For an intake team in Arkansas, a Cigna card means three layers: Evernorth’s national ABA policy EN0499 with the autism resource guide, Arkansas’s autism mandate and prior-authorization law, and the plan’s funding type. Many Cigna members are on self-funded employer plans, so check funding first. Cigna is not an Arkansas PASSE.
Evernorth 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, when the provider is independently licensed or a BCBA and the policy covers ABA. Treatment needs the completed assessment and treatment plan on the ABA Prior Authorization Form. Neither document mentions Arkansas, so the national criteria apply.[1][2][3]
Evernorth’s Administrative Guidelines carry an Arkansas Regulatory Addendum for fully insured business. Citing A.C.A. § 23-63-1801 et seq., it limits recoupment to 18 months after payment (except fraud), lets the provider submit a corrected claim up to six months after a recoupment, bars retroactive eligibility denials after 120 days when eligibility was verified, and requires 90 days’ notice of a material contract amendment. The addendum does not apply to self-funded plans.[1][2][3]
Arkansas’s autism mandate is Ark. Code § 23-99-418, created by Act 196 of 2011 (HB 1315) for health benefit plans delivered, issued or renewed on or after October 1, 2011. As enacted, it reaches group and blanket plans, HMOs and hospital and medical service corporations, and the state and public school employee plans, but not individual major medical plans. Mandated “treatment” is care “prescribed, provided, or ordered for a specfic individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary and evidence-based,” including “Applied behavior analysis when provided by or supervised by a Board Certified Behavior Analyst,” plus pharmacy, psychiatric, psychological and speech, occupational and physical therapy care. The enacted text says ABA services “shall: (1) Have an annual limitation of fifty thousand dollars ($50,000); and (2) Be limited to children under eighteen (18) years of age.” Coverage may not carry visit limits or less favorable dollar limits, deductibles or coinsurance than physical illness, “shall not be denied on the basis that the treatment is habilitative in nature,” and an insurer may not review the medical necessity of ongoing autism treatment “to a greater extent than it does for other illnesses.” It does not displace IEP or IFSP obligations, and from 2014 exchange plans are excused from benefits beyond the essential health benefits. Those age and dollar terms have since moved in practice: Arkansas Blue Cross’s current ABA policy applies the $50,000 cap only to “Grandfathered” plans and quotes the Arkansas Insurance Department that it “will not allow age limits for any service for the treatment of autism.” We could not open the current codified text of § 23-99-418, so confirm the plan’s own terms. Self-funded ERISA plans sit outside the statute.[4][9]
Arkansas regulates behavior analysts by registration, not licensure, and only since 2025. Act 432 of 2025 (the Arkansas Behavior Analyst Registration Act, Ark. Code § 17-97-601 et seq.) has the Arkansas Psychology Board register a “registered behavior analyst” on proof of BCBA or BCBA-D certification and a criminal background check, for two years at a time. The Act protects the title: unless registered, a person may not hold themselves out as a registered behavior analyst. It does not make practice itself unlawful without registration. It also offers temporary registration to a behavior analyst licensed elsewhere, or BACB-certified, who practices in Arkansas “on a short-term basis,” and reciprocity for analysts licensed in comparable states. The BACB’s licensure table lists Arkansas (2025, AR Psychology Board). Payers credential on BACB certification: the mandate itself keys ABA to a Board Certified Behavior Analyst. Commercial ABA rates are negotiated and unpublished; the public benchmark is the Arkansas Medicaid fee schedule (97151 $20.00, 97153 $15.00, 97155 $22.50, 97156 $20.00 per 15-minute unit).[7][8][4][10]
Cigna publishes no ABA rate table. Evernorth tells ABA providers: “For your fee schedule and a listing of autism spectrum disorder–related services eligible for reimbursement, refer to Exhibit A in your Provider Agreement.” 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. For a public benchmark, Arkansas Medicaid pays 97153 at $15.00 per 15 minutes.[3][2][10]
Billing details from Evernorth’s own documents. Codes: "All ABA services must be billed with CPT codes 97151–97158, 0362T, and 0373T ONLY," so H-codes are not accepted for ABA. Telehealth: "All ABA CPT codes are covered telehealth services"; on the CMS-1500 use "Modifier 95 in Field 24-D to specify telehealth" and "02 for Place of Service in Field 24-B"; neither document says the authorization must flag telehealth. Filing: claims must be "submitted within 90 days of the date of service or as otherwise defined in your Provider Agreement" unless state law gives longer; for coordination of benefits the 90 days run from the primary payer’s EOB or EOP; a claim Evernorth returns for more information gets a fresh 90 days from its request; corrected claims carry frequency code 7 (replace) or 8 (void) in field 22, without a "Corrected Claim" stamp. Reauthorization (EN0499): an updated treatment plan; "Quantitative baseline, interim and current data" with the dates they were collected for every behavior and skill across all settings; current data collected within 60 days before the continued-treatment start date and within 60 days before the request is received; a standardized assessment no more than one year before the start date; and a written plan to address barriers if progress stalls. EN0499 asks for dated data, not graphs by name. Supervision runs one to two hours per ten hours of direct treatment, with no published cap on technicians per supervisor.[2][3][1]
The questions that decide whether a family can start with Cigna / Evernorth in Arkansas, and what they have to bring. Each maps onto something intake should ask on the first call.
No expiry on the diagnosis, but the standardized instrument and baseline data must be from within 60 days before treatment, and current data within 60 days of a continued-treatment request.[1]
A healthcare professional licensed to practice independently whose scope includes diagnosis, applying DSM-5-TR criteria.[1]
No single instrument is mandated; it must be standardized, valid, complete and the current edition (for example Vineland-3, not Vineland-II).[1]
EN0499 requires no referral; assessments need no PA, treatment needs the ABA PA form. Evernorth publishes no ABA order form or validity period. On the claim, Evernorth’s administrative guidelines (September 2026) define a complete CMS-1500 claim without a referring provider (they require the rendering provider’s name, NPI and license type and the billing provider’s name, address and NPI); any "Referring Provider" reported on an 837 claim "must include the name and NPI." For a fully insured Arkansas plan, § 23-99-418 (as enacted) defines mandated treatment as care “prescribed, provided, or ordered” by a licensed physician or licensed psychologist who finds it medically necessary and evidence-based, so keep that prescription on file.[2][1][4][3]
“All ABA CPT codes are covered telehealth services,” and EN0499 allows in-person, telehealth or hybrid delivery chosen on clinical factors. Bill modifier 95; providers “must meet all state requirements to provide virtual behavioral services.” On the claim, Evernorth wants "Modifier 95 in Field 24-D to specify telehealth" and "02 for Place of Service in Field 24-B"; its documents do not say the authorization must flag telehealth.[2][1][3]
EN0499 sets no age cap; focused intervention “should not be restricted by age.” For fully insured Arkansas plans, § 23-99-418 as enacted in 2011 limited mandated ABA to children under 18 with a $50,000 annual cap; Arkansas Blue Cross’s current policy says the Arkansas Insurance Department “will not allow age limits for any service for the treatment of autism” and applies the $50,000 cap only to grandfathered plans. Self-funded ERISA plans are outside the statute.[1][4][9]
Ask the plan: Live benefits verification or the Evernorth Autism Care Coordinator team, 877.279.7603: establish fully insured vs. self-funded first.
Fully insured Arkansas plans, plus risk-based provider organizations and nonfederal self-funded governmental plans (Act 575 of 2023), fall under the Prior Authorization Transparency Act. As enacted in Act 1106 of 2015, a nonurgent prior-authorization decision is due “within two (2) business days of obtaining all necessary information,” and an urgent one “no later than one (1) business day after receiving all information needed.” Act 575 adds that an adverse determination must be made by a physician with an unrestricted Arkansas license, that the provider may discuss the denial with that physician within one business day (urgent) or two business days (nonurgent) of receiving it, and that an insurer that approved at least 90% of a provider’s requests for a service in a six-month evaluation period may not require prior authorization of that provider for that service. Self-funded 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. Evernorth publishes no Arkansas-specific ABA turnaround.[5][6][11]
Ask the plan: At benefits verification ask whether the plan is fully insured (Arkansas-regulated) or self-funded ERISA, and what reauthorization lead time Evernorth expects.
Evernorth publishes no Arkansas-specific ABA coordination rule. If the child also has Arkansas Medicaid (fee-for-service or a PASSE), this plan pays first: Medicaid pays only the difference up to its maximum and “will not make any payment if the amount received from the third party insurance is equal to or greater than the Medicaid allowable rate” (Section I § 131.000; 42 CFR 433.139). TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). We did not verify Arkansas’s rule for ordering two parents’ group plans, so get the order from the plan.[12][13][14][15]
Ask the plan: Ask Cigna/Evernorth at benefits verification for the member’s coordination-of-benefits order and record every other coverage the child has.
Coverage decides whether Cigna / Evernorth in Arkansas 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.
Case supervision by a BCBA, a Licensed Behavior Analyst, or an independently licensed clinician 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. EN0499 publishes no cap on the number of technicians one supervisor may oversee.[1]
“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).” EN0499 also 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)."[2][1]
No per-day cap. All ABA codes bill in 15-minute units, and only 97151–97158, 0362T and 0373T may be used.[2]
Each service record needs dates and times, location, the intervention, who was present, and the “Name, credential (if applicable), and signature of ABA provider who rendered the service.”[1]
Goals and data are reported for each setting; primarily educational or vocational services are not covered, and ABA in academic settings must still meet the direct-treatment definition. The line-of-sight requirement does not apply to telehealth.[1]
“Evernorth does not credential nonlicensed/noncertified staff. Services for these staff members must be billed under the supervising provider.” On a CMS-1500, list only a BCBA or other licensed provider in box 33; electronic claims use payer ID 62308.[2]
No. Evernorth says all ABA services must be billed with CPT 97151–97158, 0362T and 0373T only.
EN0499 asks for dated quantitative baseline, interim and current data (current data within 60 days) and a standardized assessment within a year; it does not name graphs.
90 days from the date of service unless your agreement or state law allows longer; for secondary claims, 90 days from the primary payer’s EOB.
Yes, under Evernorth policy EN0499 for ASD, with Arkansas’s § 23-99-418 mandate for fully insured group plans.
No, for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed or a BCBA. PA starts at treatment.
For fully insured plans, Evernorth’s Arkansas addendum limits recoupment to 18 months after payment (except fraud) and allows a corrected claim within six months after a recoupment.
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.
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