For an intake team in Indiana, a Cigna card means three layers at once: the carrier's national clinical policy, Indiana's autism insurance mandate (Ind. Code 27-8-14.2), and the plan's funding type deciding which of the two actually binds. This guide stacks them in order.
Cigna (through Evernorth Behavioral Health) covers ABA for autism under national policy EN0499 with one of the friendliest front doors in the industry: no prior authorization on assessment codes 97151, 97152, and 0362T. The rigor arrives at the treatment step, which requires the completed assessment plus a treatment plan with Cigna's ABA PA form. That clinical policy is national — what changes in Indiana is the legal floor underneath it: the state mandate below governs what fully-insured plans must cover, while self-funded employer plans answer to ERISA and federal parity instead. Plan funding type is therefore the first fact to establish on every benefits check. The full national policy breakdown lives in our Cigna / Evernorth guide; this page covers what changes in Indiana.[1][2]
Indiana’s mandate (2001) was the first autism insurance mandate in the country, and it remains one of the strongest: group accident and sickness policies must cover ASD treatment prescribed by the treating physician under a treatment plan, with no age limits and no dollar, visit, or hour caps — and cost-sharing no less favorable than for physical illness generally. Individual-policy insurers must offer (not automatically include) the coverage, and self-funded ERISA plans are exempt by preemption. There’s little parity tension here because the statute imposes no quantitative limits of its own.[3][4]
We checked: Cigna / Evernorth publishes no Indiana-specific ABA policy, form, or supplement — the national policy plus the state mandate is the whole picture. That’s worth knowing in itself: it means benefits verification (plan funding type, mandate applicability, benefit limits) is where Indiana-specific answers come from, not a carrier document.[1]
Indiana began licensing behavior analysts in May 2025 (IC 25-8.5, via the Professional Licensing Agency’s Behavior Analyst Committee), built on current BCBA/BCaBA certification with biennial renewal. Expect commercial payers to fold the LBA license into credentialing requirements as it phases in. On rates: Cigna does not publish commercial ABA fee schedules for Indiana (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement, so treat rate expectations as a contracting conversation, not a lookup.[5]
The questions that decide whether a family can start with Cigna / Evernorth in Indiana, and what they have to bring. Each maps onto something intake should ask on the first call.
Cigna's recency rule attaches to the standardized assessment rather than to the diagnosis, and it is tight: initiation requires a standardized, validated instrument in its current edition administered within 60 days before treatment start. Continued treatment needs current data no more than 60 days old, a repeat standardized assessment within a year, and a re-assessment after any break longer than 60 days. Indiana's mandate adds no recency rule of its own.[1]
A standardized, validated instrument in its current edition — the policy gives Vineland-3 as the example rather than a closed list — administered within 60 days before treatment start, with the deficits it measures mapped to DSM-5-TR ASD domains and into the treatment plan's goals. Continued treatment requires a repeat standardized assessment within a year.[1]
The most permissive position in this directory: Cigna's March 2025 autism resource guide states that all ABA CPT codes are covered telehealth services, with the delivery model chosen on the individual's needs. Indiana's April 2026 modifier-95 restriction is a Medicaid rule and does not reach a commercial Cigna plan.[2]
None from either direction, which is unusual. The carrier's national ABA policy states no age limit, and Indiana's mandate — the first autism insurance mandate in the country — imposes none either: group accident and sickness policies must cover treatment of an autism spectrum disorder prescribed by the insured's treating physician under a treatment plan, with no age limit and no dollar, visit or hour cap anywhere in IC 27-8-14.2. Individual-policy insurers must only offer the coverage, and self-funded ERISA plans are outside the chapter entirely — so an individual or self-funded plan may lawfully lack the benefit.[3]
Ask the plan: Benefits verification on the specific plan, via the payer portal or the number on the member’s card — ask three things: is this a fully-insured Indiana group policy (the mandate reaches it), an individual policy (IC 27-8-14.2-5 requires only that the coverage be offered, so ask whether this policy took it up), or a self-funded ERISA plan (outside the chapter entirely); and if the plan is outside the mandate, what age or hour limit the plan document itself imposes on ABA.
Yes on a fully-insured Indiana group plan, and it is the statute that requires it: coverage is “limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan.” The mandate names no credential for the person delivering the service — that comes from the carrier and from Indiana's separate licensure chapter — but the treating physician's prescription is a coverage condition. Capture the prescribing physician and the plan they signed off on. Individual policies (offer-only) and self-funded ERISA plans are outside the chapter.[3]
Ask the plan: Benefits verification on the specific plan, via the payer portal or the number on the member’s card — confirm the funding type first, because the statutory prescription requirement only reaches fully-insured Indiana group policies. On an individual or self-funded ERISA plan, ask the carrier directly whether it requires a treating-physician prescription and a treatment plan, and get the answer with the authorization.
Depends on how the plan is funded. A fully insured plan issued in Indiana (group, individual or HMO) falls under IC 27-1-37.5-23, in force since July 1, 2025: urgent PA answered “not later than twenty-four (24) hours after receiving the request,” every other PA “not later than forty-eight (48) hours,” with weekends and state and federal holidays excluded; a missed deadline means the service “shall be automatically deemed authorized” (IC 27-1-37.5-28). A self-funded private-employer plan follows the federal ERISA claims rule instead: urgent within 72 hours; pre-service within a reasonable time “but not later than 15 days after receipt of the claim,” with one 15-day extension; and a request to extend an ongoing course of treatment that involves urgent care must be decided within 24 hours if made at least 24 hours before the authorization expires. Cigna adds its own submission window: “we encourage providers to request authorizations up to 30 days in advance of or two weeks after the start date of service. A delay in request may result in a retrospective review and could delay the determination for up to 30 days.” Assessment codes 97151, 97152 and 0362T need no PA when the diagnosis is autism and the provider is independently licensed or a BCBA.[7][8][9][2]
Ask the plan: Benefits verification call or the Cigna (CignaforHCP) provider portal: ask whether the plan is fully insured and issued in Indiana (state 24/48-business-hour clock) or self-funded ERISA (federal 72-hour / 15-day clock), and what turnaround the plan quotes for ABA.
Depends on the family and on plan funding. For a fully insured Indiana group plan, 760 IAC 1-38.1 sets the order: the plan covering the person as employee or subscriber pays before one covering them as a dependent; for a child whose parents are married or living together, “the plan of the parent whose birthday falls earlier in a calendar year” is primary (same birthday: the plan that has covered that parent longest); for parents who are divorced, separated or do not live together, with no court decree, the order is custodial parent, custodial parent's spouse, noncustodial parent, noncustodial parent's spouse — and a decree that makes one parent responsible for health coverage overrides it. A self-funded ERISA plan sets its COB rules in its plan document instead. TRICARE is always “last pay” behind other health coverage (32 CFR 199.8), so this plan pays before TRICARE. If the child also has Indiana Medicaid, this plan pays first and IHCP pays last — but IHCP still requires its own PA (“must also obtain PA from the appropriate IHCP PA contractor”) and will not pay for services this plan denied as out-of-network, so be in this plan's network and get both authorizations.[10][11][12][13][14][15]
Ask the plan: At intake, collect every coverage the child has, both parents' birthdays and any custody or court-decree terms; then ask Cigna (and the other carrier) on the benefits call whether each plan is fully insured or self-funded and which one they show as primary.
EN0499 as quoted in this guide sets the credential bar for who performs the ABA assessment and supervises the case — an independently licensed provider or a BCBA — rather than naming who may make the ASD diagnosis. The diagnosis must be a DSM-5-TR autism spectrum diagnosis, with Rett syndrome (F84.2) excluded. Indiana's mandate requires only that the treatment be prescribed by the insured's treating physician.[1][2][3]
Ask the plan: Evernorth Behavioral Health provider services (the behavioral health number on the member's card) — ask which diagnosing credentials EN0499 accepts.
Coverage decides whether Cigna / Evernorth in Indiana pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Assessment and case supervision must come from a BCBA, a licensed behavior analyst, or an independently licensed clinician with documented ABA training, with direct supervision at the standard 1–2 hours per 10 hours of direct treatment; Evernorth does not credential non-licensed staff. Indiana adds the licensure layer: LBA/LABA applications went live May 13, 2025 and practising ABA without the licence is prohibited, technicians excepted while directed by a licensed analyst.[1][5][6]
Restrictive, and the restriction is about other therapies as much as about ABA codes. EN0499 does not cover ABA delivered at the same time as another therapy (speech, OT) to the same child, and only one provider may bill a unit of time, with the standard supervision exceptions. Agency-to-agency transitions with overlapping authorization periods require documented coordination.[1]
Every session note needs the date, start and end times, location, focus, a detailed description of the intervention, the persons present, the service type, and the rendering provider's name, credential and signature. No countersignature requirement and no signing deadline are published.[1]
Evernorth does not credential non-licensed staff, so RBT-delivered services bill under the supervising provider, and the treatment plan must name a credentialed supervisor. In Indiana that supervisor must hold the state LBA licence.[1][5]
Not published as a per-day unit ceiling. EN0499 bounds the day from a different direction: ABA is not covered when delivered at the same time as another therapy to the same child, and only one provider can bill a unit of time, with the standard supervision exceptions. Requested intensity is set in the treatment plan and authorized on the ABA PA form rather than against a published cap.[1]
Ask the plan: The treatment authorization itself, and Evernorth Behavioral Health provider services (the behavioral health number on the member's card) — ask whether any per-day MUE is applied to ABA codes on this plan.
Not published as a payable-settings list. Two sourced facts bear on setting nonetheless: the treatment plan must carry dated baseline data per setting, so settings are declared and measured rather than assumed; and every session note must record the location. Whether a given setting is payable is a plan-benefit question.[1]
Ask the plan: Benefits verification on the specific plan — ask which places of service are payable for ABA, and whether school-based delivery is excluded before you write school goals.
Yes — under the carrier's national policy for ASD, layered on Indiana's mandate (Ind. Code 27-8-14.2) for fully-insured plans. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.
Indiana’s mandate (2001) was the first autism insurance mandate in the country, and it remains one of the strongest: group accident and sickness policies must cover ASD treatment prescribed by the treating physician under a treatment plan, with no age limits and no dollar, visit, or hour caps — and cost-sharing no less favorable than for physical illness generally. See the mandate section above for ages, caps, and exemptions — and remember federal parity limits how hard the numeric caps can be enforced against group plans.
Commercial ABA rates are not published — they are negotiated in your participating-provider agreement. Benchmark against the Indiana Medicaid fee schedule where one exists, and treat rate-setting as part of contracting.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo