BCBS Texas (HCSC)

CommercialTX

ABA billing requirements · Source: BCBS Texas (HCSC) — Clinical Payment & Coding Policy ABA

High confidence

Verified 2026-03-01

1 active policy alert

BCBS Texas updates preservice review requirements for ABAEffective 2026-04-01

BCBS Texas is updating its clinical payment and coding policies for ABA services effective April 2026. Changes include updated preservice review criteria, expanded documentation requirements for initial authorization requests, and clarified modifier billing rules for 97153 and 97155.

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline15 days

Unit tracking cadenceMonthly

Requires FBA Yes

Diagnostic eval validity12 months

Re-eval cadenceEvery 6 months

BH carve-out managerMagellan

State licensure requiredLBAS (TX State Board of Examiners of Psychologists) — required for Medicaid billing

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsBaseline data, Target behaviors, Methods, Goals, Discharge criteria

Progress summary cadenceEvery 6 months

Policy Notes

Age limits may apply based on the member's benefit plan. Refer to the member's benefit plan for specific age limits. Hour caps may also apply.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for BCBS Texas (HCSC).

Official policy source:BCBS Texas (HCSC) — Clinical Payment & Coding Policy ABA

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Data last verified: 2026-03-01 · Confidence: High · See our methodology

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