---
title: Superior HealthPlan ABA coverage (Texas Medicaid MCO).
url: "https://carelu.com/payers/superior-healthplan-texas"
markdown_url: "https://carelu.com/payers/superior-healthplan-texas.md"
state: TX (Texas)
payer: Superior HealthPlan (TX)
kind: Medicaid managed care plan (MCO)
parent_program: Texas Medicaid (THSteps-CCP)
description: "How Superior HealthPlan (Centene) administers the Texas Medicaid ABA benefit — TMPPM criteria, PA on every ABA code, the statewide STAR Health foster-care line, and Superior's PA-list history."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Superior HealthPlan ABA coverage (Texas Medicaid MCO).

_Payer Guide · Superior HealthPlan · Last updated September 2026 · 6 primary sources_

> TMPPM criteria; PA on every ABA code; the only STAR Health (foster care) plan statewide.

Superior HealthPlan — Centene's Texas plan and one of the largest Medicaid footprints in the state — administers the THSteps-CCP Autism Services benefit on the TMPPM's criteria; its provider notices point straight at the state manual for diagnosis and clinical rules. Two things make Superior structurally important for ABA intake: its breadth (STAR and STAR Kids across multiple service areas including Bexar, El Paso, Hidalgo, Lubbock, Nueces, MRSA West, and Travis), and its exclusivity — Superior is the only STAR Health plan, so every Texas foster-care child, statewide, routes ABA through Superior.

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 — PA on all ABA services before delivery, including the 97151 evaluation [1]
- **Prior auth for treatment**: Required — 97153, 97154, 97155, 97156, 97158, 99366 all on Superior's PA list; TMPPM 90/90/180 cadence [1][4]
- **Autism diagnosis required?**: Yes — ASD per TMPPM criteria (Superior defers to the state manual) [2][4]

## At a glance

- **Plan type:** Texas Medicaid MCO (Centene) — STAR, STAR Kids, STAR Health, STAR+PLUS MBCC
- **Clinical rules:** TMPPM Autism Services criteria (state baseline, no distinct policy)
- **Prior auth:** Required on ALL ABA services before delivery, evaluation included
- **Foster care:** Sole STAR Health plan — all Texas foster-care ABA runs through Superior
- **Submission:** Superior provider portal / PA Requirements page (superiorhealthplan.com)
- **Rates:** Not published — contract-specific (generally tracks the HHSC fee schedule)

## How Superior runs the benefit

Superior announced the ABA benefit at its February 2022 launch with prior authorization required on every service code — 97151 for the evaluation, then 97153, 97154, 97155, 97156, 97158, and 99366 for treatment and team meetings — and its notices defer to the TMPPM for medical-necessity criteria, so the state's 3-year diagnosis recency, 90/90/180 cadence, and 8-hour daily cap all apply unchanged. Requests go through Superior's provider portal, with the plan's Prior Authorization Requirements page as the code-level reference. And the PA posture is stable: Superior's January 1, 2026 PA-removal list touched no ABA codes (the Medicaid removals were 36471, A6216, and A6218 only), so plan on full PA for the foreseeable future. [1][2][3]

## The STAR Health angle

If your practice serves children in foster care, Superior is unavoidable: STAR Health is administered by Superior alone, statewide. That makes Superior credentialing and PA fluency a de facto requirement for foster-care ABA anywhere in Texas — and it means intake should treat "foster care" as a routing answer, not just a demographic note. The clinical rules are the same TMPPM baseline; the population's documentation (medical consenters, caseworker involvement) is the added layer to plan for. [2]

## Intake gates

The questions that decide whether a family can start with Superior HealthPlan (TX), 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. [4][2]
- **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. [4][2]
- **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). [4][2]
- **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. [4][2]
- **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. [4][2][6]
- **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. [4][2]
- **Prior-auth decision time**: Superior "will respond to complete prior authorization requests within two Business Days for CHIP products, and within three Business Days for non-CHIP products" — three business days for STAR, STAR Kids and STAR Health, the same as the Texas statutory limit for nonhospitalized members (Tex. Gov't Code § 540.0303). "Urgent requests for services to be rendered within 72 hours may be submitted with reason for urgency indicated" and are decided within 72 hours. The clock runs on a complete request: an incomplete one is returned by fax listing what is missing, and "If the documentation/information is not provided within three Business Days from Superior's provider notification … the request may result in an adverse benefit determination." Lead time: "It is recommended that requests be submitted five Business Days prior to the desired start date." The manual lists ABA evaluation, treatment and "subsequent re-certifications" as PA-required but sets no ABA-specific recertification lead time. [7][8][9]
- **Other insurance (who pays first)**: "Federal and state law require Medicaid (STAR/STAR+PLUS/STAR Kids/CHIP) be the payer of last resort." If the child has other insurance, "you must submit your claim to the primary insurance for consideration," then file with Superior attaching "a copy of the EOB, EOP or rejection letter from the other insurance" — without it the claim pends or denies. On authorization Superior is unusually specific: "An authorization is not required if an authorization from the primary insurance carrier indicating approval is received," but "If the other insurance carrier has denied and Superior is being asked to pay as primary for a service that requires an authorization, the provider will be required to request authorization prior to payment with Superior as primary" — so if the commercial plan may deny ABA, get Superior's PA in place before starting. STAR Health (foster care): "Superior does not actively pursue Coordination of Benefits (COB) for STAR Health members." [7][10]

## Delivery and billing rules

Coverage decides whether Superior HealthPlan (TX) 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. [4][2][5]
- **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. [4][2]
- **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. [4][2]
- **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. [4][2]
- **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. [4][2]
- **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. [4][2]

## What intake should collect for Superior HealthPlan (TX)

- **Program line:** STAR vs. STAR Kids vs. STAR Health — foster-care children are always Superior (STAR Health).
- **ASD dx + recency:** TMPPM rules apply: qualified diagnoser, DSM criteria + severity, within 3 years.
- **Prescriber referral:** Signed referral for the evaluation PA, per the state baseline.
- **PA on file before service:** Superior requires PA on every ABA code before delivery — no assessment-first shortcut.

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

## Verification of benefits (VOB) data

How Superior HealthPlan (TX) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00393
- **Payer ID (Availity):** 39188 — Availity's list also carries several Centene-corporate entries (SHP11/FSHP11/DSHP11 "SUPERIOR HEALTH/CENTENE CORP") alongside the clean-name match used here (39188, "Superior Health Plan of Texas") — confirm 39188 is correct for professional (837P) 270/271 eligibility specifically, not just claims.
- **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:** Submit via Superior's provider portal; verify code-level PA status on Superior's Prior Authorization Requirements page (superiorhealthplan.com) — Superior's 1/1/2026 PA-removal list did not touch any ABA codes.
- **97152:** 97152 does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.
- **97153:** Either 97153 or 97155 may be billed for direct individual treatment hours — bill the code matching who delivered the session.
- **97154:** Either 97154 or 97158 may be billed for direct group treatment hours.
- **97155:** Also the code used to bill the required progress summary submitted after the first 90 days of treatment. Only DIRECT supervision (LBA observing the LaBA/BT with the client) is reimbursable under this code — indirect supervision (caseload review, data discussion) is not billable.
- **97156:** Continued treatment authorization considers caregiver attendance at ≥85% of planned sessions.
- **97157:** 97157 does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.
- **99366:** School-district personnel may participate and count toward the 3-participant licensed-professional minimum but are not separately reimbursable.
- **0362T:** 0362T does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.
- **0373T:** 0373T does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.

### Contacts

- **Provider services phone:** 1-877-391-5921
- **Phone menu path:** One line covers CHIP, STAR, STAR Health, STAR Kids, and STAR+PLUS — no separate ABA/BH prompt found.
- **Hours:** 8 a.m.–5 p.m. Central Time, Monday–Friday (STAR Health extends to 6 p.m. CT)
- **Portal:** [Superior HealthPlan Secure Provider Portal](https://www.superiorhealthplan.com/providers/login.html)

Questions to ask on a verification call:

- Does Superior support real-time (vs. batch) 270/271 eligibility responses for payer ID 00393?
- Confirm 39188 is the correct Availity payer ID for Superior's professional 270/271 eligibility specifically, distinct from the Centene-corporate entities (SHP11/FSHP11/DSHP11) also on the list.
- Is the ABA copay or coinsurance charged per visit or per day, and does the plan's out-of-pocket maximum apply to ABA services?
- Are CPT codes 97152, 97157, 0362T, and 0373T billable under Superior's Autism Services benefit?
- Is there a daily/weekly unit cap for 97156 (parent/caregiver training) or 99366 (team meeting)?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23)
- https://www.superiorhealthplan.com/newsroom/effective-0201222-new-medicaid-benefit-for-aba-services-prior-auth-required.html (accessed 2026-07-23)
- https://www.tmhp.com/news/2021-07-30-hhsc-release-autism-services-benefits-effective-february-1-2022 (accessed 2026-07-23)
- https://www.tmhp.com/sites/default/files/file-library/edi/D00026_270_271_Medicaid_CHIP_Eligibility_Companion_Guide.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/TMPPM/2_04_Childrens_Services/2_04_Childrens_Services.htm (accessed 2026-07-23)
- https://public.tmhp.com/FeeSchedules/StaticFeeSchedule/FeeSchedules.aspx?fn=%5C%5Ctmhp.net%5CFeeSchedule%5CPROD%5CStatic%5CTexas_Medicaid_Fee_Schedule_PRCR615C.pdf (accessed 2026-07-23)
- https://www.superiorhealthplan.com/contact-us/phone-directory.html (accessed 2026-07-23)

## Common questions

### Does Superior HealthPlan cover ABA?

Yes — the Texas Medicaid Autism Services benefit on TMPPM criteria, with prior authorization required on every ABA code, evaluation included, through Superior's provider portal.

### Is Superior's ABA policy different from the state's?

No — Superior explicitly points providers to the TMPPM for diagnosis and clinical criteria and mirrors the state PA code list. What's Superior-specific is the portal, the PA-list mechanics, and the STAR Health foster-care line.

### Why does foster care always mean Superior?

STAR Health, the Texas Medicaid program for children in foster care, is administered statewide by Superior alone — every foster-care ABA case routes through it.

## Primary sources

1. [Superior — New Medicaid Benefit for ABA Services, PA Required (eff. 2/1/2022)](https://www.superiorhealthplan.com/newsroom/effective-0201222-new-medicaid-benefit-for-aba-services-prior-auth-required.html)
2. [Superior — Medicaid ABA Services for Children and Youth With Autism (2/24/2023)](https://www.superiorhealthplan.com/newsroom/medicaid-aba-services-02242023.html)
3. [Superior — Removal of PA Requirement for Certain Procedures (eff. 1/1/2026)](https://www.superiorhealthplan.com/newsroom/eff-01012026-removal-of-pa-req-for-certain-procedures-12012025.html)
4. [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)
5. [BACB RBT Handbook (updated 06/2026)](https://www.bacb.com/rbt-handbook)
6. [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)
7. [Superior HealthPlan — Provider Manual (STAR, CHIP, STAR+PLUS, STAR Kids, STAR Health), Rev. 09/01/2026 (PDF)](https://www.superiorhealthplan.com/content/dam/centene/Superior/Provider/PDFs/medicaid-provider-manual.pdf)
8. [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)
9. [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)
10. [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.