Blue Cross Blue Shield of Texas (BCBSTX), a Division of Health Care Service Corporation, runs STAR and STAR Kids in the Travis service area — distinct from BCBSTX's commercial and Federal Employee Program lines, which follow different rules entirely (see our BCBSTX commercial guide for those). BCBSTX publishes no dedicated Autism Services chapter in its combined STAR/CHIP/STAR Kids provider manual; ABA policy instead lives in a standalone PA checklist and a periodically updated PA procedure code grid. The operationally important fact for intake: BCBSTX carved Medicaid behavioral health out to Magellan as recently as mid-2023, then "insourced" it in 2024 — older documents referencing Magellan are stale.
As late as a 7/5/2023-dated PA summary, BCBSTX directed providers to "contact Magellan for authorization requirements" for Texas Medicaid behavioral health — a classic BH carve-out. On May 10, 2024, BCBSTX announced the "insourcing of Behavioral Health Services for Medicaid," and every current-generation document we could find (the ABA request form, revised 03/2024, and a September 2024 UM provider training deck) makes no mention of Magellan and instead routes ABA authorization to BCBSTX's own behavioral-health intake fax, 1-888-530-9809, or the Availity Essentials portal. (BCBSTX's separate ABA PA Requirement Checklist, revised 4/26/2024, is still linked from its Medicaid forms page but has returned a 404 since October 2026.) We found no document stating explicitly that the Magellan relationship has fully ended for every BH service line — if a legacy document you're working from still references Magellan, treat it as superseded and confirm current routing with BCBSTX's Medicaid Provider Network Representative before submitting.[1][2]
BCBSTX's Texas Medicaid Benefit Prior Authorization Procedure Code List lists 97151, 97153, 97154, 97155, 97156, and 97158 each as "Applied Behavioral Health (Allowable only for members 20 years of age or younger)," PA-required, effective 1/1/2024 — matching the statewide code set. We could not find 0362T or 99366 on this list or any other BCBSTX Medicaid document; treat their handling as unconfirmed and rely on TMPPM baseline expectations rather than a BCBSTX-specific rule. General PA turnaround per BCBSTX's own UM training material is 3 business days for routine requests — we found no ABA-specific SLA distinct from that standard.[3][4]
Follows the Texas Medicaid rule — BCBSTX's own provider documents that we checked (October 2026) set no change-of-provider rule of their 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).[5][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). BCBSTX does not publish whether its ABA network is open, so ask its provider relations team.[5][8]
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.[10][8][11]
BCBSTX’s Medicaid manual: "All claims must be submitted within 95 days of the service date unless otherwise noted in a provider’s contractual agreement with BCBSTX," and a claims appeal is filed on the Claims Reconsideration Form within 120 calendar days.[10][8][11]
The questions that decide whether a family can start with Blue Cross Blue Shield of Texas (Medicaid), and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the Texas Medicaid rule, and BCBSTX states it on its own PA code grid: 97151 and 97153-97158 are each listed as Applied Behavioral Health allowable only for members 20 years of age or younger.[3][5]
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.[5][3]
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).[5][3]
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.[5][3]
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.[5][3][7]
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.[5][3]
BCBSTX's Medicaid manual publishes no decision clock (only that "Faxes received after hours will be processed the next business day"), and its ABA checklist lists what makes a request complete without timing — so the Texas rule governs: a Medicaid MCO must decide a nonhospitalized PA "within three business days after the organization receives the request" (Tex. Gov't Code § 540.0303), with the 1 TAC § 353.425 incomplete-request process (written notice of what is missing within 3 business days; a final decision within 3 business days after it arrives). The federal ceiling is 7 calendar days standard and 72 hours expedited (42 CFR 438.210(d)); Texas's 3 business days is stricter. No ABA reauthorization lead time is published.[11][12][13][14]
Bill the other carrier first: "Providers should submit the claim to the other carrier first," then send BCBSTX the COB claim with the other carrier's remittance advice, denial letter or member EOB — "We deny Coordination of Benefits claims received without at least one of the above three items." Filing deadline: "BCBSTX must receive Coordination of Benefit claims within 95 days from the date on the other carrier's or program's PRA or letter of denial of coverage." The manual's option to bill Medicaid without billing other insurance is written for "Texas Health Steps providers" (checkups), not ABA. It does not say whether BCBSTX's ABA PA is still required when it pays second — request it.[11][15]
Coverage decides whether Blue Cross Blue Shield of Texas (Medicaid) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
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.[5][3][6]
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.[5][3]
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. TMPPM: “If services billed exceed the limitations outlined in this section, the claim will be denied, and may be appealed,” so the cap is a claim edit as well as an authorization limit. Authorization periods are two consecutive 90-day terms then recertifications of up to 180 days.[5][3]
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.[5][3]
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.[5][3]
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.[5][3]
Yes — the Texas Medicaid Autism Services benefit for STAR and STAR Kids members in the Travis service area, on TMPPM criteria. BCBSTX publishes no distinct clinical policy; its own PA code grid confirms PA is required on the core ABA codes.
Not currently — BCBSTX carved Medicaid BH out to Magellan as recently as mid-2023, but announced "insourcing" of Medicaid behavioral health in May 2024. Current PA documents route ABA to BCBSTX's own fax and portal, not Magellan.
Fax to 1-888-530-9809 or submit through the Availity Essentials provider portal, per BCBSTX's current ABA PA Requirement Checklist.
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.
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.
Ninety-five days from the date of service. HHSC’s Uniform Managed Care Claims Manual sets it for every Texas Medicaid MCO, and BCBSTX’s own manual states the same deadline. Claim appeals get 120 days from the disposition date.
HHSC requires every Texas Medicaid MCO to adjudicate 98 percent of clean claims within 30 days of receipt and 99 percent within 90 days.
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.
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