Texas autism coverage mandate (speech, OT, PT): what it means for pediatric speech and OT
Unofficial source · confirm with the payer Some facts on this page come from a secondary source (a professional association, a billing guide or a published summary), not from the payer's own documents. Each one is marked and links to where we read it; confirm it with the payer before you rely on it.
By Javier Alvarez · Updated · 1 min read
1 row: State law · Texas. Public policy, not the member's benefits.
Texas autism coverage mandate (speech, OT, PT)
Tex. Insurance Code s. 1355.015 · Texas
Unofficial source · confirm with the payer: some facts in this row come from a secondary source, not the payer.
| Where it applies | NCSL says the law defines generally recognized services to include applied behavior analysis, speech, occupational and physical therapy, medications or nutritional supplements, and other treatments. [1] Unofficial source · confirm with the payer |
|---|---|
| State law | As of 2021, NCSL summarizes Tex. Insurance Code s. 1355.015 as requiring a health benefit plan to cover screening a child for autism spectrum disorder, and all generally recognized services prescribed by the enrollee's primary care physician in the treatment plan the physician recommends. [1] Unofficial source · confirm with the payer |
| Referral | Services must be prescribed by the enrollee's primary care physician in the recommended treatment plan. [1] Unofficial source · confirm with the payer |
| Payment | NCSL says this coverage may be subject to annual deductibles, copayments and coinsurance consistent with those required for other coverage under the plan. [1] Unofficial source · confirm with the payer |
- NCSL: Autism and Insurance Coverage State Laws (updated August 24, 2021) (secondary source), checked October 30, 2026
What the Texas law says
- Where it applies. NCSL says the law defines generally recognized services to include applied behavior analysis, speech, occupational and physical therapy, medications or nutritional supplements, and other treatments. (Unofficial source · confirm with the payer)
- State law. As of 2021, NCSL summarizes Tex. Insurance Code s. 1355.015 as requiring a health benefit plan to cover screening a child for autism spectrum disorder, and all generally recognized services prescribed by the enrollee's primary care physician in the treatment plan the physician recommends. (Unofficial source · confirm with the payer)
- Referral. Services must be prescribed by the enrollee's primary care physician in the recommended treatment plan. (Unofficial source · confirm with the payer)
- Payment. NCSL says this coverage may be subject to annual deductibles, copayments and coinsurance consistent with those required for other coverage under the plan. (Unofficial source · confirm with the payer)
The law sets a floor for the plans it reaches; the plan's own policy still decides the codes, units and authorization. On the benefits call, ask whether the plan is fully insured in Texas, and if a covered service is denied, name the statute in the appeal.