Medicaid Procedures With Online Prior Authorization

Texas Medicaid providers can submit online prior authorization requests for the following services.

Home Health

  • Plan of Care [Home Health Services Plan of Care (POC)]
  • Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies
    • Medicaid Certificate of Medical Necessity for CPAP/BiPAP or Oxygen Therapy
    • Medicaid Certificate of Necessity for Chest Physiotherapy Device
    • Statement for Initial Wound Therapy System In-Home Use
    • Statement for Recertification of Wound Therapy System In-Home Use
    • Wheelchair/Scooter/Stroller Seating Assessment (Home Health Services)
    • External Insulin Pump
    • Other home health authorization requests. Authorization requests for services that are not related to the displayed options should be submitted by checking the None Apply box

Comprehensive Care Inpatient Psychiatric (CCIP)

  • Psychiatric Hospital Inpatient Admission

Comprehensive Care Program (CCP)

  • Request for CCP Outpatient Therapy (PT, SLP, or OT)
  • CCP Prior Authorizations Request:
    •  Apnea Monitor
    • Bed/Crib
    • Donor Human Milk Request
    • Formula
    • Private Duty Nursing
    • Pulse Oximeter
    • Respiratory Syncytial Virus (RSV) Prophylaxis
    • Total Parenteral Nutrition (TPN)
    • Wheelchair/Scooter/Stroller Seating Assessment (CCP)
    • Miscellaneous

Ambulance

  • Ambulance Prior Authorization (Nonemergency ambulance services)

Special Medical Prior Authorizations (SMPA):

  • Electrocardiogram
  • Medical Services
  • Outpatient Psychotherapy [Outpatient Psychotherapy/Counseling Request; Psychological/Neuropsychological Testing Request]

Obstetric (OB) Ultrasound

  • OB Ultrasound

Substance Abuse

  • Ambulatory Counseling Extension
  • Ambulatory Detoxification
  • Residential Detoxification
  • Residential Treatment

Authorization Extensions

To request an extension for approved authorization, click "Search for/extend an existing prior authorization" on the "I would like to..." web page. The following authorizations may be extended:

  • Request for Extension of Outpatient Therapy
  • Psychiatric Inpatient Extended Stay Request

Note: This list is not all-inclusive. Providers must access the "Search for/extend an existing prior authorization" web page for a complete list of authorization types that may be extended.