Texas Medicaid covers ABA for members under 21 with autism under the federal EPSDT authority, a benefit housed in the Children's Services Handbook of the Texas Medicaid Provider Procedures Manual since February 2022 and delivered through TMHP fee-for-service and the STAR, STAR Kids, and STAR Health managed-care programs (Texas HHSC; TMPPM Children's Services Handbook; EPSDT under 42 U.S.C. 1396d(r)). The direct-therapy code 97153 pays $14.50 per 15-minute unit, about $58 per hour, following an approximately 11.5% increase effective September 1, 2025 (TMHP fee schedule, eff. Sept. 1, 2025). Services may be delivered in the home, community, clinic, school, or by telehealth, and a September 2025 update eased school-based telemedicine, though concurrent supervision billing on the direct-therapy code is not authorized (TMPPM Telecommunication Services Handbook update, Sept. 1, 2025; Texas Medicaid ABA policy). Commercial plans regulated by Texas must cover ABA from the point of diagnosis if it occurs before age 10, with a $36,000 annual cap applying for ages 10 and older (Tex. Ins. Code § 1355.015).
The figures and rules on this page reflect the TMHP fee schedule effective September 1, 2025, the telemedicine updates effective September 1, 2025, and guidance current through early 2026, and this page was last reviewed in June 2026. Most members are in STAR, STAR Kids, or STAR Health managed care, where the plan may apply its own rates, authorization rules, and place-of-service restrictions. Treat every figure and rule here as a point-in-time snapshot, not a live quote. Confirm the current TMHP fee schedule, telemedicine rules, and your managed-care plan's rates and restrictions before you model revenue or submit claims.
The nine reimbursement criteria at a glance
- Is ABA covered by Texas Medicaid
- Who is eligible: age, diagnosis, and EPSDT
- The reimbursement rates and the 2025 increase
- Place of service: home, community, clinic, school, and telehealth
- The profit engine: volume and the direct-therapy code
- Concurrent and supervision billing
- Prior authorization and managed care
- The commercial mandate: from diagnosis before age 10
- Reading Texas profitability
- How this connects to the rest of your compliance stack
- Getting set up to bill Texas Medicaid: the sequence
- Texas reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by Texas Medicaid
Yes. Texas Medicaid covers ABA for members under 21 with an autism diagnosis under the federal EPSDT authority, a benefit added to the Children's Services Handbook of the Texas Medicaid Provider Procedures Manual effective February 2022 (Texas HHSC; TMPPM Children's Services Handbook; EPSDT under 42 U.S.C. 1396d(r)). A referral and an evaluation establishing the autism diagnosis are required, services are delivered by Licensed Behavior Analysts (LBAs) with licensed assistant behavior analysts (LaBAs) and behavior technicians (BTs) under supervision, and most members receive ABA through a STAR, STAR Kids, or STAR Health managed-care plan that requires prior authorization.
Who is eligible: age, diagnosis, and EPSDT
Medicaid ABA in Texas is a children's benefit, running birth through age 20, requiring Texas Medicaid enrollment, an autism diagnosis, a referral, and medical necessity, grounded in EPSDT (EPSDT, 42 U.S.C. 1396d(r)). The managed-care plan authorizes hours against the treatment plan. The commercial mandate, discussed below, uses a different and notable trigger tied to the age at diagnosis rather than a simple age cap.
The reimbursement rates and the 2025 increase
Rates current as of January 2026. Texas publishes a TMHP fee schedule, and ABA rates rose recently: the direct-therapy code 97153 pays $14.50 per 15-minute unit, about $58 per hour, following an approximately 11.5% increase effective September 1, 2025 (TMHP fee schedule, eff. Sept. 1, 2025). Because most members are in managed care, the plan may contract its own rate around that baseline. Code descriptions are paraphrased.
| Code | What it is (plain language) | Who delivers it | Rate basis |
|---|---|---|---|
| 97151 | Behavior identification assessment and treatment-plan development | Licensed Behavior Analyst (LBA) | Per TMHP fee schedule |
| 97153 | Adaptive behavior treatment by protocol (direct one-to-one therapy) | BT or LaBA under supervision | $14.50 / 15 min (eff. Sept. 1, 2025) |
| 97155 | Treatment with protocol modification and supervision | Licensed Behavior Analyst (LBA) | Per TMHP fee schedule |
| 97156 | Family adaptive behavior treatment guidance | Licensed Behavior Analyst (LBA) | Per TMHP fee schedule |
The rate is modest but rising, which makes volume and setting mix the levers, and the place of service carries its own rules in Texas, covered next.
Place of service: home, community, clinic, school, and telehealth
Texas covers ABA across multiple settings, and the setting carries its own billing and policy rules, so place of service is a planning variable here.
- Clinic (center-based). The clinic is where facility-licensure and physical-plant questions arise, connecting this setting to the facility-licensure topic below.
- Home and community. Home- and community-based delivery is covered, though some managed-care plans apply in-home restrictions and documentation requirements that vary by plan and region. Texas's Electronic Visit Verification requirement, under the federal Cures Act, applies to personal care and attendant and home health services rather than to ABA specifically, so home-based ABA is governed by the treatment plan and managed-care rules. Confirm current scope.
- School. School-based ABA is delivered under place-of-service code 03 and is tracked closely under strict coding edits. A September 2025 update eased school-based telemedicine by removing the requirement that a health professional be present with the child during school-based telemedicine (TMPPM Telecommunication Services Handbook update, Sept. 1, 2025). As elsewhere, medical ABA at school is distinct from the educational services a district provides under an individualized education program (IDEA); keep the lanes separate and document the clinical basis.
- Telehealth. ABA is deliverable by telehealth, with two Texas-specific points: only LBAs may provide supervision (97155) via telehealth, and indirect supervision activities are not reimbursable by telehealth; and the September 2025 update removed the out-of-state distant-site restriction to align with amended Texas Administrative Code telemedicine rules (Texas Medicaid ABA policy; TMPPM update, Sept. 1, 2025).
The operational takeaway is that the setting drives the rules in Texas: school-based delivery has its own coding and recently eased telemedicine rules, telehealth supervision is limited to LBAs, and managed-care plans add in-home and school-based restrictions. Capture the correct place of service on every claim and confirm each plan's setting rules.
The profit engine: volume and the direct-therapy code
As everywhere, the economic engine is code 97153, the technician-delivered one-to-one direct therapy that fills most authorized hours, and the spread over a loaded technician wage drives margin at scale. Texas's defining feature is scale: a very large Medicaid child population and high demand mean the model is fundamentally a volume engine, and the recent rate increase to $14.50 improves the per-unit spread. With concurrent supervision billing unavailable (below), margin depends on technician productivity, authorized hours, and efficient supervision rather than on stacking codes. Read the engine as volume-driven with a rising rate.
Texas is a volume engine: a large, growing Medicaid market with a recently increased rate, where setting rules and the no-concurrent-billing limit, rather than a high unit price, shape the margin.
Concurrent and supervision billing
Texas takes a restrictive line on concurrent billing that contrasts with some other states. The supervising LBA does not have to be in the room for the entire 97153 session, and concurrent billing is not authorized, so a practice cannot bill supervision (97155) simultaneously with technician direct therapy (97153) the way some states permit (Texas Medicaid ABA policy). Supervision is billed separately under its own rules, only LBAs may supervise via telehealth, and indirect supervision activities are not separately reimbursable. Build your supervision model around these limits rather than around concurrent capture.
Prior authorization and managed care
ABA in Texas requires prior authorization, and because most members are in STAR, STAR Kids, or STAR Health, the authorizing entity and the specific rules are the managed-care plan's (Texas Medicaid managed care; STAR programs). Plans differ by region in documentation expectations and in in-home and school-based restrictions, and Texas applies strict correct-coding edits. Build your authorization workflow to each plan you contract with, and expect regional variation.
The commercial mandate: from diagnosis before age 10
Medicaid is one payer, and Texas's commercial mandate has a distinctive structure. State-regulated plans must cover screening, diagnosis, and treatment of autism, including ABA, for an enrollee diagnosed before age 10, and once coverage begins it continues, so the operative trigger is the age at diagnosis rather than a fixed cutoff (Tex. Ins. Code § 1355.015). For enrollees age 10 and older, the statute allows a $36,000 annual cap on ABA, though federal mental-health parity may render that cap unenforceable as a less-favorable limitation. As always, the mandate reaches state-regulated plans, not self-funded employer (ERISA) plans. Commercial rates are negotiated. Confirm current terms with the Texas Department of Insurance.
Reading Texas profitability
Putting the pieces together, Texas is fundamentally a scale market with an improving rate.
On the favorable side, the Medicaid child population is very large and demand is high, the rate rose to $14.50 in September 2025 and the trajectory is positive, ABA is firmly covered, multiple settings (including eased school-based telemedicine) are available, and the commercial mandate's diagnosis-before-10 trigger is broad. On the constraining side, the per-unit rate is still modest, concurrent supervision billing is not authorized, telehealth supervision is limited to LBAs, and managed-care plans add regional in-home and school-based restrictions under strict coding edits. The practical read is a volume-driven model where profitability turns on scale, technician productivity, authorized hours, efficient supervision, and disciplined place-of-service coding. None of this is a projection of any practice's results, and it is not financial advice; it is the reimbursement structure you would model against.
How this connects to the rest of your compliance stack
Reimbursement is where the rest of the structure turns into revenue, and place of service is the bridge to several of the other topics:
- Facility licensure and HIPAA. The clinic setting is where facility-licensure and physical-plant questions arise, and Texas also has a broad medical-records privacy law beyond HIPAA; home, school, and telehealth delivery interact differently. See facility licensure and HIPAA.
- Licensing and credentialing. Texas licenses behavior analysts through TDLR (with a BACB or QABA pathway), and you must be licensed, enrolled in TMHP, and credentialed with each managed-care plan before rates apply. See the Texas licensing and credentialing page.
- Entity and ownership. The billing entity and its ownership are disclosed at enrollment. See the Texas entity page and the Texas ownership page.
- Practice sale and expansion. Scale, a rising rate, and a broad market make Texas attractive for expansion and consolidation. See practice expansion and sale.
Getting set up to bill Texas Medicaid: the sequence
- License and enroll. License the team through TDLR and enroll in TMHP through the Provider Enrollment and Management System (PEMS).
- Contract with the STAR plans. Credential and contract with the STAR, STAR Kids, and STAR Health plans you intend to bill, confirming regional rules.
- Secure the referral, diagnosis, and authorization. Obtain the referral and autism diagnosis and secure prior authorization from the managed-care plan.
- Bill by place of service. Capture the correct place of service, observe school-based and in-home restrictions, and apply the eased school-based telemedicine and telehealth-supervision rules.
- Model supervision without concurrent billing. Structure supervision separately, since concurrent 97155 and 97153 billing is not authorized, and only LBAs may supervise via telehealth.
- Layer in commercial payers. Contract with state-regulated plans under the diagnosis-before-10 mandate (§ 1355.015).
Texas reimbursement variables at a glance
| Variable | Texas value |
|---|---|
| Is ABA a Medicaid benefit? | Yes, under EPSDT, in the TMPPM Children's Services Handbook since February 2022 |
| Age eligibility (Medicaid) | Birth through 20 |
| Direct-therapy rate (97153) | $14.50 per 15-minute unit (about $58/hour); approximately 11.5% increase effective September 1, 2025 |
| Places of service | Home, community, clinic, school, and telehealth |
| Telehealth | Permitted; only LBAs may supervise (97155) via telehealth; indirect supervision not reimbursable; out-of-state distant-site restriction removed September 2025 |
| School-based | POS 03; September 2025 update removed the requirement that a health professional be present for school-based telemedicine; distinct from IDEA/IEP |
| Electronic Visit Verification | Applies to personal care, attendant, and home health, not to ABA specifically |
| Concurrent billing | Not authorized on 97153; supervision billed separately |
| Prior authorization | Required; set by the STAR/STAR Kids/STAR Health managed-care plan; strict coding edits |
| Commercial mandate | Yes; covers from diagnosis if before age 10; $36,000 annual cap for ages 10+; state-regulated plans (Tex. Ins. Code § 1355.015) |
| Key authorities | Texas HHSC and TMPPM Children's Services Handbook; EPSDT (42 U.S.C. 1396d(r)); Tex. Ins. Code § 1355.015 |
Frequently asked questions
Does Texas Medicaid cover ABA, and for whom?
What does Texas Medicaid pay for ABA direct therapy?
Can ABA be delivered by telehealth or at school in Texas?
Can supervision be billed concurrently with direct therapy?
Do commercial plans in Texas have to cover ABA?
Where professional advice is essential, not optional
Texas rewards scale, so the operational specifics matter: the place-of-service coding, the eased school-based telemedicine rules, the LBA-only telehealth supervision, the no-concurrent-billing limit, and the managed-care regional restrictions are the things to get right. Confirm the TMHP fee schedule, the current telemedicine and place-of-service rules, your TDLR licensure, TMHP enrollment, and managed-care rates, and your authorization workflow with a credentialing and billing specialist, and bring in counsel where reimbursement meets entity, ownership, facility licensure, and the Texas medical-records privacy law. Treat the figures here as a modeling starting point, not a projection of results, and not financial advice.
The governing authorities to know are the Texas Medicaid ABA benefit and TMHP fee schedule (Texas HHSC and the TMPPM Children's Services Handbook), the telemedicine and place-of-service rules (TMPPM Telecommunication Services Handbook), the EPSDT authority (42 U.S.C. 1396d(r)) that grounds the children's benefit, and the commercial autism mandate (Tex. Ins. Code § 1355.015), read together with federal mental-health parity.
This page describes a fee schedule and place-of-service rules that change, and managed-care plans may differ. The Texas Health and Human Services Commission, TMHP, each managed-care plan, and the Texas Department of Insurance provide current figures. Neither this page nor any secondary source should be relied on in place of direct verification, and nothing here is a revenue or profit projection.