Line: (888) 275-8750.
- **Hours:** Monday–Friday, 8 a.m.–5 p.m. local time
- **Portal:** [Availity Essentials (Molina Healthcare)](https://www.availity.com/molinahealthcare)

Questions to ask on a verification call:

- Does Molina support real-time (vs. batch) 270/271 eligibility for payer ID 00152?
- 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 Molina's Autism Services benefit?
- Is there a daily/weekly unit cap for 97156 (parent/caregiver training) or 99366 (team meeting)?
- Where can we find Molina's code-level PA requirements (Behavioral Health and Medical Prior Authorization Code Matrix), and are 97151–97158 all subject to the standard TMPPM rules or does Molina apply its own overlay?

### 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.molinahealthcare.com/providers/tx/medicaid/forms/PA.aspx (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.molinahealthcare.com/providers/tx/medicaid/resource/services.aspx (accessed 2026-07-23)

## Common questions

### Does Molina Healthcare of Texas cover ABA?

Yes — the statewide THSteps-CCP Autism Services benefit on TMPPM criteria, with PA on evaluation and treatment. Pediatric ABA members sit on Molina STAR; STAR+PLUS is the adult program and CHIP is excluded.

### Does Molina have its own Texas ABA criteria?

We found no evidence of distinct criteria — Texas MCOs must apply the TMPPM. Plan clinically to the state baseline, and confirm code-level PA handling in Molina's PA Code Matrix / Look-Up Tool since its PA guide PDFs are not reliably accessible online.

### What happened to Cigna's Texas Medicaid members?

Molina acquired Cigna's Texas Medicaid (STAR+PLUS) business in 2021 — those are adult-program members. A "Cigna Medicaid" mention in Texas today means Molina.

## 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. [Molina Healthcare of Texas — Prior Authorizations page (access-restricted)](https://www.molinahealthcare.com/providers/tx/medicaid/forms/PA.aspx)
3. [Molina TX — Medicaid/CHIP Prior Authorization Guide (access-restricted)](https://www.molinamarketplace.com/-/media/Molina/PublicWebsite/PDF/Providers/tx/medicaid/forms/MHT-Prior-Authorization-Guide-2025_R.ashx)
4. [BACB RBT Handbook (updated 06/2026)](https://www.bacb.com/rbt-handbook)
5. [Molina Healthcare of Texas — Provider Manual, STAR/STAR+PLUS/CHIP 2026 (last updated 04/2026) (PDF)](https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/tx/medicaid/manual/MHTX-Medicaid-CHIP-Provider-Manual-508.ashx)
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. [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.