Prior Authorization Requests (CSHCN Services Program)

Prescribing providers submit the following forms to request prior authorization for clients enrolled in the CSHCN Services Program. Refer to each form's instruction page for requirements and submission instructions.

Providers must submit each request below with the Texas Department of Insurance (TDI) Standard Prior Authorization Request. Failure to submit both forms will result in authorization delay or denial.

Refer to the CSHCN Services Program - Prior Authorization Contacts section for program contact information.

Cystic Fibrosis Treatment Agents

Biosynthetic Growth Hormone Agents