Certified Family Partner Services to Become a Benefit of Texas Medicaid

Date: February 25, 2025

Attention: Providers

Effective date: March 1, 2025

Call to action: Texas Children’s Health Plan (TCHP) would like to make you aware that effective for dates of service on or after March 1, 2025, Certified Family Partner (CFP) services (procedure code S9482) will be a benefit of Texas Medicaid.

Overview of Services

CFP services, also referred to as family partner support services or family peer support services, will be a benefit of Texas Medicaid for parents (birth, adoptive, and foster), legally authorized representatives (LARs), or primary caregivers of a Medicaid-eligible child or youth who meets the following criteria:

• Is 20 years of age or younger
• Is diagnosed with a serious emotional disturbance (SED) or a 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 CFP services included as a component in their person-centered and trauma-informed recovery plan (henceforth referred to as the plan of care)

CFPs provide services directly to the parents, LARs, or primary caregivers, not to the Medicaid-eligible child or youth.

CFP services are an array of formal and informal services and supports that include the following:

• Introducing parents, LARs, or primary caregivers to the mental health and substance use system
• Modeling advocacy skills
• Providing education and information
• Making referrals
• Providing skills training
• Assisting in identifying supports
• Conducting support groups
• Helping with navigating systems, such as the juvenile justice system, child protective services, and independent school districts

CFP services may be provided in the office, home, outpatient hospital, and “other location” settings. CFP services may also be provided by telehealth if certain conditions are met.

CFP services may be delivered as part of a coordinated, comprehensive, and individualized approach to treating a Medicaid-eligible child’s or youth’s SED or mental health or substance use condition. CFPs may not submit claims directly to Texas Medicaid for family partner support services. CFPs must be employed by one of the following Medicaid-enrolled provider types that may submit claims for the CFP services rendered:

• Clinic and group practices treating behavioral health conditions
• Physicians, advanced practice registered nurses, and physician assistants treating behavioral health conditions
• Licensed psychologists, licensed clinical social workers, licensed marriage and family therapists, and licensed professional counselors
• Comprehensive provider agencies of mental health targeted case management and mental health rehabilitative services
• Local mental health or behavioral health authorities (LMHAs or LBHAs)
• Chemical dependency treatment facilities
• Federally qualified health centers
• Rural health clinics
• Opioid treatment providers

How this impacts providers: 
Claim Submission Guidelines

• CFP services must be included in the plan of care for the Medicaid-eligible child or youth to be reimbursed.
• A billable unit of CFP services (procedure code S9482) is 15 minutes of continuous contact.
• The following modifiers must be submitted with procedure code S9482:

• Claims for CFP services using procedure code S9482 must be submitted with modifier HE or HF, as appropriate.
• Claims for CFP services delivered in a group setting must also be submitted with modifier HQ.
• CFP services are limited to 104 units in a rolling six-month period. This limit may be exceeded with prior authorization.

Prior Authorization

Prior authorization is not required for the first 104 units (26 hours) of CFP services in a rolling six-month period.

Prior authorization is required once the 104 units (26 hours) of CFP services (individual or group) in a rolling six-month period is exceeded.

Beginning March 1, 2025, additional CFP benefit information will be published in the Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Services Handbook.

Next step for Providers: Providers should share this update with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org

For access to all provider alerts: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts