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Texas Medicaid ABA desk card (2026)

The Texas Medicaid ABA rules your team checks most often, on one page. Every row names its source so you can check it yourself.

Checked November 2, 2026 · Billing4ABA · Billing built only for ABA.

Print it and pin it above the desk. Managed care plans set their own rules, so keep each plan's manual close too.

Who is covered and who enrolls

Benefit
ABA is covered for dates of service on or after Feb 1, 2022, under THSteps-CCP. [1]
Members
Age 20 and under, with an autism diagnosis from a comprehensive evaluation, made or reconfirmed within 3 years. [1]
Who enrolls
Only the Licensed Behavior Analyst (LBA). The LBA's individual NPI is both rendering and billing provider. Groups do not enroll. [2][3]
Who works under the LBA
LaBAs and behavior technicians (RBT, BCAT or ABAT certified) cannot enroll and work under LBA supervision. [2][3]

Codes and modifiers

97151 · Evaluation
LBA only. HO modifier required. Up to 24 units. [1][4]
97153 · Treatment by protocol
HO, HN or HM modifier may be added. [1]
97154 · Group treatment by protocol
HO, HN or HM modifier may be added. [1]
97155 · Treatment with protocol modification
HO or HN modifier required. [1]
97156 · Caregiver training
HO or HN modifier required. [1]
97158 · Group treatment with protocol modification
HO or HN modifier required. [1]
99366 · Team meeting
Maximum of 2 per rolling year. [1]

Telehealth

Allowed codes
Only 97151, 97155, 97156, 97158 and 99366, delivered as synchronous audio-video. Modifier 95 required. [1]
In person only
LaBA and technician services are delivered in person. [1]

Prior authorization timing

Required for
All ABA services. [4][1]
Request deadline
Within 3 business days of the start-of-care date. [4][1]
Initial treatment
Up to 90 days. [4][1]
Extension
One 90-day extension, requested within the 30 days before the period ends. Since Apr 1, 2025, no prescriber signature needed. [4][1]
Recertification
180-day periods, requested no earlier than 60 days before expiry. [4][1]

Units and daily limit

Unit
One unit = 15 minutes. [1]
Daily cap
Direct treatment (97153, 97154, 97155 and 97158 combined) is capped at 8 hours a day unless medical necessity supports more. [1]

Filing, appeals and plans

Timely filing (fee-for-service)
95 days from the date of service. [5]
Appeals (fee-for-service)
Within 120 days. [5]
Managed care plans
MCOs set their own rules, including prior authorization and filing limits. Check each plan's manual. [5][6]
Watch for 2027
CMS's proposed 2027 Medicare fee schedule lists six new adaptive behavior codes; 97151–97158 remain. TMHP adoption not announced. [7]

Sources

  1. [1]TMPPM Children's Services Handbook, §2.3 (TMHP)
  2. [2]TMHP: Licensed behavior analyst enrollment (PDF)
  3. [3]1 TAC §354.5011
  4. [4]TMHP news, Feb 2025: prior authorization update for autism services (effective Apr 1, 2025)
  5. [5]1 TAC §354.1003 (timely filing)
  6. [6]CASP / txABA webinar on Texas Medicaid ABA (2022). Check each plan's current instructions.
  7. [7]ABA Coding Coalition: CMS announces 2027 new and revised CPT codes

Checked November 2, 2026. Payer rules change; confirm with TMHP and the member's plan.

Billing4ABA is a billing service, not legal counsel. Payer rules change; confirm with the payer before acting.

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