---
title: "Cigna / Evernorth ABA coverage in Alaska: the intake guide."
url: "https://carelu.com/payers/cigna-alaska"
markdown_url: "https://carelu.com/payers/cigna-alaska.md"
state: AK (Alaska)
payer: Cigna / Evernorth in Alaska
kind: Commercial insurance
description: "How Cigna / Evernorth covers ABA for Alaska families: national policy EN0499, no PA on assessments, Alaska’s AS 21.42.397 autism mandate (under 21, no visit limits, small-group exemption), Alaska behavior-analyst licensure, and what intake should verify."
last_reviewed: October 2026
---

# Cigna / Evernorth ABA coverage in Alaska: the intake guide.

_Payer Guide · Cigna · Alaska · Last updated October 2026 · 17 primary sources_

> EN0499 + autism resource guide + Alaska’s AS 21.42.397 mandate; no PA on assessment codes; Evernorth has an Alaska regulatory addendum.

For an intake team in Alaska, a Cigna card means three layers: Evernorth’s national ABA policy EN0499 with the Cigna autism resource guide, Alaska’s autism mandate in AS 21.42.397, and the plan’s funding type and employer size, which decide whether the mandate applies. Many Cigna members are on self-funded employer plans, so check funding first.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed or a BCBA (Cigna autism resource guide); EN0499 sets no PA rule itself [2][1]
- **Prior auth for treatment**: Required: completed assessment and treatment plan attached to the ABA Prior Authorization Form [2][1]
- **Autism diagnosis required?**: Yes: ASD (F84.0–F84.9 except F84.2 Rett) under DSM-5-TR criteria [1]

## At a glance

- **Covers ABA?:** Yes, for ASD, per national policy EN0499
- **State mandate:** AS 21.42.397 (coverage for autism spectrum disorders)
- **Mandate age:** Under 21: coverage "is required to be provided only to individuals under 21 years of age"
- **Mandate caps:** No dollar cap and no visit limits in the statute; ordinary cost-sharing applies
- **Exempt from mandate:** Self-funded ERISA plans; small-group employers with 20 or fewer employees; waiver possible for 21–25 employees; fraternal benefit societies
- **Licensure:** Required: Alaska behavior-analyst license (AS 08.15); technicians exempt when directed by a licensed behavior analyst
- **Fee schedule:** Not public — your ABA fee schedule is Exhibit A of your Evernorth Provider Agreement; fee questions to Evernorth Provider Services, 800.926.2273

## The national policy, applied in Alaska

Cigna, through Evernorth Behavioral Health, covers ABA under EN0499 (effective May 15, 2026). Per the autism resource guide, prior authorization is no longer required for assessment codes 97151, 97152 and 0362T with an autism diagnosis, as long as the provider is independently licensed or a BCBA. Treatment needs the completed assessment and treatment plan on the ABA Prior Authorization Form. EN0499 and the resource guide contain no Alaska-specific criteria. Evernorth’s Administrative Guidelines (September 2026) do carry an Alaska Regulatory Addendum for insured plans (not self-funded ones): a fair, prompt mutual dispute-resolution process with an initial meeting within ten working days and mediation, continuity of care for a member in active treatment when a provider’s agreement ends (up to 90 days for an ongoing course of treatment, or to the end of the plan year if longer), and claims handled under AS 21.36.495. Cigna runs no Alaska Medicaid plan; Alaska Medicaid is fee-for-service. [1][2][3][17]

## The Alaska mandate: what it guarantees

Alaska’s autism mandate is AS 21.42.397. Every health care insurer that offers, issues, delivers or renews a health care insurance plan in the state (fraternal benefit societies excepted) "shall provide coverage for the costs of the diagnosis and treatment of autism spectrum disorders." The statute names ABA expressly: "habilitative or rehabilitative care" includes "applied behavior analysis or other structured behavioral therapies." Three conditions shape a claim. Treatment must be "prescribed by a licensed physician, psychologist, or advanced practice registered nurse, provided by or supervised by an autism service provider, and as identified in a treatment plan developed following a comprehensive evaluation." An "autism service provider" is someone "licensed, certified, or registered by the applicable state licensing board or by a nationally recognized certifying organization." And coverage "is required to be provided only to individuals under 21 years of age." The statute caps nothing by dollars and says coverage "may not limit the number of visits to an autism service provider for treatment," though ordinary copayments, deductibles, coinsurance and general exclusions apply. It also says coverage "must cover medically necessary treatment that is coordinated with an education program, but may not be contingent on" that coordination. Two employer-size carve-outs matter: an insurer covering a small employer with 20 or fewer employees "is not required to provide" the mandated coverage, and for a small employer with 21 to 25 employees the director may waive it if actual claims experience shows the mandate raised premiums by three percent or more over 12 months. The mandate reaches fully insured plans; self-funded employer plans answer to ERISA and federal parity instead. [4]

## Licensure, out-of-state BCBAs and rates

Alaska licenses behavior analysts. AS 08.15.010 says "A person may not practice behavior analysis in this state without a license," and practicing without one is a misdemeanor. The licensing agency is the Department of Commerce, Community, and Economic Development (the BACB’s table lists the Division of Corporations, Business and Professional Licensing, licensure since 2014); there is no separate board. A behavior analyst license requires passing the BCBA examination, current BACB certification and a fingerprint-based criminal history check; an assistant behavior analyst license requires BCaBA certification plus proof of direct supervision by a licensed behavior analyst. Technicians are not licensed: the chapter does not apply to "an individual who directly implements applied behavior analysis services, or family member implementing a behavior analysis plan within the home, who acts under the direction of a licensed behavior analyst or licensed assistant behavior analyst." For out-of-state clinicians, the only short route in statute is a temporary license "for 30 days or less in a calendar year" for someone licensed in a state whose requirements are "substantially equivalent." Telehealth does not remove the license requirement: AS 08.02.130 lets "a health care provider licensed in this state," a category that names behavior analysts licensed under AS 08.15, treat a patient in Alaska by telehealth without a prior in-person visit, and its out-of-state exception covers only physicians and members of an out-of-state physician’s multidisciplinary team for life-threatening conditions. The commercial telehealth statute, AS 21.42.422, likewise requires coverage of telehealth "by a health care provider licensed in this state." Commercial ABA rates are negotiated and unpublished; the public benchmark is the Alaska Medicaid autism-services rate chart, which from July 1, 2026 pays 97153 at $31.95 and 97151/97155/97156 at $41.97 per 15 minutes. [5][14][6][7][16]

## Claims: filing, payment and what Cigna pays

Cigna publishes no ABA rate table. Evernorth’s Administrative Guidelines say the Provider Agreement terms "include the reimbursement rates applicable to covered services" and tell ABA providers to see "Exhibit A in your Provider Agreement" for the fee schedule and reimbursable autism services; fee questions go to Provider Services at 800.926.2273. Virtual services carry modifier 95, which Evernorth says "will not change the reimbursement." Non-credentialed technicians are paid only through the supervising provider’s claim (electronic payer ID 62308). On payment, AS 21.36.495 requires a health care insurer to pay or deny a clean claim "within 30 calendar days after the insurer or a third-party administrator under contract with the insurer receives a clean claim," to send any denial or request for information within the same 30 days, and then to pay within 15 calendar days of receiving the requested information; a late claim is presumed clean and accrues 15 percent annual interest. AS 21.07.020 bars an insurer from retroactively denying a preauthorization based on medical necessity unless it rested on "materially incomplete or inaccurate information provided by or on behalf of the provider." Self-funded ERISA plans sit outside both statutes. For a public benchmark, Alaska Medicaid pays 97153 at $31.95 per 15 minutes from July 1, 2026. [3][2][8][9][16]

Evernorth’s Behavioral Health Administrative Guidelines (September 2026) set the filing limit: "We will only consider claims submitted within 90 days of the date of service or as otherwise defined in your Provider Agreement," unless "Applicable state law provides for a longer timely filing limit." For a secondary claim the 90 days run from "the primary payer’s processing date as stated on an explanation of benefits [EOB] or explanation of payment [EOP]," Medicaid-primary claims get three years, and a timely claim returned for more information gets a new 90 days from the date of the request. The Alaska Regulatory Addendum adds no filing deadline; it binds Evernorth to AS 21.36.495 on claims and overpayment recovery. State addenda do not apply to self-funded plans. The guidelines publish no check-run or weekly cut-off schedule. [3][2][8][9][16]

## Does Cigna need a referring provider on the ABA claim?

No. Evernorth’s administrative guidelines (September 2026) define a complete CMS-1500 claim as the patient’s ID number, name, address and date of birth; the subscriber’s name and address; release of information and assignment of benefits; diagnosis codes and pointer; date and place of service; CPT/HCPCS code and modifier; billed charge, units, TIN and total charge; the “Rendering provider’s name, NPI, and license type”; and the “Billing provider’s name, address, and NPI.” No referring or ordering provider is on that list. If you do report one on an 837, “Any additional provider identification on the claim, such as the “Rendering Provider” or “Referring Provider,” must include the name and NPI when submitted.” [3][2]

The ABA-specific paper-claim rules sit in the autism resource guide: use Form CMS-1500, “Print your name in box 31,” and “List only a BCBA or other licensed provider in box 33.” Evernorth does not credential non-licensed or non-certified staff, so their services are billed under the supervising provider. [3][2]

## What a reauthorization must show

Evernorth’s EN0499 sets what a continued-treatment request must show: "current data" collected "within no more than 60 days prior to the start date of the continued treatment request, as well as collected within no more than 60 days prior to the date the authorization request is received," with collection dates, for every behavior and skill targeted; data showing "ongoing and sustained progress toward mastering the treatment goals"; measurable improvement on "a reliable, valid, and standardized assessment instrument completed no more than one year prior to the start date of the continued treatment request"; an account of barriers and plan changes where progress is not shown; and dated stakeholder (caregiver) training data. EN0499 does not require the data to be graphed. [1]

## Intake gates

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

- **Diagnosis recency**: No expiry on the diagnosis, but the request needs the date it was most recently made. The clocks run on data: the standardized instrument within 60 days before treatment, baseline data within 60 days, and current data within 60 days of a continued-treatment request. [1]
- **Who may diagnose**: A healthcare professional "licensed to practice independently and whose licensure board considers diagnostics" within scope, applying DSM-5-TR criteria. [1]
- **Diagnostic tools required**: No single instrument is mandated, but the assessment must be standardized, completed by a trained administrator, and the current edition (the policy’s example: "Vineland-3 vs. Vineland-II"). [1]
- **Referral required?**: EN0499 requires no referral. Assessments 97151, 97152 and 0362T need no PA with an autism diagnosis when the provider is independently licensed or a BCBA; treatment needs the assessment and plan on the ABA PA form. For a fully insured Alaska plan, AS 21.42.397(a) requires the covered treatment to be "prescribed by a licensed physician, psychologist, or advanced practice registered nurse" and identified in a treatment plan developed after a comprehensive evaluation, so keep that prescription and the evaluation in the file. Self-funded ERISA plans sit outside the statute. [2][1][4]
- **Telehealth**: "All ABA CPT codes are covered telehealth services" per the autism resource guide, and EN0499 allows "traditional in-person service delivery, telehealth, or a hybrid," chosen on clinical factors; virtual services are billed with modifier 95. For a fully insured Alaska plan, AS 21.42.422 requires coverage "for benefits provided through telehealth by a health care provider licensed in this state" and bars requiring "prior in-person contact" before payment; the statute does not list which services or codes. Self-funded employer plans are outside it. The clinician must hold an Alaska behavior-analyst license (AS 08.15.010; AS 08.02.130). [2][1][3][7][5][6]
- **Age limit** _(plan-dependent)_: EN0499 sets no age cap; it says access to focused intervention "should not be restricted by age, cognitive level, diagnosis, or co-occurring conditions." Age terms come from the benefit plan and any controlling mandate. For fully insured Alaska plans, AS 21.42.397(b)(1) requires the autism coverage "only to individuals under 21 years of age," with no visit limits and no dollar cap; small-group plans of 20 or fewer employees are exempt. Self-funded ERISA plans are outside the statute, so plan funding type decides whether that binds. [1][4]
  - Ask the plan: Live benefits verification: establish fully insured vs. self-funded ERISA and employer size first.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. Fully insured Alaska plans follow 3 AAC 28.910: for a prospective (pre-service) request the insurer must decide and notify "not later than five working days after the date the health care insurer receives the request," with one extension of up to five working days for matters beyond its control; the clock starts when the request is filed under the insurer’s procedures, "without regard to whether all of the information necessary to make the determination accompanies the filing." Urgent requests are decided within 24 hours (3 AAC 28.912). A reduction or termination of an already-certified course of treatment is an adverse determination that must be noticed in time for the member to appeal first. SB 133 (2025) tightens this for plans issued or renewed on or after January 1, 2027: 72 hours for a complete standard request (72 hours excluding weekends if faxed), 24 hours for an expedited one, and a request with no timely written decision or request for information "is considered approved." Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1 instead: pre-service decisions "not later than 15 days after receipt of the claim," one 15-day extension, urgent care within 72 hours. Cigna/Evernorth publishes no Alaska-specific ABA turnaround or reauthorization lead time. [10][11][15]
  - Ask the plan: At benefits verification ask whether the plan is fully insured (Alaska-regulated) or self-funded (ERISA), the plan’s issue or renewal date (SB 133’s 72-hour clock starts with plans issued or renewed on or after 1/1/2027), and what reauthorization lead time Cigna/Evernorth expects.
- **Other insurance (who pays first)** _(plan-dependent)_: Alaska requires every major medical policy to carry a coordination-of-benefits provision (AS 21.42.205), and when a child has two plans the secondary insurer, "absent evidence of fraud, … must accept the primary insurer’s precertification, utilization review, or other managed care requirement determination and may not deny, delay, or reduce benefits" for a member who met the primary’s requirements (3 AAC 26.110(c)). Neither text sets the order of benefits between two parents’ plans, so get the order from the carrier. If the child also has Alaska Medicaid, Cigna/Evernorth pays first: Medicaid is payer of last resort (42 CFR 433.139), and an Alaska Medicaid provider must report any other payment and enter it "as a credit against the charge to the department" (7 AAC 145.005(i)). TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). [12][13][18][19][20][21]
  - Ask the plan: Ask Cigna/Evernorth at benefits verification for the member’s coordination-of-benefits order (and whether the plan uses the birthday rule for two parents’ plans), and record every other coverage the child has.

## Delivery and billing rules

Coverage decides whether Cigna / Evernorth in Alaska 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**: Case supervision is by a BCBA, a Licensed Behavior Analyst, or an independently licensed mental health professional with ABA training, at one to two hours per ten hours of direct treatment; at 10 hours a week or less, at least one to two hours a week. In Alaska the supervising behavior analyst must hold an Alaska license (AS 08.15.010), and technicians are exempt from licensure only when acting under a licensed behavior analyst’s or licensed assistant’s direction (AS 08.15.070(3)). [1][5]
- **Concurrent billing (97153 + 97155)**: Only one provider may bill for a unit of time, except 97153, 97154 and 97155 during direct supervision, when the BCBA or QHP directs the technician and both are face-to-face with the patient at the same time. Speech, OT and other therapies are a separate rule: EN0499 says ABA "is not covered or reimbursable when delivered to the same individual, at the same time as any other treatment modality (e.g., ABA and speech therapy, or ABA and occupational therapy)." Schedule ABA and other therapies in separate time blocks. ABA built into a speech or OT session is not billable. [2][1]
- **Daily limits / MUEs**: No per-day cap is published. All ABA services bill in 15-minute units with 97151–97158, 0362T and 0373T only; intensity must reflect severity, goals and response to treatment. For fully insured Alaska plans, AS 21.42.397(b)(2) bars limiting "the number of visits to an autism service provider." [2][1][4]
- **Session-note signature**: Each service record must include, among other things, the "Name, credential (if applicable), and signature of ABA provider who rendered the service," with dates and times, location, focus and who was present. [1]
- **Place of service**: EN0499 has goals and data reported by setting (home, clinic, school, community) and excludes primarily educational or vocational services. AS 21.42.397(b)(4) requires fully insured plans to cover medically necessary treatment coordinated with an education program, without making coverage contingent on it. [1][4]
- **Bill as provider**: Evernorth does not credential non-licensed or non-certified staff; their services are billed under the supervising provider. On a CMS-1500 the rendering provider prints their name in box 31 and only a BCBA or other licensed provider goes in box 33; electronic claims use payer ID 62308. [2]

## What intake should collect for Cigna / Evernorth in Alaska

- **Plan funding type and employer size:** Fully insured (AS 21.42.397 applies) vs. self-funded ERISA, and whether the employer is a small group of 20 or fewer (exempt).
- **Child’s age:** The Alaska mandate requires coverage only under 21.
- **Diagnosis report:** Diagnosing clinician’s name, credentials and licensure type, plus the date of the most recent diagnosis. Provisional or rule-out diagnoses don’t count.
- **Standardized assessment timing:** Instrument administered within 60 days before treatment starts.
- **Prescription and treatment plan:** AS 21.42.397 ties coverage to treatment prescribed by a physician, psychologist or APRN, in a plan following a comprehensive evaluation.

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

## Common questions

### Does Cigna require graphs for ABA reassessments?

No. Evernorth’s EN0499 requires dated data collected within 60 days before both the requested start date and the request’s receipt, sustained progress, and a standardized assessment from the past year, but it does not require graphs.

### What are Cigna (Evernorth)’s claim filing deadlines for Alaska ABA claims?

90 days from the date of service unless your provider agreement or a longer state limit applies; secondary claims get 90 days from the primary payer’s EOB/EOP date, and a claim returned for more information gets a new 90 days. No check-run schedule is published.

### Does Cigna cover ABA therapy in Alaska?

Yes, under national policy EN0499 for ASD, with Alaska’s AS 21.42.397 mandate layered on for fully insured plans. Self-funded employer plans and small groups of 20 or fewer employees are outside the mandate.

### Does the Cigna ABA assessment need prior authorization in Alaska?

No, for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed or a BCBA. PA starts at treatment.

### Does a BCBA need an Alaska license to bill Cigna?

Alaska law bars practicing behavior analysis in the state without a license, so plan on the Alaska license; the out-of-state route in statute is a temporary license of up to 30 days a year.

### What does Cigna pay for ABA in Alaska?

Cigna publishes no ABA rates. Evernorth says your fee schedule is in Exhibit A of your Provider Agreement; call Evernorth Provider Services (800.926.2273). Alaska Medicaid’s rate for 97153 ($31.95 per 15 minutes from July 1, 2026) is the public benchmark.

### Does Cigna require a referring provider (box 17) on ABA claims?

No. Evernorth’s complete-claim definition for the CMS-1500 lists the rendering and billing providers but no referring provider. If you report a referring provider on an electronic claim, include both the name and the NPI.

## Primary sources

1. [Evernorth EN0499 — Intensive Behavioral Interventions (eff. 5/15/2026)](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/en_mm_0499_coveragepositioncriteria_intensive_behavioral_interventions.pdf)
2. [Cigna / Evernorth autism resource guide (March 2025)](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/autism-resource-guide.pdf)
3. [Evernorth Behavioral Health Administrative Guidelines (PCOMM-2026-191, September 2026; incl. Alaska Regulatory Addendum)](https://static.evernorth.com/assets/evernorth/provider/pdf/resourceLibrary/behavioral/ebh-provider-admin-guide.pdf)
4. [AS 21.42.397 — Coverage for autism spectrum disorders](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=21.42.397&secEnd=21.42.397)
5. [AS 08.15 — Behavior Analysts (license required; temporary license; exemptions)](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=08.15.010&secEnd=08.15.990)
6. [AS 08.02.130 — Telehealth (licensed providers; out-of-state physician exception)](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=08.02.130&secEnd=08.02.130)
7. [AS 21.42.422 — Coverage for telehealth (commercial)](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=21.42.420&secEnd=21.42.425)
8. [AS 21.36.495 — Prompt payment of health care insurance claims](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=21.36.495&secEnd=21.36.495)
9. [AS 21.07 — Patient and provider protection; required contract provisions (AS 21.07.020: no retroactive denial of preauthorization)](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=21.07.001&secEnd=21.07.250)
10. [3 AAC 28.900–28.989 — Utilization review, grievances and external review (3 AAC 28.910 standard, 28.912 expedited, 28.936 180-day grievance)](https://www.akleg.gov/basis/aac.asp?media=print&secStart=3.28.900&secEnd=3.28.999)
11. [SB 133 (2025), enrolled — prior authorization deadlines, AS 21.07.100–21.07.180 (plans issued or renewed on or after Jan. 1, 2027)](https://www.akleg.gov/PDF/34/Bills/SB0133Z.PDF)
12. [AS 21.42.205 — Coordination of benefits provision required](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=21.42.205&secEnd=21.42.205)
13. [3 AAC 26.110(c) — Secondary insurer must accept the primary insurer’s precertification](https://www.akleg.gov/basis/aac.asp?media=print&secStart=3.26.010&secEnd=3.26.999)
14. [BACB — U.S. Licensure of Behavior Analysts (Alaska, 2014: Division of Corporations, Business and Professional Licensing)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
15. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
16. [Alaska DOH, Division of Behavioral Health — Medicaid Procedure Codes and Rates, Autism Services (effective July 1, 2026)](https://health.alaska.gov/media/3kyjzoiw/fy2027-autism-services-fee-schedule-2026-07-01.pdf)
17. [Alaska House Finance Committee minutes, Feb. 13, 2025 (Department of Health: Alaska Medicaid is fee-for-service)](https://www.akleg.gov/pdf/34/M/HFIN2025-02-130902.pdf)
18. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
19. [7 AAC 145.005 — Conditions for payment (12-month claim deadline; payment from other sources)](https://www.akleg.gov/basis/aac.asp?media=print&secStart=7.145.001&secEnd=7.145.060)
20. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
21. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 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.