A Cigna card in Hawaii means Evernorth’s national ABA policy (EN0499, effective May 15, 2026), Cigna’s autism resource guide for billing and authorization, and Hawaii’s Luke’s Law for fully insured plans. We found no Hawaii-specific Cigna ABA policy. Cigna’s assessment rule helps intake: with an autism diagnosis, the assessment codes need no prior authorization.
EN0499 covers an ABA assessment and treatment for a confirmed ASD diagnosis (F84.0–F84.9, except F84.2 Rett syndrome) made under DSM-5-TR by a professional licensed to practice independently with diagnosis in scope. It requires the diagnoser’s name, credentials and licensure and "the date on which the diagnosis was most recently made." The assessment must be done by a BCBA, licensed behavior analyst, or independently licensed mental health clinician trained in ABA, using a standardized instrument completed in full. Case supervision must match the standard of "one to two hours per ten hours of direct treatment," with at least one to two hours a week when direct treatment is 10 hours or less. Continued treatment needs a standardized assessment completed no more than a year before the continuation start date.[1][2]
The resource guide (March 2025): no PA for 97151, 97152 or 0362T with an autism diagnosis, when the provider is independently licensed or a BCBA; treatment needs the ABA PA form; all ABA codes are covered by telehealth; only one provider may bill a unit of time except 97153, 97154 and 97155 during direct supervision; and Evernorth does not credential unlicensed or uncertified staff, whose services are billed under the supervising provider.[1][2]
Hawaii’s autism mandate is Luke’s Law, Act 235 of 2015. It added the same autism section three times — to the insurance code as HRS § 431:10A-133, to chapter 432 for mutual benefit societies (HMSA’s chapter), and, through HRS § 432D-23, to HMO contracts — so every state-regulated carrier in Hawaii carries it. The text is narrow by current standards. Policies issued or renewed after January 1, 2016 must cover the diagnosis and treatment of autism for "individuals under fourteen years of age," and applied behavior analysis "shall be subject to a maximum benefit of $25,000 per year for services for children ages thirteen and under." Payments for anything other than ABA do not count toward that cap, and cost-sharing may be "no less favorable" than for substantially all medical services.[3][4]
The statute also sets rules intake should know: treatment requests "shall include a treatment plan," and the carrier may review the plan and medical necessity at its discretion; treatment must be "prescribed or ordered" by a licensed physician, psychiatrist, psychologist, licensed clinical social worker or registered nurse practitioner; coverage excludes custodial care, services by family or household members, experimental treatment and "services provided outside of the State"; network autism providers must clear state and federal criminal background checks; and a child diagnosed under an older DSM edition "may be required to undergo repeat evaluation" when a new edition is published. Exempt: self-funded employer plans (not state-regulated insurance) and disability, accident-only, Medicare, Medicare supplement, student, dental-only and vision-only policies and policies of six months or less. Whether a $25,000 annual ABA dollar limit can still be applied to a given plan alongside federal parity rules is a plan-level question; the statute text itself has not been amended since 2015.[3][4]
Hawaii licenses behavior analysts under HRS chapter 465D, run by the Department of Commerce and Consumer Affairs. A license requires having passed the BCBA examination and maintaining active BACB status as a BCBA or BCBA-D (HRS § 465D-8). Section 465D-7 exempts, among others, BCaBAs practicing "under the direction of a licensed behavior analyst," RBTs who directly implement ABA "under the direction of a licensed behavior analyst or a licensed psychologist," licensed psychologists and their supervisees, and graduate students and people accruing BACB experience hours under a licensed behavior analyst. Luke’s Law then limits covered autism treatment to providers "licensed by a state licensure board," so the supervising analyst on a commercial claim needs the Hawaii license, not just BACB certification.[6][5][10][3]
The questions that decide whether a family can start with Cigna / Evernorth in Hawaii, and what they have to bring. Each maps onto something intake should ask on the first call.
No expiry, but Cigna wants "the date on which the diagnosis was most recently made," and continued treatment needs a standardized assessment completed no more than one year before the continuation start date.[1]
A healthcare professional "licensed to practice independently and whose licensure board considers diagnostics to be within their scope of practice."[1]
No diagnostic instrument named; the ABA assessment must use a reliable, valid, standardized instrument covering the DSM-5-TR ASD domains, completed in full, with standardized scores provided.[1]
Cigna’s policies need no referral; they need prior authorization for treatment. Luke’s Law covers treatment "prescribed or ordered" by a licensed physician, psychiatrist, psychologist, LCSW or registered nurse practitioner, with a treatment plan on each request.[2][3]
"All ABA CPT codes are covered telehealth services" (Cigna autism resource guide); EN0499 allows in-person, telehealth or hybrid delivery.[2][1]
EN0499 sets no age cap. Luke’s Law requires coverage only for children under 14 on fully insured plans; beyond 13 it depends on the plan, and self-funded plans are outside the statute.[1][3]
Ask the plan: Benefits verification — funding type and the plan’s ABA age terms.
Group plans follow 29 CFR 2560.503-1 (directly or through 45 CFR 147.136): pre-service decisions "not later than 15 days," one 15-day extension, urgent within 72 hours. Cigna warns that a late request may go to retrospective review and delay the decision "for up to 30 days." We found no shorter Hawaii initial-decision statute; HRS § 432E-5 sets internal appeals at 72 hours expedited and 60 days.[7][8][2][9]
Ask the plan: Cigna Autism Care Coordinator team 877-279-7603.
Order is set by the plans’ COB provisions; ask Cigna which plan is primary. If the child also has QUEST, Cigna pays first and Medicaid last. TRICARE pays after this plan; CHAMPVA pays last.[11][12][13][14]
Ask the plan: Cigna benefits verification — record every other coverage.
Coverage decides whether Cigna / Evernorth in Hawaii 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, LBA or independently licensed mental health professional trained in ABA, consistent with "one to two hours per ten hours of direct treatment"; at least one to two hours a week of direct case supervision when direct treatment is 10 hours a week or less; the supervisor’s name and credentials documented.[1]
Only one provider may 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)."[2]
No per-day unit cap in EN0499 or the resource guide; hours are authorized on medical necessity. On fully insured Hawaii plans Luke’s Law caps ABA at $25,000 a year for children 13 and under.[1][3]
EN0499 expects treatment across the settings where behaviors occur (including academic settings and telehealth); all ABA codes are covered by telehealth. Luke’s Law excludes "services provided outside of the State."[1][2][3]
"Evernorth does not credential nonlicensed/noncertified staff. Services for these staff members must be billed under the supervising provider." Bill only 97151–97158, 0362T and 0373T. In Hawaii the supervising analyst needs an HRS ch. 465D license, and Luke’s Law covers treatment only from a state-licensed provider.[2][6][3]
EN0499 requires documentation of the specific service delivered and the supervisor’s name and credentials, but sets no session-note signature rule.[1]
Ask the plan: Evernorth Provider Services 800-926-2273 or the provider agreement.
Yes — for ASD (excluding Rett syndrome) under EN0499. Fully insured Hawaii plans also carry Luke’s Law: coverage for children under 14, ABA capped at $25,000 a year for ages 13 and under.
No — 97151, 97152 and 0362T need no prior authorization with an autism diagnosis, when the provider is independently licensed or a BCBA. Treatment does.
Cigna’s autism resource guide says all ABA CPT codes are covered telehealth services.
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.
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