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Autism Services Benefits Added to TMPPM

Last updated on 2/1/2022

This article was modified on 02/25/2022 to correct procedure code 99336 to 99366.

Note: Texas Medicaid managed care organizations (MCOs) must follow all aspects of the Medicaid Autism Services Policy as outlined in this provider notice. MCOs must provide all medically necessary, Medicaid-covered services to eligible clients. Providers should contact the client's specific MCO for details.

Effective February 1, 2022, the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, has been updated to include autism services benefits.

Providers can access the PDF version of the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook at this link.

Providers can access the HTML version of the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, section 2.3, “Autism Services,” at this link

Autism services include coverage of medically necessary applied behavior analysis (ABA) services for individuals with a diagnosis of autism spectrum disorder (ASD) and provides coordination of the service array in interdisciplinary team meetings. Autism services include the following topics:

  • ABA
  • Requirements for prior authorization for ABA evaluation and treatment
  • Clinical documentation requirements
  • Licensed behavior analysts (LBA) as a new provider type and descriptions of licensed assistant behavior analysts (LaBAs) and behavior technicians (BTs) who may work under the supervision of an LBA (Note: LaBAs and BTs may not enroll as Medicaid providers.)
  • Requirements for interdisciplinary team meetings
  • Prior authorization, billing, and reimbursement for procedure codes 97151, 97153, 97154, 97155, 97156, 97158, and 99366
  • Autism services delivery through managed care and fee-for-service Medicaid

For more information, call the TMHP Contact Center at 800-925-9126.