Effective November 1, 2025: Transition of Utilization Review for Applied Behavior Analysis (ABA) Services

Date: 07/23/25

Please Note: This article has been updated as of 9/18/2025.

Effective November 1, 2025, prior authorization requests for all Applied Behavior Analysis (ABA) services will transition from Magellan Healthcare (URA #5197) to Centene Management Company, LLC, Texas (URA #5396) for Superior HealthPlan STAR, STAR Health, STAR Kids and STAR+PLUS Medicaid for Breast and Cervical Cancer (MBCC) program members.

Beginning on November 1, 2025, all prior authorization requests for ABA services must be submitted to the Superior through one of the following prior authorization request submission methods:

• Online:
  • Availity Essentials Portal
  • Superior’s Secure Provider Portal
• Phone:
  • 1-800-218-7508
• Fax:
  • 1-800-690-7030

Prior authorization is required for the following procedure codes:

• Evaluation and re-evaluation procedure code 97151.
• An initial course of ABA treatment, and for subsequent recertifications for treatment procedure codes 97153, 97154, 97155, 97156, 97158.
• Interdisciplinary team meeting code 99366.

The table below lists the procedures that require prior authorization.

Procedure Code	Description	Criteria
97151	BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN	Texas Medicaid Provider Procedures Manual
97153	ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN
97154	GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15 MIN
97155	ADAPTIVE BHV TX PRTCL MODIFICATION PHYS/QHP EA 15 MIN
97156	FAMILY ADAPTIVE BHV TX GDN PHYS/QHP EA 15 MIN
97158	GROUP ADAPTIVE BHV PRTCL MODIFCATION PHYS/QHP EA 15 MIN
99366	TEAM CONF W/PAT BY HC PRO

Providers can also use Superior’s Pre-Auth Needed Tool, via the link below, to verify prior authorization requirements for specific procedure codes.

• Medicaid and CHIP Prior Authorization webpage

For any questions, please contact your Provider Representative. To access their information, visit the Find My Provider Representative webpage.