Understanding Medicaid Billing for ABA Services in Texas: A Step-by-Step Guide

Getting reimbursed for the care you’ve already delivered shouldn’t feel like a full-time job—but in the world of ABA therapy, it often does. Especially in Texas, where Medicaid billing comes with its own maze of rules, authorizations, and documentation.

Here’s the thing: once you understand how the process truly works, you can turn what feels complicated into a reliable, repeatable system. Let’s break it down in plain English.

What Is Medicaid Billing for ABA Services?

Medicaid billing is the process of getting paid by Texas Medicaid for Applied Behavior Analysis (ABA) services provided to children with autism or related developmental conditions.

In Texas, Medicaid covers ABA for children under 21 years of age who have a formal diagnosis of Autism Spectrum Disorder (ASD) and whose treatment is deemed medically necessary.

The goal is simple—to help children receive consistent, evidence-based therapy that improves communication, learning, and social skills. But the process behind the scenes? That’s another story.

It sounds simple enough, but here’s the catch: every claim must meet specific documentation and submission rules. One small error—a missing modifier, a late authorization, or an expired credential—can delay payment for weeks.

And every delay affects your cash flow, payroll, and your ability to deliver continuous care. That’s why mastering Medicaid billing isn’t just administrative—it’s essential to keeping your ABA practice financially healthy.

How Medicaid ABA Billing Works (Step by Step)

To make it easier, let’s simplify the entire process into five clear, actionable stages. Think of this as your roadmap to faster, smoother reimbursements.

🩺 Stage-by-Stage Breakdown

1. Enrollment and Credentialing

Before you can bill Medicaid, your clinic or provider must be enrolled and credentialed correctly.
This means your Licensed Behavior Analyst (LBA) registers through TMHP and gets approved to deliver ABA services in Texas.

Here’s what’s involved:

• Applying with the correct taxonomy code (103K00000X).

• Completing a site visit if required.

• Maintaining updated credentials and re-attestation schedules.

• Contracting with Texas Medicaid’s Managed Care Organizations (MCOs) for network participation.

If you skip or delay even one of these steps, your claims won’t get paid—no matter how accurate your billing is.

2. Diagnostic Evaluation and Treatment Planning

This is where the clinical side meets the billing side. Every Medicaid-funded ABA service must start with a comprehensive diagnostic evaluation conducted by a qualified professional.

Once the diagnosis is confirmed, your team develops an individualized treatment plan. This plan outlines:

• The child’s current behavior challenges.

• The target skills or goals for therapy.

• How progress will be measured.

• The duration and intensity of therapy sessions.

To get authorization, the treatment plan must show that the services are medically necessary—not educational or optional. Include caregiver involvement, as Medicaid often views parent training as a core part of therapy.

3. Prior Authorization (PA)

Before you begin therapy, Medicaid requires prior authorization for all ABA services. This means sending the child’s evaluation, treatment plan, and required forms to the appropriate MCO (like Superior, Community First, or Molina).

Each MCO reviews your submission to confirm:

• The client qualifies for coverage.

• The plan is medically necessary.

• The number of hours and type of services requested make sense for the diagnosis.

If something’s missing—like a signature, date, or clear goal—the request will be denied or delayed.

That’s why successful clinics track every PA request like clockwork. A simple spreadsheet or an integrated ABA therapy billing system can make all the difference in catching missing items early.

Pro Tip: Never start therapy before PA approval. Medicaid doesn’t retroactively pay for sessions done before authorization.

4. Service Delivery and Documentation

Once approval comes through, your work shifts from waiting to doing.
But what you do after each session is just as important as the therapy itself.

Every session must have:

• The client’s name and Medicaid ID.

• The date, start and end times.

• The CPT code for the service (like 97153 for technician-led therapy).

• The LBA’s supervision notes.

• Parent or caregiver signature (if required).

Documenting accurately shows that the care was delivered exactly as authorized.
Any mismatch between your treatment plan and your notes can lead to claim rejections or audits later.

Remember, in Texas Medicaid, every line you write can protect your reimbursement.

5. Claim Submission

After the services are rendered and documented, it’s time to get paid.
Claims are submitted to TMHP or the relevant MCO depending on the client’s plan.

This is where precision counts:

• Use the correct CPT codes and modifiers.

• Ensure the rendering and billing provider match Medicaid’s requirements.

• Double-check the number of units matches the PA.

• Attach necessary documentation when required.

Most billing teams now use specialized software or partner with medical billing experts who handle behavioral health claims.
They ensure claims are scrubbed, validated, and submitted electronically with minimal error risk.

That’s the difference between getting paid in 14 days vs. 60 days.

Why So Many ABA Claims Get Denied in Texas

Even experienced providers face denials. But the reasons are often predictable—and avoidable.

Here’s what causes most issues:

• Submitting without valid prior authorization.

• Missing or incomplete parent involvement documentation.

• Using outdated CPT codes.

• Incorrect modifiers like HO, HN, or HM.

• Billing under the wrong NPI or taxonomy.

Sometimes, denials happen because of timing—a claim submitted after the authorization expires or too close to the filing deadline.

Texas Medicaid doesn’t forgive easily, and appeal processes take time. That’s why many clinics outsource to trusted billing partners who know how to handle behavioral health claims from start to finish.

The Emotional Side of Billing

Let’s be real—no therapist starts their career dreaming about claim forms or payer portals.
You chose ABA therapy because you wanted to change lives. But when reimbursement issues pile up, it’s easy to feel stuck in paperwork instead of progress.

It’s not just administrative stress—it’s emotional.

You’re trying to keep your staff paid.
You’re explaining to parents why sessions might pause until authorizations renew.
You’re fighting to get reimbursed for time you already gave to help a child speak their first full sentence.

When the system slows you down, it can feel like it values forms more than children.
But here’s the truth: understanding Medicaid billing isn’t just about money. It’s about control—taking ownership of your practice’s stability so you can focus on what truly matters: helping kids thrive.

How to Make Medicaid Billing Easier

You don’t have to do this alone.
Here are five strategies that simplify Medicaid billing for ABA practices across Texas:

1. Invest in experts.
   Hiring or partnering with experienced ABA billing professionals can reduce denials by up to 40% and save you countless hours.

2. Use the right technology.
   Choose billing software that connects scheduling, therapy notes, authorizations, and claims in one place.
   Integration reduces manual entry errors and gives real-time claim status tracking.

3. Audit internally.
   Run monthly checks comparing documented sessions vs. billed claims. You’ll catch issues before Medicaid does.

4. Track rule updates.
   Texas Medicaid policies evolve frequently—especially around reauthorization timelines and documentation requirements.

5. Document with empathy.
   Don’t just record what you did; show why it mattered.
   Notes that demonstrate functional improvement strengthen your case for continued care and renewals.

Final Thoughts: Turning Paperwork into Progress

At the heart of Medicaid billing is one simple truth: every claim tells a story of progress.
Behind each CPT code is a therapist helping a child find their voice.
Behind each approval letter is a parent breathing easier knowing therapy continues.

When you understand the system, billing stops feeling like an obstacle—it becomes a tool for growth.
You don’t just get paid faster; you build a stronger, more sustainable ABA practice that supports your team and your clients.

Because every form you complete, every claim you submit, every detail you track—it all leads to one thing: changing lives, one session at a time.