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How to Get Paid Faster: ABA Billing Tips for Texas Providers
- Veronica Cruz
- Jun 27
- 4 min read
Updated: 21 hours ago
Let’s be honest—running an ABA therapy practice in Texas isn’t just about helping kids.It’s about navigating an exhausting maze of insurance rules, billing codes, authorizations, Medicaid rules, denials, and compliance.
You're expected to deliver clinical excellence and run a business at the same time—with zero room for error in your billing.
If any of the following sounds familiar, you're in the right place:
● You're tired of waiting weeks (or months) to get paid.
● You’re drowning in denials because of “coding mistakes.”
● Medicaid requirements feel like a moving target.
● You want to focus on therapy—but billing keeps pulling you back in.
This guide is for you.
We’ll walk you through the biggest billing roadblocks ABA providers in Texas face—and show you how to get ahead of them.
The Insurance Reality in Texas: What Providers and Parents Need to Know
ABA billing in Texas comes with unique—and often misunderstood—rules. Here's the truth:
1. Medicaid Covers ABA Therapy (But It’s Not Simple)
Texas Medicaid covers ABA for children under 21 diagnosed with autism—but only when it’s properly documented and delivered by a licensed behavior analyst (LBA). Services must include:
● Behavioral assessments
● Individualized treatment plans
● Parent/caregiver training
● Ongoing therapy with measurable outcomes
Here’s where most providers stumble: if your documentation or CPT coding isn’t airtight, claims get denied.
2.Texas Has a Children's Autism Program—But Few Know How to Use It
The Texas HHSC offers up to 180 hours/year of ABA therapy for eligible children aged 3 to 15. But the rules are strict:
● You must meet the 85% attendance requirement
● Parents must attend training
● Only licensed providers may bill
● There’s a lifetime cap of 720 hours per child
We often talk to providers who didn’t even know this program existed—or who got denied because they didn’t meet administrative criteria.
🔍 Explore the Children’s Autism Program
3. Private Insurance & CHIP: Coverage Is Inconsistent
While many private plans in Texas now include ABA therapy, coverage depends on the insurer and employer. Some require prior authorizations, others don’t. Some limit hours. Others cover only specific CPT codes.
The most common problem? Therapists providing services without verifying benefits—then scrambling when the claim is denied.
➡️ Medicaid and CHIP: Program Info
The Most Common ABA Billing Mistakes—and How to Fix Them
Let’s break down the day-to-day challenges that bleed your time, revenue, and sanity—and how Cube Therapy Billing helps you solve them.
Claim Denials (The Silent Revenue Killer)
You’ve done the work. But the claim? Denied. Again.
Why? Usually:
● Incorrect CPT codes
● Missing treatment notes
● Expired authorizations
● Lack of medical necessity documentation
What we do differently: At Cube Therapy Billing, we use internal pre-bill audits, payer-specific checklists, and tracking systems that reduce denials to under 2%. Clean claims go out the first time—and revenue flows in faster.
Medicaid & State Compliance (Because One Size Doesn’t Fit Texas)
Texas Medicaid and private payers all have different rules. You can’t treat them the same. If you’re not constantly updating your documentation templates and authorization workflows, you’re leaving money on the table.
How we help: We stay current with HHSC guidelines, CHIP changes, and plan-specific policies—so you don’t have to.
Is your scheduling system hurting your authorizations?
CPT Code Confusion (And Why It’s Costing You)
You know the codes: 97151, 97153, 97155, 97156. But using them incorrectly—even slightly—can sink your revenue.
For example:
● Billing 97153 for program modification (should be 97155)
● Forgetting parent training documentation for 97156
● Missing session times or signature logs
What we do differently: We train your therapists and admin staff on proper code use. And we verify every claim matches its documentation.
Tech Gaps That Break Your Workflow
Juggling EHRs, Excel, Google Docs, and clearinghouses? It’s a disaster waiting to happen.
We centralize it all. Cube Therapy Billing works with your systems—or helps you pick smarter tools. We also streamline telehealth billing for Medicaid and commercial plans.
Staff Training That Actually Sticks
Even one untrained RBT or careless session note can delay payments. We help your team get it right—every time.
● Live CPT code refreshers
● Documentation do's and don’ts
● Internal audits before claims go out
Prepare your team for insurance audits (before they happen)
Why ABA Providers Trust Cube Therapy Billing
We're not just another billing company. We're therapy billing specialists who understand the Texas ABA ecosystem inside and out.
Here’s how we stand out:
● 98.9% clean claim rate
● Texas Medicaid and CHIP experts
● Fast denial turnaround and appeals
● Real-time tracking dashboards
● EHR integration and audit readiness
● Credentialing and benefits verification
Final Word: Let Billing Fuel Your Growth—Not Drain It
Texas is one of the fastest-growing states for ABA therapy. But that growth means more competition, more regulation, and more pressure to get paid faster.
If billing, denials, and compliance are taking your attention away from clinical care—it’s time for a smarter approach.
Let Cube Therapy Billing take care of the headaches so you can focus on outcomes. We're here to help you grow, stay compliant, and get paid what you deserve.
FAQs
Does Medicaid in Texas cover ABA therapy?
Yes. Texas Medicaid covers ABA therapy for children under 21 with an autism diagnosis, when delivered by licensed providers and following HHSC guidelines.
What’s the most common reason for claim denials?
Incorrect CPT coding or missing documentation—especially around 97153, 97155, and 97156.
What is the Children's Autism Program?
A state-supported initiative offering up to 180 hours/year of ABA services for kids aged 3–15. There are strict eligibility and attendance rules.
