For an intake team in Arizona, a Cigna card means three layers at once: the carrier's national clinical policy, Arizona's autism insurance mandate (Steven's Law, its dollar caps freshly repealed by SB 1590), and the plan's funding type deciding which of the two actually binds.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 — EN0499 expects a confirmed ASD diagnosis (F84.0–F84.9, Rett excluded) by an independently licensed professional, a current-version standardized assessment instrument (e.g., Vineland-3) administered within 60 days before treatment start, and an individualized plan with baseline data. That clinical policy is national — what changes in Arizona is the legal floor underneath it: the state mandate below governs what fully-insured group 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 Arizona.[1][2]
Steven's Law (HB 2847, 2008) lives in four parallel sections of the insurance code — A.R.S. §§ 20-826.04, 20-1057.11, 20-1402.03, and 20-1404.03 — covering state-regulated group coverage: large-group contracts, HMO plans, and group and blanket disability policies. Plans may not deny or limit treatment based solely on an autism spectrum disorder diagnosis, and may not exclude medically necessary behavioral therapy, which the statute defines to include ABA (discrete trial training, pivotal response training, intensive behavioral intervention), delivered or supervised by a licensed or certified provider. The headline change: SB 1590 (signed May 7, 2025) struck the dollar-cap subsection from all four sections — the old $50,000/year (under age 9) and $25,000/year (ages 9–16) behavioral-therapy maximums are repealed, taking the statute's only age tiers with them, and the ASD definition now tracks the current DSM. No annual dollar ceiling remains on any state-regulated group plan (federal parity had already made the caps largely unenforceable; SB 1590 cleaned the statute to match — do not treat the old $50K/$25K numbers as current). Exemptions: policies issued to an individual or small employer (those reach ABA via the ACA EHB benchmark instead), limited-benefit coverage, and self-funded ERISA plans. Ordinary cost sharing is still permitted.[3][4][5]
We checked: the current EN0499's state-mandate paragraph names only New York and Virginia — there is no Arizona carve-out, so Arizona fully-insured business runs on the standard EN0499 criteria, including the no-assessment-PA fast path and the 60-day assessment-instrument recency rule. Cigna publishes no Arizona-specific ABA policy or supplement, and it runs no AHCCCS Medicaid plan in Arizona. SB 1590's cap repeal still binds Cigna's Arizona-regulated group plans at the benefit level regardless of the clinical policy — so benefits verification (plan funding type, benefit terms) is where the Arizona-specific answers come from.[1]
Arizona requires a state license to practice behavior analysis — A.R.S. § 32-2091, administered by the Arizona Board of Psychologist Examiners (behavior analysts sit under the psychology board, not a standalone board) — and BCBA certification alone is not sufficient; AHCCCS itself defines "Behavior Analyst" as a person licensed under § 32-2091. On rates: Cigna does not publish commercial ABA fee schedules for Arizona (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement. Benchmark against the AHCCCS fee schedule (97153 at $17.91–$23.69 per 15-minute unit by credential tier), remembering the ABA codes live on the AHCCCS physician fee schedule, not the behavioral-health one.[6][7]
Cigna’s behavioral health network is run by Evernorth. Its autism resource guide (March 2025): “Individual providers and autism clinics must complete an application if they would like to join our network” — individuals use the Evernorth Behavioral Provider Information Form, and autism clinics and large group practices use the Evernorth Screening Application for Autism Clinics. Processing can take up to 90 days (questions after that go to BehavioralContracting@Evernorth.com), and once a clinic contract is signed, each certified or licensed provider must be credentialed, which “can take an additional 60 to 90 days.” Evernorth “does not credential nonlicensed/noncertified staff”; their services are billed under the supervising provider. The guide does not say whether the network is accepting new ABA providers in a given area, so ask Provider Services (800-926-2273).[2]
Evernorth publishes no ABA fee schedule. The guide sends questions about “credentialing, contracts, or rates” to your provider relations representative, so your rates are in your Evernorth contract.[2]
Arizona licenses the practice: “A person who wishes to practice as a behavior analyst must be licensed pursuant to this article” (A.R.S. § 32-2091.02, Board of Psychologist Examiners), and practicing unlicensed is a class 2 misdemeanor (§ 32-2091.12). Arizona is unusual in giving out-of-state clinicians a telehealth-only route: under A.R.S. § 36-3606 a health care provider “who is not licensed in this state may provide telehealth services to a person located in this state” after registering with the board that licenses the comparable profession, holding “a current, valid and unrestricted license to practice in another state that is substantially similar,” carrying malpractice coverage that includes Arizona telehealth, and following Arizona’s scope and standard-of-care rules. Behavior analysts are licensed under Title 32, chapter 19.1, which § 36-3601 includes in the definition of “health care provider.” A registered provider may not open an Arizona office (except within a multistate group that includes an Arizona-licensed provider) or see Arizona patients in person without an Arizona license. Fewer than ten telehealth encounters a year, or care in consultation with an Arizona-licensed provider who keeps ultimate authority, is exempt from registration.[8][9][10][11][13]
Evernorth, which manages Cigna’s behavioral benefits, frames it as a compliance duty rather than a member-state rule. Its Administrative Guidelines (September 2026): “Providers must meet all state requirements to provide virtual behavioral services, including any licenses and certifications,” must “comply with their state laws about the use of audio or video-based technology,” and providers who meet the telehealth specialty requirements “may deliver services virtually with no additional credentialing” after attesting on the Attested Specialty Form, when Evernorth adds “telehealth” to the provider profile. The guidelines do not say in terms which state’s license a remote BCBA needs, so read “all state requirements” against Arizona’s licensure law above and confirm with Evernorth before a remote start.[8][9][10][11][13]
Cigna’s behavioral benefits, ABA included, are administered by Evernorth Behavioral Health, whose administrative guidelines (revised September 2026) “will only consider claims submitted within 90 days of the date of service or as otherwise defined in your Provider Agreement” — a longer state-law limit overrides it, the clock resets to the date Cigna asks for more information, and Medicaid-secondary claims get three years. Appeals must be started in writing within 180 calendar days of the payment or denial decision. The guidelines’ Arizona regulatory addendum lets a provider ask for an appeal or adjustment of an underpaid claim within one year of payment on insured and non-Medicare HMO plans, and 180 days on self-insured plans.[13]
Arizona’s prompt-pay statute, A.R.S. § 20-3102, requires a health care insurer to adjudicate a clean claim “within thirty days after the health care insurer receives the clean claim or within the time period specified by contract,” and, absent a written contract setting a different period, to pay the approved portion within thirty days after adjudication; late payment carries interest at the legal rate. If the claim is not clean, the insurer must ask for the missing information in writing within thirty days and then adjudicate within thirty days of receiving it. Neither side may reopen a paid or denied claim more than one year after the insurer paid or denied it, except for fraud (§ 20-3102(J)). These statutes bind fully insured plans issued in the state; a self-funded employer plan (ERISA) is not subject to them and follows its plan documents and your contract.[12]
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.”[13][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.[13][2]
The questions that decide whether a family can start with Cigna / Evernorth in Arizona, and what they have to bring. Each maps onto something intake should ask on the first call.
EN0499 puts no expiry on the ASD diagnosis — it requires only that the submission carry "the name, credentials, and type of licensure of the individual who made the diagnosis" and "the date on which the diagnosis was most recently made." The 60-day clocks run on the assessment instead: administration of the standardized assessment instrument must be completed within 60 days prior to the start of treatment, and quantitative baseline data must be collected within 60 days prior to the start of treatment.[1]
"A confirmed diagnosis of autism spectrum disorder (ASD); (ICD-10-CM Diagnosis Codes F84.0 – F84.9, with the exception of F84.2, Rett syndrome) based on the criteria in the DSM-5-TR by a healthcare professional who is licensed to practice independently and whose licensure board considers diagnostics to be within their scope of practice." The ABA assessment itself is then performed by a BCBA, LBA, or an independently licensed mental health clinician with documented ABA training.[1]
EN0499 names no instrument but sets six tests the instrument must pass: it must be reliable, valid and standardized, measure functioning in the DSM-5-TR ASD domains (social communication/interaction; restricted, repetitive behavior), be completed in its entirety and as designed, have established reliability and validity for the population tested, be administered by someone trained to administer and interpret it, and be the most current version — "must be the Vineland-3 vs. Vineland-II." Date of administration, respondent and form type must be recorded.[1]
No referral or physician order is required. Prior authorization is not required on assessment codes 97151, 97152 or 0362T with an autism diagnosis "as long as the provider is independently licensed or a Board Certified Behavior Analyst (BCBA) and the patient's policy covers ABA services"; the authorization gate arrives at the treatment step, with the completed assessment and treatment plan.[2][1]
"All ABA CPT codes are covered telehealth services," subject to EN0499. The policy adds a documentation duty rather than a code restriction: where services are delivered "via telehealth modalities," the record must show the service still meets the definition of direct treatment/direct engagement "regardless of treatment location or modality" and is conducted per the treatment-plan goals. Because the guide covers all ABA CPT codes, that includes the 97151 assessment and 97152 supporting assessment and the BCBA’s 97155 direction of a technician. EN0499 sets supervision at one to two hours per ten hours of direct treatment, with the BCBA “face-to-face with the individual and either the Registered Behavior Technician® [RBT®] or the Board Certified Assistant Behavior Analyst® [BCaBA®]”; it does not say that face-to-face must be in person.[2][1]
Steven's Law now carries no explicit age limit: SB 1590 (signed May 7, 2025) struck the dollar-cap subsection from all four sections of the mandate, and the age tiers — under 9, and 9 through 16 — lived inside that subsection. Optum's own state-mandate entry describes the change as repealing "the maximum benefit limitations for behavioral therapy coverage for eligible persons who are 16 years old and younger." The carrier's national ABA policy adds no age bound of its own, so age comes from the benefit document, not the statute.[3][4][1]
Ask the plan: Benefits verification on the specific plan — funding type first, then the ABA benefit terms.
Evernorth (Cigna behavioral health) makes coverage determinations "in accordance with the time frames required under applicable law" and publishes no day counts; for ABA it asks 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 no longer need PA with an autism diagnosis. So the governing clock depends on funding. For a fully insured plan issued in Arizona, A.R.S. § 20-3404 governs: urgent requests "not later than five days after the receipt of all necessary information", non-urgent "not later than fourteen days after receipt of all necessary information", with the same five/fourteen days again after the provider completes an incomplete request — and "A prior authorization request is deemed granted if a health care services plan or its utilization review agent fails to comply with the deadlines." A granted authorization cannot be rescinded after services are rendered in good faith, absent fraud. A self-funded employer plan sits outside state law and follows ERISA: a non-urgent pre-service decision "not later than 15 days after receipt of the claim by the plan", extendable once by up to 15 days; an urgent one within 72 hours; the clock starts when the request is filed, whether or not it is complete; and an urgent request to extend an approved course is decided within 24 hours if made "at least 24 hours prior to the expiration" of the current authorization.[13][2][14][15]
Ask the plan: At benefits verification, ask whether the plan is fully insured (a policy issued in the state) or a self-funded employer (ERISA) plan — that decides which clock applies — then ask the carrier’s behavioral health precert line its expected ABA turnaround and how early it wants the reauth.
Arizona’s COB rule for group plans (A.A.C. R20-6-214) sets the order: the plan covering the person other than as a dependent pays first; for a dependent child, "The plan of a parent whose birthday occurs earlier in a calendar year shall cover a dependent child before" the other parent’s plan (month and day only); for separated or divorced parents, the custodial parent’s plan, then the custodial parent’s spouse’s, then the non-custodial parent’s, unless a court decree the plan knows of says otherwise. Self-funded plans follow their own plan document. Evernorth spells the same order out: the employee/subscriber plan is "always considered the primary payer" over a dependent plan; married parents follow "the 'birthday rule'"; divorced, separated or not-living-together parents follow the custodial rule (custodial parent, their spouse, non-custodial parent, their spouse) unless a court decree assigns it, and joint custody without a named parent falls back to the birthday rule. Paper COB claims need "a copy of the primary payer's explanation of payment (EOP)." Government coverage sorts itself by federal rule: a commercial plan pays before TRICARE, which is secondary to every other health plan but "In any double coverage situation involving Medicaid, CHAMPUS is always the primary payer"; CHAMPVA "is the last payer to OHI"; and Medicaid pays after all of them (42 CFR 433.139), so a child with commercial plus Medicaid needs this plan’s authorization and EOB before Medicaid will pay.[16][13][17][18][19]
Ask the plan: Collect both parents’ plans, dates of birth, and any custody decree at intake; confirm primary/secondary with each carrier’s COB unit (and whether the plan is self-funded) before the first claim.
Coverage decides whether Cigna / Evernorth in Arizona 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.
One to two hours per ten hours of direct treatment. "Direct case supervision (occurs concurrently with the delivery of direct treatment to the individual and consists of BCBA face-to-face with the individual and either the Registered Behavior Technician or the Board Certified Assistant Behavior Analyst) and indirect case supervision is consistent with the general accepted standard of care of one to two hours per ten hours of direct treatment." When direct treatment is 10 hours per week or less, a minimum of one to two hours per week of direct case supervision is provided, and the supervisor's name and credentials must be documented.[1]
Yes — and Evernorth writes it as an explicit carve-out from its general rule: "Only one provider can bill for a unit of time, with the exception of CPT codes 97153, 97154, and 97155 (direct supervision when the BCBA/qualified health care provider directs the technician and both are face-to-face with the patient at the same time)." Both must be with the patient; analyst time away from the patient is not inside the exception. 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]
The person who delivered the service signs the note. EN0499's Documentation Expectations require "A separate written record ... for each individual receiving ABA intervention corresponding with each service noted through identified CPT® Code." Each record must include at least the start and end date and time, the location, the focus of service, a detailed description of the intervention, the individuals present, the specific service delivered (direct service, supervision, stakeholder training and so on), and the "Name, credential (if applicable), and signature of ABA provider who rendered the service." EN0499 sets no deadline for signing.[1]
Under the supervising provider, because the technician cannot be credentialed: "Evernorth does not credential nonlicensed/noncertified staff. Services for these staff members must be billed under the supervising provider." Practically, the BCBA's credential is what the claim rides on for technician-delivered 97153.[2]
No POS list is published. EN0499 requires the treatment plan to identify the "settings and environments where treatment will occur (e.g., home, clinic, school, community setting)" and to collect data corresponding to each location of service; for settings with competing behavioral expectations — "academic setting, vocational placement, services delivered via telehealth modalities" — the record must show the service still meets the direct-treatment definition. Which of those settings is payable is a benefit-document question.[1][2]
Ask the plan: Evernorth Provider Services at 800.926.2273 for school and community settings, plus the member's benefit document.
Not published. The resource guide sets the code set (97151–97158, 0362T and 0373T only, all in 15-minute increments) but no per-day unit ceiling and no statement of which MUE table Evernorth applies.[2]
Ask the plan: Evernorth Provider Services at 800.926.2273.
Yes — under national policy EN0499 for ASD (no Arizona carve-out exists), layered on Steven's Law for state-regulated group plans. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.
No — SB 1590 (signed May 7, 2025) repealed the $50,000/$25,000 annual behavioral-therapy caps from all four Steven's Law sections. No annual dollar ceiling remains on any state-regulated group plan.
Evernorth (Cigna’s behavioral health arm) publishes no ABA fee schedule. Its autism resource guide sends questions about credentialing, contracts or rates to your provider relations representative, so the rate is in your Evernorth contract.
Apply to Evernorth: individuals use the Evernorth Behavioral Provider Information Form and autism clinics the Screening Application for Autism Clinics. Allow up to 90 days for the application and another 60 to 90 days to credential each provider after the clinic contract. Technicians are not credentialed; their services bill under the supervising provider.
Arizona requires a license (A.R.S. § 32-2091.02) but lets an out-of-state provider deliver telehealth after registering under A.R.S. § 36-3606. Evernorth (Cigna) requires providers to “meet all state requirements to provide virtual behavioral services, including any licenses”; confirm with Evernorth before a remote start.
Evernorth Behavioral Health, which administers Cigna’s ABA benefit, considers claims submitted within 90 days of the date of service unless your provider agreement or a longer state-law limit says otherwise.
Arizona law (A.R.S. § 20-3102) gives a fully insured plan 30 days from receipt to adjudicate a clean claim and, unless your contract says otherwise, 30 more days to pay the approved amount, with interest at the legal rate after that. Self-funded employer plans are not bound by the statute.
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.
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.
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