---
title: Aetna Better Health of Texas ABA coverage (Texas Medicaid MCO).
url: "https://carelu.com/payers/aetna-better-health-texas"
markdown_url: "https://carelu.com/payers/aetna-better-health-texas.md"
state: TX (Texas)
payer: Aetna Better Health of Texas
kind: Medicaid managed care plan (MCO)
parent_program: Texas Medicaid (THSteps-CCP)
description: "How Aetna Better Health of Texas fits the state Medicaid ABA benefit — the TMPPM baseline that governs it, its Bexar and Tarrant service areas, and which plan-specific details you'll need to confirm directly because they aren't publicly verifiable."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# Aetna Better Health of Texas ABA coverage (Texas Medicaid MCO).

_Payer Guide · Aetna Better Health (TX) · Last updated October 2026 · 9 primary sources_

> TMPPM state baseline in Bexar & Tarrant; plan-specific PA mechanics not publicly verifiable.

Aetna Better Health of Texas serves STAR, STAR Kids, and CHIP in the Bexar and Tarrant service areas — putting it alongside UnitedHealthcare in the DFW/Tarrant STAR Kids market. Like every Texas MCO, it delivers the statewide THSteps-CCP Autism Services benefit and must apply the TMPPM medical-necessity criteria. An honesty note that shapes this guide: Aetna Better Health's Texas provider manual and PA pages block automated retrieval, and we found no distinct TX ABA clinical policy in public sources — so this page gives you the state baseline that verifiably governs, and flags exactly which plan-level mechanics to confirm with the plan before your first submission.

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 — the statewide TMPPM benefit puts PA on all ABA services, the 97151 evaluation included (24 units, 30-day window); Aetna Better Health of Texas’s 2025–2026 manual adds no ABA rule of its own [3][5]
- **Prior auth for treatment**: Required — state 90/90/180 cadence; the plan’s manual routes PA on the Texas Universal Authorization Form by fax (1-866-835-9589) and publishes its PA code list in an online tool [3][5]
- **Autism diagnosis required?**: Yes — ASD per the statewide TMPPM criteria; the plan’s manual adds none of its own [3][5]

## At a glance

- **Plan type:** Texas Medicaid MCO (CVS/Aetna) — STAR, STAR Kids, CHIP (Bexar & Tarrant SDAs)
- **Clinical rules:** TMPPM Autism Services criteria (statewide baseline; no distinct TX policy found)
- **Prior auth:** Required on evaluation and treatment, per the state benefit
- **Auth cadence:** State 90/90/180 cadence; 3-year dx recency; 8 hrs/day cap
- **Plan mechanics:** Texas Universal Authorization Form, PA fax 1-866-835-9589, allow 3 business days; appeals via Availity
- **Rates:** Not published — contract-specific

## What verifiably governs: the state baseline

Every fact on the Texas Medicaid guide applies to Aetna Better Health members: PA required on the 97151 evaluation (24-unit cap) with a signed prescriber referral and an ASD diagnosis made or reconfirmed within 3 years; treatment authorized in two 90-day periods then 180-day recertifications, with the prescriber signature no longer required on the 90-day extension since April 1, 2025; the 8-hour daily direct-treatment cap; the HO/HN/HM credential modifiers; and the telehealth ban on BT/LaBA-delivered direct treatment. Build your clinical package to that baseline and it will be substantively correct regardless of Aetna's intake mechanics. [3][4]

## What to confirm with the plan directly

The plan’s 2025–2026 provider manual (published August 2026) has no ABA section, so the clinical rules are the TMPPM’s. Its general prior-authorization process: complete the Texas Universal Authorization Form, fax acute-care requests to the Prior Authorization department at 1-866-835-9589 with supporting clinical information, and allow at least 3 business days; the current list of services and codes that need PA is in the online tool at medicaidportal.aetna.com/propat. A request for something that does not need PA comes back “PA not required,” which “does not mean that service is approved.” Claim appeals are filed through Availity. Before your first case, confirm with provider relations that the plan accepts your ABA packet on that form. [5][6]

## Switching providers or plans, and joining the network

The Texas Medicaid rule — Aetna Better Health’s 2025–2026 provider manual has no ABA section of its own. A family that moves to a new ABA provider outside the current group needs a new authorization request with all the documentation of an initial evaluation, plus a change-of-therapy-provider letter signed by the responsible adult giving the date therapy ended (or the last date of service) and the names of both providers (TMPPM § 2.3.9). A move to another provider within the same group keeps the same evaluation, plan of care and authorization period. If the child changes health plans, "Health plan prior authorizations do not automatically transfer," but the new MCO must continue an existing authorization it is told about, at the same amount, duration and scope, until the earliest of 90 days, the end of the authorization, or its own new decision (Managed Care Handbook § 2.8). [3][8]

Joining the network: a provider must be enrolled in Texas Medicaid before an MCO can enroll it; "Individual MCOs and DMOs have their own guidelines for contracting providers," and Medicaid enrollment "does not guarantee that an MCO or DMO will contract enroll or credential a particular provider." All Medicaid MCOs credential through the Texas Association of Health Plans' contracted credentialing verification organization (Handbook § 2.2.1). Aetna Better Health does not publish whether its ABA network is open, so ask its provider relations team. [3][8]

## What is Aetna Better Health of Texas’s timely filing limit and payment turnaround for ABA claims?

HHSC sets the claim clocks for every Texas Medicaid MCO in its Uniform Managed Care Claims Manual: a provider must file a claim with the MCO "within 95 Days from the date of service," and the MCO must deny a claim it does not receive in that window unless an exception applies (wrong plan, other insurance, newborns, newly enrolled providers). The MCO must tell the provider it "has 120 Days from the date of disposition to appeal the Claim," and must adjudicate an appealed claim within 30 days. Its performance standard is to adjudicate 98 percent of clean claims within 30 days of receipt and 99 percent within 90 days, with every claim finalized within 24 months of the date of service. When another insurer is billed first, the claim “must be refiled and received by the MCO within 95 Days from the date of disposition by the other insurance resource.” HHSC sets no weekly submission cutoff or check-run day; each MCO runs its own payment cycle. The TMPPM Managed Care Handbook repeats the 95-day rule and sends appeals to the MCO first, then to HHSC as a complaint. [2][8][5]

The plan’s own manual (2025–2026) restates the 95 days and adds its terms: “If a claim is not received by Aetna Better Health within 95 days, the claim will be denied unless excepted,” and with other insurance the 95 days run from the primary carrier’s EOB. On payment it says both that participating providers “shall be paid … no later than 30 working days after receipt of a completed clean claim” and that the plan pays interest “at an 18 percent annual rate, calculated daily,” on any clean claim left un-adjudicated past the 30-day deadline; it notifies the provider within 30 days if a claim is not clean. Claim appeals go through Availity, and EFT/ERA enrolment runs through ECHO. No weekly submission cutoff or check-run day is published. [2][8][5]

## Intake gates

The questions that decide whether a family can start with Aetna Better Health of Texas, 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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][5]
- **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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][5]
- **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). Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][5]
- **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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][5]
- **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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][5]
- **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. The plan manual’s general telemedicine passage (patient-site presenters; “A patient’s private home is not an established home site”) defers to “the state’s rules for Medicaid services,” and the TMPPM says its ABA remote-delivery rules “supersede that of the Telecommunication Services Handbook.” Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. TMPPM’s Telecommunication Services Handbook makes modifier 95 the telehealth marker and sets no telehealth place-of-service code. [1][3][5]
- **Prior-auth decision time**: Aetna Better Health of Texas’s 2025–2026 manual: complete the Texas Universal Authorization Form, fax it to the Prior Authorization department at 1-866-835-9589 with the clinical support, and “Allow at least 3 business days for a response if medically appropriate”; urgent requests for non-urgent services run on the routine clock, and the current PA code list is in the online tool at medicaidportal.aetna.com/propat. Concurrent review decisions are made within one business day. The statute sets the same ceiling for every Texas Medicaid MCO: a nonhospitalized PA must be decided “within three business days after the organization receives the request” (Tex. Gov’t Code § 540.0303), and an incomplete request follows 1 TAC § 353.425. No ABA reauthorization lead time is published; the TMPPM cadence (two 90-day periods, then 180-day recertifications) applies. [5][10][11][3]
- **Other insurance (who pays first)** _(plan-dependent)_: Medicaid pays last: bill the commercial plan first. Aetna Better Health of Texas’s 2025–2026 manual: “Providers must submit claims within 95 days of the rendering of service, or within 95 days of the primary carrier’s EOB in the Coordination of Benefits (COB) case, to include Medicare for Dual Eligible STAR Kids Members.” The manual does not say whether the plan waives its own ABA prior authorization when it pays second, so get the Texas Medicaid PA as well. [5][12]
  - Ask the plan: Aetna Better Health of Texas provider services (number on the member card) — ask whether ABA needs the plan’s PA when a commercial plan is primary.

## Delivery and billing rules

Coverage decides whether Aetna Better Health 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.

- **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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][5]
- **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. TMPPM: “If services billed exceed the limitations outlined in this section, the claim will be denied, and may be appealed” — so the cap is enforced on the claim, not only on the authorization. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][5]
- **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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][5]
- **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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. [3][5]

## What intake should collect for Aetna Better Health of Texas

- **STAR / STAR Kids vs. CHIP:** CHIP is excluded from the ABA benefit — confirm the Medicaid line.
- **ASD dx + recency:** State baseline: qualified diagnoser, DSM severity, within 3 years.
- **Prescriber referral:** The signed referral is a state requirement — it will be needed whatever Aetna's form looks like.
- **Plan mechanics on file:** Call provider relations once, document the submission channel/forms/fax, and template it.

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

## Verification of benefits (VOB) data

How Aetna Better Health of Texas ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Payer ID (pVerify):** 000944 — pVerify separately lists "AETNA BETTER HEALTH (TX) CHIP" (000945) as a distinct product from the Medicaid line (000944) used here — confirm the member's line of business before routing.
- **Payer ID (Availity):** 38692
- **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:** Aetna Better Health of Texas's plan-specific submission mechanics (form, portal, UM fax/phone) are not publicly verifiable — its provider manual and PA pages return errors to automated retrieval. Confirm directly with provider relations before first submission.
- **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:** 1-800-248-7767 (Bexar service area) / 1-800-306-8612 (Tarrant service area)
- **Hours:** 8 a.m.–5 p.m., Monday–Friday
- **Portal:** [Availity](https://apps.availity.com/)

Questions to ask on a verification call:

- Confirm which payer ID routes Aetna Better Health of Texas's Medicaid line eligibility (000944) vs. its CHIP line (000945).
- Does Aetna Better Health of Texas support real-time (vs. batch) 270/271 eligibility for this payer ID?
- 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 this plan'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.aetnabetterhealth.com/content/dam/aetna/medicaid/texas/providers/pdf/tx_provider_manual.pdf (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.aetnabetterhealth.com/texas/providers/contact-us.html (accessed 2026-07-23)

## Common questions

### Does Aetna Better Health of Texas cover ABA?

Yes — as a Texas Medicaid MCO it delivers the statewide THSteps-CCP Autism Services benefit under TMPPM criteria: PA on evaluation and treatment, ages 0–20, 3-year dx recency. CHIP members are excluded.

### Does Aetna Better Health have its own Texas ABA policy?

No. Its 2025–2026 provider manual has no ABA section, and Texas MCOs must apply the TMPPM criteria, so plan clinically against the state baseline.

### How do I submit an ABA PA to Aetna Better Health of Texas?

The plan’s manual routes prior authorization on the Texas Universal Authorization Form, faxed to 1-866-835-9589 with the clinical documentation; allow at least 3 business days. Check the online PA tool (medicaidportal.aetna.com/propat) for the current code list, and confirm with provider relations that your ABA packet is complete.

### What happens to the ABA authorization if a family switches providers or plans?

A new ABA provider outside the current group must file a new authorization with initial-evaluation documentation and a change-of-provider letter signed by the responsible adult (TMPPM § 2.3.9). A new health plan must continue an existing authorization for up to 90 days, or until it ends or the new plan decides.

### Is Aetna Better Health's ABA network open to new providers?

It does not publish an open or closed status. Enroll in Texas Medicaid first, then apply to the plan; Medicaid enrollment does not guarantee an MCO contract. Ask provider relations.

### What is the timely filing limit for Aetna Better Health of Texas (Texas Medicaid)?

Ninety-five days from the date of service. HHSC’s Uniform Managed Care Claims Manual sets it for every Texas Medicaid MCO. Claim appeals get 120 days from the disposition date.

### How fast does Aetna Better Health of Texas have to pay a clean claim?

HHSC requires every Texas Medicaid MCO to adjudicate 98 percent of clean claims within 30 days of receipt and 99 percent within 90 days. The plan’s manual pays 18 percent annual interest on clean claims left un-adjudicated past 30 days. No weekly cutoff or check-run day is published.

## Primary sources

1. [TMPPM Telecommunication Services Handbook (Vol. 2)](https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/TMPPM/2_19_Telecommunication_Srvs/2_19_Telecommunication_Srvs.htm)
2. [HHSC Uniform Managed Care Manual, Chapter 2.0 — Uniform Managed Care Claims Manual (v2.14)](https://www.hhs.texas.gov/sites/default/files/documents/laws-regulations/handbooks/umcm/2-0.pdf)
3. [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)
4. [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)
5. [Aetna Better Health of Texas — Medicaid (STAR, STAR Kids) and CHIP Provider Manual 2025–2026 (published August 2026)](https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/texas/providers/pdf/tx_provider_manual.pdf)
6. [Aetna Better Health of Texas — plan site](https://www.aetnabetterhealth.com/texas/index.html)
7. [BACB RBT Handbook (updated 06/2026)](https://www.bacb.com/rbt-handbook)
8. [TMPPM Medicaid Managed Care Handbook, §§ 2.2.1 (enrollment, contracting, credentialing), 2.6.3 (out-of-network) and 2.8 (authorizations when a client changes plans)](https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/TMPPM/2_12_Medicaid_Managed_Care/2_12_Medicaid_Managed_Care.htm)
9. [Aetna Better Health of Texas — Provider Notices & Newsletters (index)](https://www.aetnabetterhealth.com/texas/providers/notices-newsletters.html)
10. [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)
11. [1 TAC § 353.425 — incomplete prior authorization requests](https://www.law.cornell.edu/regulations/texas/1-Tex-Admin-Code-SS-353-425)
12. [TMPPM Third Party Liability Handbook](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 October 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.