Go to the Top of Mind home page
April 2025 Top of Mind
Now available: Texas Medicaid Certified Family Partner benefit for caregivers
On March 1, 2025, Texas Medicaid added a new Certified Family Partner/Peer (CFP) benefit (procedure code S9482) specifically for caregivers.*
CFP benefits offer informal and formal support services to the birth, adoptive and foster parents, legally authorized representatives or primary caregivers of Medicaid-eligible children and youth who meet the following criteria:
- Is 20 years of age or less
- Diagnosed with a serious emotional disturbance (SED), mental health or substance use condition as defined in the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)
- Has a person-centered and trauma-informed plan of care that includes CFP services
Note: Providers can offer up to 26 hours of service every 6 months without a prior authorization.
Support available for caregivers
CFP services may provided in office, home, outpatient hospital and other settings as needed. Telehealth services are also an option if certain conditions are met. Services that can be provided include:
- Information and education about the mental health and substance use system
- Skills training
- Support groups
- Advocacy
- Making referrals
- Finding additional support resources
- Navigating systems: juvenile justice system, child protective services, independent school districts and more
Who can provide services
CFP services may be offered as part of a coordinated, comprehensive and individualized program delivered by Medicaid-enrolled providers such as:
- Clinics, group practices, physicians, advanced practice registered nurses and physician assistants treating behavioral health conditions
- Licensed professionals including psychologists, clinical social workers, marriage and family therapists and professional counselors
- Mental health rehabilitative services
- Agencies providing targeted case management for mental health
- Local mental health or behavioral health authorities
- Chemical dependency treatment facilities
- Federally qualified health centers
- Rural health clinics
- Opioid treatment providers
How to submit claims
To help ensure proper reimbursement, CFPs must be included in the Medicaid-eligible child/youth plan of care. Claims must include procedure code S9482 with the proper modifier(s):
95 – Delivered by synchronous audiovisual technology
FQ – Delivered by synchronous audio-only technology
HE – Mental health program
FH – Substance use program
HQ – Group-delivered services
Claims should be submitted electronically through the Provider Express secure portal, not directly to Texas Medicaid.
Prior authorization guidance
Prior authorization is required for CFP individual or group services once the 104 units (26 hours) is exceeded during a rolling six-month period. CFP services may exceed 26 hours during that period with prior authorization.
Note: A billable unit is 15 minutes of continuous contact.
Questions?
For more CFP benefit information please see the Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook. You may also call the Texas Medicaid Health Plan Contact Center at 1-800-925-9126, 7 a.m.–7 p.m. CT, Monday–Friday.
* Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.
