Form 1143, Cystic Fibrosis Treatment Agents Prior Authorization Request (CSHCN)

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Effective Date: 2/2024


Updated: 2/2024


HHSC requires prior authorization for cystic fibrosis treatment agents for people enrolled in the Children with Special Health Care Needs (CSHCN) Services Program.

How to Submit

Providers should send the completed form by fax or mail to the CSHCN Services Program.

Fax: 512-776-7238


Texas Health and Human Services 
CSHCM Services Program 
Mail Code 1938
P.O. Box 149030 
Austin, TX 78714-9947


Refer comments or questions about this form to the CSHCN Services Program at 800-252-8023.