Texas prior authorization laws (2026)
General reference compiled from public statutes and the AMA state-law chart. This is not legal advice. Statutes change; confirm the current law before relying on it.
Decision deadlines
Prior authorization (State-regulated health plans)
Standard decision: 5 business_days.
Tex. Ins. Code § 1369.304 · sourceGold-card law
Providers with a strong approval history may be exempted from prior authorization for qualifying services, with an approval threshold around 90% over a minimum of 5 requests (12 months (extended from 6 by HB 3812)). Prescription drugs are not included. Confirm current eligibility with the payer.
Texas HB 3459, Insurance Code Ch. 4201 Subchapter N · sourceFrequently asked questions
How long does an insurer have to decide a prior authorization in Texas?
Under Tex. Ins. Code § 1369.304, a standard prior authorization decision is generally due within 5 business_days. Confirm the current statute, as timeframes vary by plan type.
Does Texas have a gold-card prior authorization law?
Yes. Texas has a gold-card law (Texas HB 3459, Insurance Code Ch. 4201 Subchapter N) that can exempt providers with a strong approval history from prior authorization for qualifying services. Confirm current eligibility thresholds with the payer.
Other states
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