---
title: "Cigna ABA coverage: prior auth, plans & telehealth."
url: "https://carelu.com/payers/cigna"
markdown_url: "https://carelu.com/payers/cigna.md"
state: US (national)
payer: Cigna / Evernorth
kind: Commercial insurance
description: "How Cigna/Evernorth covers ABA: no PA on assessment codes, treatment authorization requirements under EN0499, treatment-plan standards, session-note rules, and full telehealth coverage."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Cigna ABA coverage: prior auth, plans & telehealth.

_Payer Guide · Cigna / Evernorth · Last updated September 2026 · 2 primary sources_

> No PA on assessment codes; EN0499 treatment authorization; full telehealth.

Cigna (through Evernorth Behavioral Health) covers ABA for autism with one of the more intake-friendly front doors in the industry: no prior authorization on assessment codes. The rigor arrives at the treatment-authorization step, where policy EN0499 sets detailed requirements for assessments, treatment plans, and progress data. Understanding both halves lets an intake team start families fast without setting up a denial later.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Not required for assessment codes 97151, 97152, 0362T (with ASD dx + licensed/BCBA provider) [2]
- **Prior auth for treatment**: Required — assessment + plan with the ABA PA form [2]
- **Autism diagnosis required?**: Yes — ASD only; Rett syndrome (F84.2) excluded under EN0499 [1]

## At a glance

- **Covers ABA?:** Yes — ASD only (Rett syndrome excluded)
- **Assessment PA:** None for 97151, 97152, 0362T (with ASD dx + licensed/BCBA provider)
- **Treatment PA:** Required — assessment + plan + PA form
- **Submission window:** Encouraged: up to 30 days before or within 2 weeks after start; retrospective only after 90+ days (EN0499)
- **Telehealth:** "All ABA CPT codes are covered telehealth services"
- **Policy:** EN0499 (eff. 5/15/2026) + autism resource guide
- **Assessment recency:** Standardized assessment within 60 days of treatment start

## The intake-friendly part: no assessment PA

With an autism diagnosis on file, an independently licensed provider or BCBA can run assessment codes 97151, 97152, and 0362T without prior authorization (when the plan covers ABA). For intake, that means the sequence can be: verify benefits → book the assessment immediately → build the treatment request from the assessment. No authorization purgatory between first call and first appointment — if your intake process is fast enough to use it. [2][1]

## Treatment authorization

The treatment PA package is the completed assessment plus treatment plan with Cigna's ABA PA form, which Cigna's autism resource guide encourages providers to submit up to 30 days before or within two weeks after the start of service ("A delay in request may result in a retrospective review"). EN0499 (eff. 5/15/2026) sets the actual retrospective trigger: "A retrospective authorization request for ABA is any request made when more than 90 days have passed since the start date of the requested authorization, or any time after the patient has discharged." Initiation requires a standardized, validated instrument — current edition, e.g., Vineland-3 — administered within 60 days before treatment start, with deficits mapped to DSM-5-TR ASD domains and to the treatment plan's goals. [1][2]

- **Treatment-plan bar:** Measurable goals with operational definitions and mastery criteria; dated baseline data per setting; caregiver-training goals with their own baselines and data plans; a named, credentialed supervisor; and defined discharge criteria with a fading plan. [1][2]
- **Session notes:** Every note needs date, start/end times, location, focus, detailed intervention description, persons present, service type, and the rendering provider's name, credential, and signature. [1][2]
- **Continued treatment:** Updated plan with current data (≤60 days old), sustained progress, a repeat standardized assessment within a year, and re-assessment after any break over 60 days. [1][2]

## Billing restrictions worth knowing at intake

ABA isn't covered when delivered at the same time as another therapy (speech, OT) to the same child — so intake should map the family's existing therapy schedule, not just list it. Only one provider can bill a unit of time, with the standard supervision exceptions. And if a family is transitioning from another ABA agency, overlapping authorization periods require documented coordination between agencies — capture the outgoing provider's details up front. [1]

## Supervision and credentialing

Assessment and case supervision must come from a BCBA, licensed behavior analyst, or independently licensed clinician with documented ABA training, with direct supervision at the standard 1–2 hours per 10 hours of direct treatment. Evernorth doesn't credential non-licensed staff — RBT services bill under the supervising provider. [1]

## How Cigna / Evernorth works state by state

The clinical policy above is national, but three state-level layers change what a family's card actually buys: the state autism mandate (what fully-insured plans must cover), the carrier's state Medicaid plans (which follow the state Medicaid rules, not this commercial policy), and plan funding type (self-funded ERISA plans can carve benefits differently).

- **Georgia** (mandate: Ava’s Law (O.C.G.A. § 33-24-59.10)): fully-insured Cigna / Evernorth plans issued in Georgia sit under the state mandate. State Medicaid baseline: [Georgia Medicaid guide](https://carelu.com/payers/georgia-medicaid).
- **North Carolina** (mandate: N.C.G.S. § 58-3-192 (autism coverage)): fully-insured Cigna / Evernorth plans issued in North Carolina sit under the state mandate. State Medicaid baseline: [North Carolina Medicaid guide](https://carelu.com/payers/north-carolina-medicaid).
- **Indiana** (mandate: Indiana autism insurance mandate (IC 27-8-14.2)): fully-insured Cigna / Evernorth plans issued in Indiana sit under the state mandate. State Medicaid baseline: [Indiana Medicaid (IHCP) guide](https://carelu.com/payers/indiana-medicaid).
- **Virginia** (mandate: Virginia autism insurance mandate (§ 38.2-3418.17)): fully-insured Cigna / Evernorth plans issued in Virginia sit under the state mandate. State Medicaid baseline: [Virginia Medicaid (DMAS) guide](https://carelu.com/payers/virginia-medicaid).
- **Tennessee** (mandate: Tenn. Code Ann. § 56-7-2367 (neurological parity)): fully-insured Cigna / Evernorth plans issued in Tennessee sit under the state mandate. State Medicaid baseline: [TennCare (Tennessee Medicaid) guide](https://carelu.com/payers/tenncare-tennessee-medicaid).
- **Ohio** (mandate: Ohio autism insurance mandate (R.C. 3923.84)): fully-insured Cigna / Evernorth plans issued in Ohio sit under the state mandate. State Medicaid baseline: [Ohio Medicaid guide](https://carelu.com/payers/ohio-medicaid).
- **New Jersey** (mandate: P.L. 2009, c.115 (N.J.S.A. 17:48-6ii et al.)): fully-insured Cigna / Evernorth plans issued in New Jersey sit under the state mandate. State Medicaid baseline: [NJ FamilyCare (New Jersey Medicaid) guide](https://carelu.com/payers/new-jersey-medicaid).
- **Maryland** (mandate: Habilitative services mandate (Md. Ins. § 15-835 + COMAR 31.10.39.03)): fully-insured Cigna / Evernorth plans issued in Maryland sit under the state mandate. State Medicaid baseline: [Maryland Medicaid (Medical Assistance) guide](https://carelu.com/payers/maryland-medicaid).
- **Colorado** (mandate: Colorado autism insurance mandate (C.R.S. § 10-16-104(1.4))): fully-insured Cigna / Evernorth plans issued in Colorado sit under the state mandate. State Medicaid baseline: [Health First Colorado (Colorado Medicaid) guide](https://carelu.com/payers/colorado-medicaid).
- **Utah** (mandate: Utah autism insurance mandate (Utah Code § 31A-22-642; caps removed 2020)): fully-insured Cigna / Evernorth plans issued in Utah sit under the state mandate. State Medicaid baseline: [Utah Medicaid guide](https://carelu.com/payers/utah-medicaid).
- **Arizona** (mandate: Steven’s Law (A.R.S. § 20-826.04; dollar caps repealed by SB 1590, 2025)): fully-insured Cigna / Evernorth plans issued in Arizona sit under the state mandate. State Medicaid baseline: [AHCCCS (Arizona Medicaid) guide](https://carelu.com/payers/arizona-ahcccs).
- **New York** (mandate: NY autism mandate (Ins. Law §§ 3216(i)(25), 3221(l)(17), 4303(ee))): fully-insured Cigna / Evernorth plans issued in New York sit under the state mandate. State Medicaid baseline: [New York Medicaid (NYS DOH / eMedNY) guide](https://carelu.com/payers/new-york-medicaid).
- **New Mexico** (mandate: New Mexico autism insurance mandate (NMSA 1978 § 59A-22-49)): fully-insured Cigna / Evernorth plans issued in New Mexico sit under the state mandate. State Medicaid baseline: [New Mexico Medicaid (Turquoise Care) guide](https://carelu.com/payers/new-mexico-medicaid).
- **Missouri** (mandate: Missouri autism insurance mandate (RSMo § 376.1224)): fully-insured Cigna / Evernorth plans issued in Missouri sit under the state mandate. State Medicaid baseline: [MO HealthNet (Missouri Medicaid) guide](https://carelu.com/payers/missouri-medicaid).
- **Texas** (mandate: Texas autism mandate (Tex. Ins. Code § 1355.015)): fully-insured Cigna / Evernorth plans issued in Texas sit under the state mandate. State Medicaid baseline: [Texas Medicaid (THSteps-CCP) guide](https://carelu.com/payers/texas-medicaid).
- **Massachusetts** (mandate: ARICA — Ch. 207, Acts of 2010 (M.G.L. c. 175 § 47AA et al.)): fully-insured Cigna / Evernorth plans issued in Massachusetts sit under the state mandate. State Medicaid baseline: [MassHealth (Massachusetts Medicaid) guide](https://carelu.com/payers/masshealth-massachusetts-medicaid).
- **Florida** (mandate: Steven A. Geller Autism Coverage Act (§ 627.6686, Fla. Stat.)): fully-insured Cigna / Evernorth plans issued in Florida sit under the state mandate. State Medicaid baseline: [Florida Medicaid — Behavior Analysis Services (AHCA) guide](https://carelu.com/payers/florida-medicaid).
- **Kansas** (mandate: Kansas autism insurance mandate (K.S.A. 40-2,194)): fully-insured Cigna / Evernorth plans issued in Kansas sit under the state mandate. State Medicaid baseline: [KanCare (Kansas Medicaid) guide](https://carelu.com/payers/kansas-medicaid).
- **Nebraska** (mandate: Neb. Rev. Stat. § 44-7,106 (autism coverage, 25 hr/wk cap)): fully-insured Cigna / Evernorth plans issued in Nebraska sit under the state mandate. State Medicaid baseline: [Nebraska Medicaid (Heritage Health) guide](https://carelu.com/payers/nebraska-medicaid).
- **Idaho** (mandate: No autism statute — DOI Bulletin 18-02 (habilitative-parity floor, plan years from 2019)): fully-insured Cigna / Evernorth plans issued in Idaho sit under the state mandate. State Medicaid baseline: [Idaho Medicaid guide](https://carelu.com/payers/idaho-medicaid).
- **Iowa** (mandate: Iowa autism mandates (Iowa Code §§ 514C.31, 514C.28; caps and age limits removed by H.F. 330 from 1/1/2026)): fully-insured Cigna / Evernorth plans issued in Iowa sit under the state mandate. State Medicaid baseline: [Iowa Medicaid (IA Health Link) guide](https://carelu.com/payers/iowa-medicaid).
- **Oklahoma** (mandate: Nick’s Law (36 O.S. § 6060.21; age and hour caps removed 2022)): fully-insured Cigna / Evernorth plans issued in Oklahoma sit under the state mandate. State Medicaid baseline: [Oklahoma Medicaid (SoonerCare / SoonerSelect) - Oklahoma Health Care Authority guide](https://carelu.com/payers/oklahoma-medicaid).
- **Michigan** (mandate: Michigan autism mandate (MCL 500.3406s, 550.1416e; through age 18, $50K/$40K/$30K caps allowed)): fully-insured Cigna / Evernorth plans issued in Michigan sit under the state mandate. State Medicaid baseline: [Michigan Medicaid guide](https://carelu.com/payers/michigan-medicaid).
- **Hawaii** (mandate: Luke’s Law (HRS § 431:10A-133; under 14, $25,000/yr ABA cap)): fully-insured Cigna / Evernorth plans issued in Hawaii sit under the state mandate. State Medicaid baseline: [Hawaii Medicaid (Med-QUEST / QUEST Integration) guide](https://carelu.com/payers/hawaii-medicaid).
- **California** (mandate: SB 946 autism mandate (H&S § 1374.73, Ins. Code § 10144.51; no age or dollar caps)): fully-insured Cigna / Evernorth plans issued in California sit under the state mandate. State Medicaid baseline: [Medi-Cal (California Medicaid) guide](https://carelu.com/payers/medi-cal-california-medicaid).
- **Pennsylvania** (mandate: Act 62 of 2008 (40 P.S. § 764h; under 21, CPI-adjusted cap $51,908 for 2026)): fully-insured Cigna / Evernorth plans issued in Pennsylvania sit under the state mandate. State Medicaid baseline: [Pennsylvania Medicaid (Medical Assistance) guide](https://carelu.com/payers/pennsylvania-medicaid).

## Intake gates

The questions that decide whether a family can start with Cigna / Evernorth, and what they have to bring.

- **Diagnosis recency**: Cigna's recency rule attaches to the standardized assessment rather than to the diagnosis, and it is the tightest in this directory. Initiation requires a standardized, validated instrument in its current edition administered within 60 days before treatment start. Continued treatment needs an updated plan with current data no more than 60 days old, sustained progress, a repeat standardized assessment within a year, and a re-assessment after any break in service longer than 60 days. If the family's most recent testing is older than 60 days, plan to administer during the assessment window — which Cigna lets you open without prior authorization. [1]
- **Diagnostic tools required**: A standardized, validated instrument in its current edition — EN0499 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 carried through into the treatment plan's goals. Continued treatment requires a repeat standardized assessment within a year. The instrument is the hinge of the treatment authorization, so pick it before the assessment rather than after. [1]
- **Referral required?**: No referral or physician order is required by EN0499, and — the part that makes Cigna the friendliest front door in this directory — no prior authorization is required on assessment codes 97151, 97152 and 0362T when there is an autism diagnosis on file and the provider is independently licensed or a BCBA. Treatment is the gated step: the completed assessment plus a treatment plan on Cigna's ABA PA form, which Cigna's autism resource guide encourages providers to submit up to 30 days before or within two weeks after the start of service. The retrospective line is EN0499's, not that window: a request becomes retrospective "when more than 90 days have passed since the start date of the requested authorization, or any time after the patient has discharged." [1][2]
- **Telehealth**: The most permissive published 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 — in person, telehealth or hybrid — chosen on the individual's needs rather than by code. State Medicaid telehealth restrictions do not reach commercial Cigna business. [2]
- **Other insurance (who pays first)**: Evernorth follows the NAIC order-of-benefit rules "subject to applicable law and the terms of the benefit plan." Dependent child of married parents living together: the "birthday rule" — "The plan of the parent whose birthday falls earlier in the calendar year is primary" (month and day only; same birthday, the longer-running plan). Divorced or separated parents: a court decree first, otherwise custodial parent, custodial parent's spouse, noncustodial parent, noncustodial parent's spouse. When Cigna is secondary, bill the primary first and submit to Cigna with the primary's explanation of payment; the 90-day filing limit runs from the primary's processing date. Cigna pays ahead of Medicaid (payer of last resort by federal law — the Medicaid program may still require its own PA), TRICARE (secondary to other health insurance by law) and CHAMPVA (pays after other health insurance). [3][5][6][7]
- **Age limit** _(plan-dependent)_: EN0499 publishes no age limit for ABA. The bound on a Cigna card therefore comes from the plan document and, on fully-insured business, from the state autism mandate — Maryland's habilitative mandate runs through the month the enrollee turns 19, Missouri's ABA dollar cap runs through age 18, Indiana's mandate has no age term at all. Establish plan funding type before quoting any bound. [1]
  - Ask the plan: Benefits verification on the specific plan — confirm the ABA benefit exists, the funding type, and any age or visit limit.
- **Prior-auth decision time** _(plan-dependent)_: Cigna/Evernorth publishes no clock of its own: "We (or our designees) make coverage determinations in accordance with the time frames required under applicable law." For self-funded employer plans that is the ERISA claims rule — a pre-service decision within 15 days (one 15-day extension) and 72 hours for urgent care; fully insured plans follow the state's utilization-review law. What Cigna does publish on timing is encouragement, not a rule: its autism resource guide says "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." EN0499 (eff. 5/15/2026) sets the actual retrospective trigger: "A retrospective authorization request for ABA is any request made when more than 90 days have passed since the start date of the requested authorization, or any time after the patient has discharged." [3][1][2][4]
  - Ask the plan: Benefits verification: fully insured (state UR deadlines) or self-funded/ASO (ERISA)? Confirm the reauthorization window with the Cigna Autism Care Coordinator team (877-279-7603).
- **Who may diagnose** _(ask the plan)_: 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. What the policy does fix about the diagnosis is its content: a DSM-5-TR autism spectrum diagnosis, with Rett syndrome (F84.2) expressly excluded. [1][2]
  - Ask the plan: Evernorth Behavioral Health provider services (the behavioral health number on the member's card) — ask which diagnosing credentials EN0499 accepts before relying on a diagnosis from a non-doctoral clinician.

## Delivery and billing rules

Coverage decides whether Cigna / Evernorth pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: 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 at all, so the supervising clinician is also the contractual party. The treatment plan must name a credentialed supervisor and define discharge criteria with a fading plan. [1]
- **Concurrent billing (97153 + 97155)**: Two rules, and the first one catches more claims than the second. ABA is not covered when delivered at the same time as another therapy — speech, OT — to the same child, which makes the family's existing therapy schedule an intake fact rather than a note. And only one provider can bill a unit of time, with the standard supervision exceptions. Where a family is transitioning from another ABA agency, overlapping authorization periods require documented coordination between the agencies, so capture the outgoing provider's details and get releases signed up front. [1]
- **Session-note signature**: EN0499 specifies the note element by element: 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]
- **Bill as provider**: Evernorth does not credential non-licensed staff, so RBT-delivered services bill under the supervising provider. The treatment plan must carry a named, credentialed supervisor, and assessment codes are payable only when performed by an independently licensed provider or a BCBA. [1]
- **Daily limits / MUEs** _(ask the plan)_: 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.
- **Place of service** _(ask the 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.

## What intake should collect for Cigna / Evernorth

- **Member ID + plan details:** Card photo, subscriber info, and whether the plan actually includes the ABA benefit.
- **Diagnosis documentation:** DSM-5-TR ASD diagnosis; note Rett syndrome (F84.2) is excluded under EN0499.
- **Recent standardized assessment:** E.g., Vineland-3 within 60 days of treatment start — or plan to administer one during your assessment window.
- **Current therapy schedule:** Days/times of speech, OT, PT — concurrent-service timing directly affects billability.
- **Prior/current ABA provider:** Transitions need documented coordination; get releases signed at intake.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Cigna / Evernorth ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00004
- **Payer ID (Availity):** 62308
- **Payer ID (Change Healthcare / Optum):** 62308
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Evernorth Behavioral Health
- **BH administrator payer ID:** 62308
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### How the 271 reports ABA benefits

- **ABA benefit bucket (service type code):** MH
- **Deductible applies to ABA:** yes — Base deductible for MH-flavored codes is returned per the companion guide's own worked example, but REMAINING deductible/benefit amounts are explicitly withheld for Mental Health, Pharmacy, and Vision plans (§7.2.2-7.2.3) — a real 271 for an ABA member may show the base figure but not how much has been used.
- **Cost-share type:** plan-dependent — Both copay (EB*C) and coinsurance (EB*A) segments are structurally supported per plan; which applies to a given member is plan-document-specific.
- **271 response quality for ABA:** high

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes — for ASD, per national policy EN0499 (Rett syndrome/F84.2 excluded) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | Yes — "all ABA CPT codes are covered telehealth services" per Cigna's March 2025 provider guide | plan-dependent — no telehealth modifier list published nationally |
| 97152 | Yes — for ASD, per national policy EN0499 (Rett syndrome/F84.2 excluded) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | Yes — "all ABA CPT codes are covered telehealth services" per Cigna's March 2025 provider guide | plan-dependent — no telehealth modifier list published nationally |
| 97153 | Yes — for ASD, per national policy EN0499 (Rett syndrome/F84.2 excluded) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | Yes — "all ABA CPT codes are covered telehealth services" per Cigna's March 2025 provider guide | plan-dependent — no telehealth modifier list published nationally |
| 97154 | Yes — for ASD, per national policy EN0499 (Rett syndrome/F84.2 excluded) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | Yes — "all ABA CPT codes are covered telehealth services" per Cigna's March 2025 provider guide | plan-dependent — no telehealth modifier list published nationally |
| 97155 | Yes — for ASD, per national policy EN0499 (Rett syndrome/F84.2 excluded) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | Yes — "all ABA CPT codes are covered telehealth services" per Cigna's March 2025 provider guide | plan-dependent — no telehealth modifier list published nationally |
| 97156 | Yes — for ASD, per national policy EN0499 (Rett syndrome/F84.2 excluded) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | Yes — "all ABA CPT codes are covered telehealth services" per Cigna's March 2025 provider guide | plan-dependent — no telehealth modifier list published nationally |
| 97157 | Yes — for ASD, per national policy EN0499 (Rett syndrome/F84.2 excluded) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | Yes — "all ABA CPT codes are covered telehealth services" per Cigna's March 2025 provider guide | plan-dependent — no telehealth modifier list published nationally |
| 97158 | Yes — for ASD, per national policy EN0499 (Rett syndrome/F84.2 excluded) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | Yes — "all ABA CPT codes are covered telehealth services" per Cigna's March 2025 provider guide | plan-dependent — no telehealth modifier list published nationally |
| 99366 | Not confirmed (see code notes) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | — | plan-dependent — no telehealth modifier list published nationally |
| 0362T | Yes — for ASD, per national policy EN0499 (Rett syndrome/F84.2 excluded) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | Yes — "all ABA CPT codes are covered telehealth services" per Cigna's March 2025 provider guide | plan-dependent — no telehealth modifier list published nationally |
| 0373T | Yes — for ASD, per national policy EN0499 (Rett syndrome/F84.2 excluded) | — | plan-dependent — EN0499 is a medical-necessity policy only; no coding/reimbursement mechanics (unit caps, POS) are published in it per plan-dependent | plan-dependent | Yes — "all ABA CPT codes are covered telehealth services" per Cigna's March 2025 provider guide | plan-dependent — no telehealth modifier list published nationally |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 99366, 0362T, 0373T:** Verify via: Cigna/Evernorth provider services — EN0499 is a medical-necessity policy only; per-code PA status, unit caps, and POS are plan-dependent or unconfirmed nationally.

### Contacts

- **Provider services phone:** 1-800-926-2273 (Evernorth Behavioral Health)
- **Portal:** [CignaforHCP / Provider.Evernorth.com](https://cignaforhcp.cigna.com/app/login)

Questions to ask on a verification call:

- Does this plan require prior authorization on ABA assessment codes (97151/97152/0362T) separately from treatment codes, since EN0499 does not state a per-code PA distinction?
- Is 99366 (interdisciplinary team meeting) a covered, billable benefit under this plan?
- What are the daily/session unit caps for 97151-97158 and 0362T/0373T under this specific plan?
- What place-of-service settings does this plan allow for ABA, and what modifiers (beyond the confirmed telehealth-everywhere policy) does it require?
- Does this plan support real-time (vs. batch) 270/271 eligibility for payer ID 00004?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23)
- https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/autism-resource-guide.pdf (accessed 2026-07-23)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://www.cigna.com/static/www-cigna-com/docs/5010-270-271-companion-guide.pdf (accessed 2026-07-23)
- https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/en_mm_0499_coveragepositioncriteria_intensive_behavioral_interventions.pdf (accessed 2026-07-23)
- https://static.cigna.com/assets/chcp/pdf/resourceLibrary/behavioral/ebh-provider-admin-guide.pdf (accessed 2026-07-23; source document older than 18 months)

## Common questions

### Does Cigna require prior authorization for ABA?

Not for assessment codes (97151, 97152, 0362T) when there's an autism diagnosis and the provider is independently licensed or a BCBA. Treatment services do require authorization — assessment plus treatment plan with the PA form.

### Does Cigna cover ABA by telehealth?

Yes — its March 2025 provider guide states all ABA CPT codes are covered telehealth services, with delivery (in-person, telehealth, hybrid) based on the individual's needs.

### Can a child receive ABA and speech therapy under Cigna?

Yes, but not at the same time of day — Cigna doesn't cover ABA delivered concurrently with another therapy session. Intake should capture the existing therapy schedule to plan around it.

## Primary sources

1. [Cigna EN0499 — Intensive Behavioral Interventions](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/en_mm_0499_coveragepositioncriteria_intensive_behavioral_interventions.pdf)
2. [Cigna autism resource guide (Mar 2025)](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/autism-resource-guide.pdf)
3. [Evernorth Behavioral Health Administrative Guidelines (March 2026) (PDF)](https://static.evernorth.com/assets/evernorth/provider/pdf/resourceLibrary/behavioral/ebh-provider-admin-guide.pdf)
4. [29 CFR § 2560.503-1(f)(2) — ERISA group health plan claim decision deadlines](https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XXV/subchapter-F/part-2560/section-2560.503-1)
5. [42 CFR § 433.139 — Medicaid payment of claims involving third party liability](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
6. [32 CFR § 199.8 — TRICARE double coverage](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/part-199/section-199.8)
7. [VA — CHAMPVA Guidebook (updated Jan. 1, 2025) (PDF)](https://www.va.gov/files/2025-12/CHAMPVA-Guidebook.pdf)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.