Effective 08/31/26: Criteria Change for Cognitive Rehabilitation Therapy for Medicaid STAR+PLUS Waiver and STAR+PLUS Dual Waiver Members

Date: 07/22/26

Effective  August 31, 2026, Superior HealthPlan will utilize different medical necessity review criteria due to clinical policy retirement for Cognitive Rehabilitation Therapy for Medicaid STAR+PLUS Waiver and STAR+PLUS Dual Waiver members.

Superior ensures medical necessity review criteria are current and appropriate for members and the scope of services provided.

Applicable Products: Medicaid STAR+PLUS Waiver and STAR+PLUS Dual Waiver

Procedure Code	Description	Criteria
97129	Therapeutic interventions that focus on cognitive function & compensatory strategies, direct patient contact; 1st 15 minutes	Texas Health and Human Services Commission, STAR+PLUS Handbook, 6330 – Cognitive Rehabilitation Therapy
97130	Therapeutic interventions that focus on cognitive function & compensatory strategies, direct patient contact; each additional 15 minutes
97537	Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes

To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.

For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.