---
title: "Cigna / Evernorth ABA coverage in Hawaii: the intake guide."
url: "https://carelu.com/payers/cigna-hawaii"
markdown_url: "https://carelu.com/payers/cigna-hawaii.md"
state: HI (Hawaii)
payer: Cigna / Evernorth in Hawaii
kind: Commercial insurance
description: "How Cigna / Evernorth covers ABA for Hawaii families — EN0499 criteria, no prior authorization on assessment codes, prior authorization for treatment, telehealth for all ABA codes, Luke’s Law (under 14, $25,000/yr ABA cap), and Hawaii licensure."
last_reviewed: October 2026
---

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

_Payer Guide · Cigna · Hawaii · Last updated October 2026 · 11 primary sources_

> EN0499 + autism resource guide + Hawaii’s Luke’s Law (under 14, $25K/yr ABA).

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.

## 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 and the policy covers ABA (Cigna autism resource guide) [3]
- **Prior auth for treatment**: Required — after the assessment and treatment plan, submit the Applied Behavior Analysis Prior Authorization Form; Cigna suggests requesting up to 30 days before or two weeks after the start date [3][2]
- **Autism diagnosis required?**: Yes — confirmed ASD (F84.0–F84.9, excluding F84.2 Rett syndrome) per DSM-5-TR, with the diagnoser’s name, credentials, licensure and the date of the most recent diagnosis [2]

## At a glance

- **Covers ABA?:** Yes — for ASD (excluding Rett syndrome), per EN0499
- **State mandate:** Luke’s Law — HRS § 431:10A-133 (insurers), a parallel HRS ch. 432 art. 1 section (mutual benefit societies such as HMSA), HRS § 432D-23 (HMOs such as Kaiser); Act 235, 2015
- **Mandate age:** Individuals under fourteen years of age
- **Mandate caps:** ABA capped at $25,000 per year for children ages thirteen and under; cost-sharing no less favorable than for substantially all medical services
- **Exempt from mandate:** Self-funded employer (ERISA) plans; disability, accident-only, Medicare, Medicare supplement, student accident and health, dental-only and vision-only policies, and policies or renewals of six months or less
- **Licensure:** Yes — HRS ch. 465D licensed behavior analyst (DCCA): passed BCBA exam + active BCBA/BCBA-D; RBTs and BCaBAs exempt when working under a licensed behavior analyst
- **Fee schedule:** None published — contracted rates in your Evernorth agreement; ask Provider Relations

## The national policy, applied in Hawaii

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. [2][3]

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. [2][3]

## The Hawaii mandate: Luke’s Law

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. [4][5]

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. [4][5]

## Licensure in Hawaii

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. [7][6][12][4]

## How does Cigna pay for ABA, and is its network open?

Cigna publishes no ABA fee schedule. In-network ABA is paid at the rates in your Evernorth behavioral-health agreement; the autism resource guide sends "questions about credentialing, contracts, or rates" to your Provider Relations representative, and billing questions to Provider Services at 800.926.2273. Bill only 97151-97158, 0362T and 0373T, in 15-minute units. [3]

Network: Evernorth says it "is committed to expanding our network of autism providers." Individual analysts apply on the Evernorth Behavioral Provider Information Form and autism clinics or large groups on the Evernorth Screening Application for Autism Clinics; processing can take up to 90 days, and after a clinic contract each certified or licensed provider must be credentialed (another 60 to 90 days) before rendering in-network services. Evernorth requires the clinician to hold a national certification or state license (BCBA, BCBA-D, BCaBA, licensed behavior analyst or other behavioral-health licensure). It "does not credential nonlicensed/noncertified staff" such as technicians, whose services "must be billed under the supervising provider." [3]

## How fast must Cigna pay a clean ABA claim in Hawaii?

Hawaii’s prompt-pay statute covers insurers issuing comprehensive medical plans, as well as mutual benefit societies and HMOs. "Unless shorter payment timeframes are otherwise specified in a contract," a claim that is not contested or denied must be paid within thirty calendar days of receiving a written claim or fifteen calendar days of receiving an electronic one. A contested or denied claim must be flagged within 15 days (written) or 7 days (electronic), naming the contested part and the reason, unless the plan sends at least a monthly reimbursement report carrying that information. After you supply requested information the same 30- or 15-day clock applies, and late payments carry interest "at a rate of fifteen per cent a year," added automatically once it reaches $2. Before recouping a payment the plan must give 30 days’ written notice, and you have 60 days from that notice to appeal (HRS § 431:13-108). Self-funded employer plans are not covered by the statute. [13]

## What is Cigna’s timely filing limit for ABA claims?

Cigna’s timely filing policy, for claims submitted directly to Cigna: it will consider "Participating provider claims submitted three (3) months [90 days] after the date of service" and out-of-network claims submitted six months (180 days) after the date of service. The limit is longer where applicable law requires it or your provider agreement allows more time, and in coordination-of-benefits cases it runs from the processing date on the primary carrier’s EOB. [3][1][14]

More of Evernorth’s filing rules (administrative guidelines, September 2026): 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]," and the primary EOP goes in with the claim unless the COB data is sent electronically; Medicaid gets three years; a claim returned for more information gets a fresh 90 days from the date of the request. Corrected or replacement claims carry frequency code 7 (replace) or 8 (void) in box 22, not a "Corrected Claim" stamp, and no separate corrected-claim deadline is published. Evernorth publishes no weekly payment cycle or submission cutoff; it offers ERA and EFT "to help reduce your payment cycle." [3][1][14]

Which codes: Evernorth’s autism resource guide (March 2025) says "All ABA services must be billed with CPT codes 97151–97158, 0362T, and 0373T ONLY," so state HCPCS ABA codes such as H0031, H0032, H2014 or H2019 are not billable to Cigna for ABA. The same guide says "All ABA CPT codes are covered telehealth services." [3][1][14]

## 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.” [1][3]

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. [1][3]

## What must a Cigna ABA reauthorization request contain, and are graphs required?

Evernorth’s EN0499 (effective May 15, 2026) sets what a continued-treatment request must show: an updated treatment plan covering current deficits and progress in every targeted area; "Quantitative baseline, interim and current data ... with dates reported from when the data were collected" for every behavior and skill, across all settings; current data collected "within no more than 60 days prior to the start date of the continued treatment request" and within 60 days before the request is received; data showing "ongoing and sustained progress"; and a reliable, valid, standardized assessment completed no more than one year before the continued-treatment start date. Where progress is not shown, the request must name the barriers and the protocol changes made. EN0499 asks for dated quantitative data, not for graphs as such; graphs are a common way to present it, but the policy does not require them. [2]

## Network, out-of-network benefits, billing credentials and payment appeals (Evernorth)

Who may deliver and who may bill (Evernorth's ABA code table): 97151, 97155, 97156, 97157, 97158, 0362T and 0373T are provided and billed by a BCBA-D, BCBA or licensed mental health provider; 97152, 97153 and 97154 may be provided by a BCaBA or technician but are billed by the BCBA-D, BCBA or licensed mental health provider. "All ABA services must be billed with CPT codes 97151–97158, 0362T, and 0373T ONLY." Evernorth's guide names no HM/HN/HO credential modifiers. [3][1]

Joining the network: Evernorth says it "is committed to expanding our network of autism providers." Individuals file the Evernorth Behavioral Provider Information Form; autism clinics and large groups file the Screening Application for Autism Clinics; "It may take up to 90 days for an application to be processed," and after the clinic contract each certified or licensed provider must be credentialed, "an additional 60 to 90 days." "Providers must be fully credentialed to render in-network services." A departing provider or roster change goes to Provider Services (800.926.2273) or the Clinic Location Changes form. [3][1]

Out-of-network: it depends on the product. HMO, HMO Open Access, Cigna Connect and OAP In-Network plans cover in-network care only (emergencies aside); POS and Open Access Plus plans cover out-of-network services at a reduced benefit level. Evernorth's guidelines publish no single case agreement process; a family without out-of-network benefits needs an in-network provider, and Evernorth's care managers email in-network providers near the family to find an opening. [3][1]

Payment disputes: call Provider Services first; then appeal "in writing within 180 calendar days of the date of the initial payment or denial decision" (or of the last adjustment). Fee-schedule and reimbursement disputes can go through the reconsideration feature on Provider.Evernorth.com. Medical necessity appeals should include the clinical record; untimely-filing appeals need proof of timely submission or of a COB delay. "Most appeals are resolved within 60 calendar days," with notice within 75 days unless state law differs. Some out-of-network providers must attach a patient-signed Appointment of Representative form. [3][1]

## Intake gates

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

- **Diagnosis recency**: 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. [2]
- **Who may diagnose**: A healthcare professional "licensed to practice independently and whose licensure board considers diagnostics to be within their scope of practice." LCSW: yes — Hawaii licenses LCSWs to practise independently and puts "Clinical diagnosis" inside their scope (HRS § 467E-1(8)), which is what Evernorth's test asks. Hawaii scope rule: the practice of social work includes "(8) Clinical diagnosis or psychotherapy, or both, provided by a licensed clinical social worker" (HRS § 467E-1), and Luke's Law covers autism treatment "prescribed or ordered" by a licensed physician, psychiatrist, psychologist, licensed clinical social worker or registered nurse practitioner (HRS § 431:10A-133). [2][11][4]
- **Diagnostic tools required**: 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. [2]
- **Referral required?**: 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. [3][4]
- **Telehealth**: "All ABA CPT codes are covered telehealth services" (Cigna autism resource guide); EN0499 allows in-person, telehealth or hybrid delivery. The assessment and supervision codes are included: the resource guide's "All ABA CPT codes" covers 97151 (initial assessment and reassessment) and 97155 (protocol modification / direct supervision) as much as 97153, and neither document caps the share of supervision that may be remote. Neither names a required telehealth POS code or modifier, so confirm claim coding with Evernorth Provider Services (800.926.2273). [3][2]
- **Age limit** _(plan-dependent)_: 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. [2][4]
  - Ask the plan: Benefits verification — funding type and the plan’s ABA age terms.
- **Prior-auth decision time** _(plan-dependent)_: 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. [8][9][3][10]
  - Ask the plan: Cigna Autism Care Coordinator team 877-279-7603.
- **Other insurance (who pays first)** _(plan-dependent)_: 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. [15][16][17][18]
  - Ask the plan: Cigna benefits verification — record every other coverage.

## Delivery and billing rules

Coverage decides whether Cigna / Evernorth in Hawaii 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 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. [2]
- **Concurrent billing (97153 + 97155)**: 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)." 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. [3][2]
- **Daily limits / MUEs**: 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. [2][4]
- **Session-note signature**: 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. [2]
- **Place of service**: 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." [2][3][4]
- **Bill as provider**: "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. [3][7][4]

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

- **Plan funding type:** Fully insured (Luke’s Law applies) or self-funded employer plan (exempt).
- **Child’s age:** Luke’s Law covers children under 14, with ABA capped at $25,000 a year for ages 13 and under.
- **Diagnosis details:** Name, credentials and licensure of the diagnoser and the date of the most recent diagnosis — EN0499 asks for all of them. Rett syndrome (F84.2) is excluded.
- **Treatment order:** Luke’s Law covers treatment prescribed or ordered by a physician, psychiatrist, psychologist, LCSW or registered nurse practitioner.

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

## Common questions

### Does Cigna pay an out-of-network ABA provider?

Only on plans with out-of-network benefits. Evernorth's September 2026 guidelines say HMO, Connect and OAP In-Network plans cover in-network care only, while POS and Open Access Plus plans cover out-of-network services at a reduced benefit level. Evernorth publishes no single case agreement process for ABA; its care managers help families find an in-network provider.

### Does Cigna require graphs for ABA reassessments?

Not graphs as such. EN0499 requires dated quantitative baseline, interim and current data (current data no more than 60 days old), an updated plan and a standardized assessment no more than a year old; graphs are a common way to show the data, but the policy does not require them.

### Does Cigna accept H0031 or H0032 for ABA?

CPT 97151–97158, 0362T and 0373T only; HCPCS H-codes such as H0031/H0032 are not billable for ABA (Evernorth autism resource guide).

### Does Cigna cover ABA therapy in Hawaii?

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.

### Does Cigna require prior authorization for the ABA assessment?

No — 97151, 97152 and 0362T need no prior authorization with an autism diagnosis, when the provider is independently licensed or a BCBA. Treatment does.

### Does Cigna pay for ABA by telehealth?

Cigna’s autism resource guide says all ABA CPT codes are covered telehealth services.

### Can the ABA assessment (97151) or BCBA supervision (97155) be done by telehealth with Cigna in Hawaii?

Yes. Evernorth's autism resource guide says all ABA CPT codes are covered telehealth services, and EN0499 allows in-person, telehealth or hybrid delivery. No POS code or modifier is published; confirm claim coding with Provider Services (800.926.2273).

### What is Cigna's ABA fee schedule in Hawaii?

There is no public one. Cigna pays in-network ABA at the rates in your Evernorth agreement; Evernorth directs rate and contract questions to your Provider Relations representative.

### Is Cigna accepting new ABA providers in Hawaii?

Evernorth says it is committed to expanding its autism network. Apply with the Behavioral Provider Information Form (individuals) or the Screening Application for Autism Clinics (groups); allow up to 90 days, plus 60 to 90 days of individual credentialing for a clinic.

### Does Cigna require RBT certification for ABA technicians?

Evernorth credentials only certified or licensed clinicians (BCBA, BCBA-D, BCaBA, licensed behavior analyst or other licensure). It does not credential technicians; their services are billed under the supervising provider. EN0499 describes direct supervision of the RBT or BCaBA delivering treatment.

### Does Cigna pay for ABA delivered at school in Hawaii?

EN0499 treats school as a possible treatment setting but excludes educational services. It lists school among the settings where treatment goals may be set ("home, clinic, school, community setting"), requires the record to show that ABA in an academic setting still meets the direct-treatment definition, and excludes services "primarily educational or vocational in nature, or related to academic or work performance." Whether school hours are payable on a given plan is a benefit-document question.

### What is Cigna’s timely filing limit in Hawaii?

90 days from the date of service for a participating provider and 180 days out of network, unless your agreement or applicable law allows longer (Cigna’s When to File policy).

### 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 Behavioral Health Administrative Guidelines (PCOMM-2026-191, September 2026): Claims filing deadline, Coordination of benefits, corrected claims, ERA, Appeals](https://static.evernorth.com/assets/evernorth/provider/pdf/resourceLibrary/behavioral/ebh-provider-admin-guide.pdf)
2. [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)
3. [Cigna / Evernorth autism resource guide for behavioral health providers (March 2025)](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/autism-resource-guide.pdf)
4. [HRS § 431:10A-133 — Autism benefits and coverage; notice; definitions (Luke’s Law; current text, archived 8/10/2026)](https://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0010A-0133.htm)
5. [S.B. 791 C.D. 1 (2015), enacted as Act 235 — Luke’s Law: §§ 3–6 add the insurer, mutual-benefit-society and HMO autism sections](https://www.capitol.hawaii.gov/session2015/bills/SB791_CD1_.htm)
6. [HRS § 465D-7 — Behavior analysts: exemptions (am. L 2023, c 167)](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0465D/HRS_0465D-0007.htm)
7. [HRS § 465D-8 — Behavior analysts: application for licensure](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0465D/HRS_0465D-0008.htm)
8. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
9. [45 CFR 147.136 — Internal claims and appeals for group and individual coverage (eCFR)](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-147/section-147.136)
10. [HRS § 432E-5 — Complaints and appeals procedure for enrollees](https://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0432E/HRS_0432E-0005.htm)
11. [HRS § 467E-1 — Social workers: definitions (practice of social work incl. "(8) Clinical diagnosis or psychotherapy, or both, provided by a licensed clinical social worker")](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0467E/HRS_0467E-0001.htm)
12. [HRS § 465D-2 — Behavior analysts: definitions](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0465D/HRS_0465D-0002.htm)
13. [HRS § 431:13-108 — Reimbursement for accident and health or sickness insurance benefits (Hawaii Revised Statutes)](https://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0013-0108.htm)
14. [Cigna for Health Care Professionals — When to File (timely filing policy)](https://static.cigna.com/assets/chcp/resourceLibrary/clinicalReimbursementPayment/medicalClinicalReimburseWhenToFile.html)
15. [Med-QUEST memo QI-2431 / FFS 24-13 (Dec 31, 2024) — Coverage of IBT for children under 21 with ASD: Guidelines for ABA (Attachments A–C)](https://medquest.hawaii.gov/content/dam/formsanddocuments/provider-memos/qi-memos/qi-memos-2024/QI-2431,%20FFS%2024-13%20Replaces%20QI-2301,%20FFS%2023-01%20Coverage%20of%20IBT%20for%20treatment%20of%20children%20under%2021%20years%20of%20age%20with%20ASD_Guidelines%20for%20ABA._FINAL%20(part%201)%20-%20signed.pdf)
16. [42 CFR 433.139 — Medicaid payment of claims involving third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
17. [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)
18. [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.