For an intake team in Kansas, a Cigna card means three layers at once: the carrier's national clinical policy, Kansas's autism insurance mandate (K.S.A. 40-2,194), 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. That clinical policy is national — what changes in Kansas is the legal floor underneath it: the state mandate below governs what fully-insured large-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 Kansas.[1][2]
Kansas's mandate, K.S.A. 40-2,194, is one of the narrower ones in our directory. It reaches large-group policies, service-corporation contracts, fraternal benefit societies, and HMOs (issued/renewed after 1/1/2015; grandfathered plans from 1/1/2016), and 2023's SB 24 redefined "large employer" down to 51+ employees. Coverage is limited to covered individuals under age 12, and ABA carries hour-based caps: 1,300 hours/year for 4 years for a child diagnosed between birth and age 5, otherwise 520 hours/year until age 12 — though plans may exceed the caps with prior approval when medically necessary, the statute's own escape valve. Day care, facility-based, and school-based services are excluded; after 7/1/2016 ABA under the mandate must be delivered by providers licensed or exempt under the ABA licensure act. Small employers (2–50) can obtain a waiver by showing a 2.5%+ premium increase, self-funded ERISA plans sit outside the statute entirely, and a member diagnosed under any DSM edition cannot be forced into re-evaluation upon DSM revision. Advocacy analysis (not a regulator determination) treats the under-12 age limit and hour caps as unenforceable quantitative limits under MHPAEA for parity-covered plans — so treat cap-based denials as appealable, not final.[3][4][6]
We checked the current EN0499 line by line: it contains no Kansas entry and no Kansas carve-out — the national criteria apply in Kansas, subject to the standard proviso that state law and the plan contract can override. Cigna also operates no Medicaid plan in Kansas, so a Cigna card here is always commercial. That makes benefits verification (plan funding type, mandate applicability, benefit limits) the place Kansas-specific answers come from, not a carrier document.[1]
Kansas has required licensure for practicing behavior analysts since July 1, 2016: the Licensed Behavior Analyst (LBA) and Licensed Assistant Behavior Analyst (LaBA) credentials under the applied behavior analysis licensure act (K.S.A. 65-7501 et seq.), administered by the Behavioral Sciences Regulatory Board and keyed to BACB certification — and the mandate itself conditions ABA coverage on licensed or exempt providers, so licensure is a coverage requirement, not just a credentialing one. On rates: Cigna does not publish commercial ABA fee schedules for Kansas (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement. The usual Medicaid benchmark is also unusually opaque here: current KanCare autism-services rates are only available through the KMAP interactive fee-schedule lookup, so pull them there before a rate negotiation.[5]
Cigna publishes no ABA rate table. Evernorth, which runs Cigna’s behavioral health network, puts the rates in the contract: its Administrative Guidelines (September 2026) say the Provider Agreement and the guidelines set the terms, which “include the reimbursement rates applicable to covered services,” and tell 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.” Fee-schedule and contract questions go to Provider Services at 800.926.2273. Virtual services are billed with 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, KanCare pays 97153 at $16.25 per 15 minutes since 7/1/2024 (KMAP Bulletin 24125); the other autism codes are in the KMAP fee-schedule lookup.[7][8]
Kansas licenses the practice: “no person shall practice applied behavior analysis in this state unless they are” a licensed behavior analyst, a licensed assistant behavior analyst under LBA supervision, a supervised trainee, or a licensed psychologist (K.S.A. 65-7503(a)). The exemptions cover people providing services under IDEA or Section 504 and providers qualified under the HCBS autism waiver, not out-of-state analysts. The statute does not say in terms whether video sessions with a child located in Kansas are practice “in this state,” so the safe plan is a Kansas LBA (Behavioral Sciences Regulatory Board) before the first remote session.[9][7]
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 Kansas’s licensure law above and confirm with Evernorth before a remote start.[9][7]
On fully insured Kansas coverage, the prompt payment act gives the insurer 30 days from receipt to "pay a clean claim for reimbursement" or send a written or electronic notice that it is denying all or part of the claim (with each reason) or needs specific additional information. Interest runs "at the rate of 1% per month" on any amount still unpaid 30 days after receipt, and is added without a separate claim. Once the provider supplies the requested information (due within 30 days of the request), the insurer has 15 days to pay or deny, again at 1% a month if it does not. The act exempts good-faith disputes and suspected fraud, and it binds insurers issuing accident and sickness policies, so a self-funded employer plan administered by Cigna follows its plan document instead (K.S.A. 40-2442).[10]
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.[11]
Cigna (Evernorth) publishes no referring-provider requirement for ABA. Its autism resource guide gives the ABA paper-claim instructions field by field and names only box 31 (your name), the claims mailing address and box 33 ("List only a BCBA or other licensed provider in box 33"); box 17 is not mentioned. The Evernorth administrative guidelines state for SureFit, Connect and HMO/POS plans alike that "Referrals are not required for behavioral health services."[2][7]
Leave box 17 blank unless a referral actually exists for the service. Bill technician time under the supervising provider: "Evernorth does not credential nonlicensed/noncertified staff. Services for these staff members must be billed under the supervising provider."[2][7]
No. EN0499 (effective 5/15/2026): "Provision of ABA treatment 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)." The policy defines that overlap as concurrent billing: "multiple providers bill for services rendered to the same patient when those services occur at the same time."[1][2]
Schedule ABA hours around speech, OT and PT, and keep session start and stop times that show no overlap. The only same-time billing EN0499 and Cigna's autism resource guide allow is within ABA: 97153 or 97154 alongside 97155 when the BCBA directs the technician face-to-face.[1][2]
CPT codes only. Evernorth’s autism resource guide states that “All ABA services must be billed with CPT codes 97151–97158, 0362T, and 0373T ONLY,” that “All of the ABA CPT codes are in 15-minute increments,” and that “Only one provider can bill for a unit of time,” except 97153, 97154 and 97155 billed during direct supervision. HCPCS H-codes such as H0031, H0032, H2014 or H2019 are not accepted for ABA on Cigna plans. EN0499’s coding section lists the same ten CPT codes as medically necessary when the policy’s criteria are met.[2][1]
EN0499’s “Criteria for Continued Treatment with ABA” require dated numbers rather than graphs. The request needs an updated treatment plan and “Quantitative baseline, interim and current data … with dates reported from when the data were collected for all behaviors and skills” across every setting where treatment occurs. Current data must be “collected within no more than 60 days prior to the start date of the continued treatment request, as well as … within no more than 60 days prior to the date the authorization request is received.” It also needs a reliable, valid, standardized assessment “completed no more than one year prior to the start date,” dated data on stakeholder (caregiver) training goals, and, where progress has stalled, the barriers and the protocol changes made. A new standardized assessment and fresh data are required after any break in treatment longer than 60 days. The policy defines interim data as covering at least the previous six months and allows it to be “reported as patient data points and/or as a relevant average.” The policy does not require graphs.[1]
The questions that decide whether a family can start with Cigna / Evernorth in Kansas, 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. On the claim, Evernorth’s Behavioral Health Administrative Guidelines (September 2026) say: “If billing telehealth services, please use the following guidance: Modifier 95 in Field 24-D to specify telehealth. 02 for Place of Service in Field 24-B.” Modifier 95 “will not change the reimbursement.” To deliver virtual sessions the provider first attests to Evernorth’s telehealth specialty requirements on the Attested Specialty Form, which adds “telehealth” to the provider profile. The guidelines and EN0499 say nothing about flagging telehealth on the ABA authorization itself.[7][2][1]
Cigna (Evernorth Behavioral Health) makes "coverage determinations in accordance with the time frames required under applicable law," and warns: "You must supply all information requested within the time frames specified … Failure to provide information within the time frames requested may result in nonpayment." ABA requests go to the Autism Utilization Management team. Lead time is published: "For ABA, we encourage 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" — so file each reauthorization up to 30 days before the current one ends. Kansas fully insured plans are held to the Insurance Department's utilization-management standards adopted by K.A.R. 40-4-41: prospective (pre-service) review "Within 15 calendar days of the receipt of request" (one 15-calendar-day extension, with at least 45 days to supply missing information) and "no later than 72 hours" for urgent care; an urgent request to extend a current course of treatment is decided within 24 hours if received "at least 24 hours before the expiration of the currently certified period." Self-funded ERISA plans land on the same numbers under 29 CFR 2560.503-1 (15 days, 72 hours urgent), so 15 calendar days / 72 hours from receipt is the ceiling either way.[7][2][12][13]
Evernorth follows the NAIC order "subject to applicable law and the terms of the benefit plan": "The plan of the parent whose birthday falls earlier in the calendar year is primary … Only the month and day of birth are relevant" (same birthday: the longer-running plan); a court decree controls for divorced or separated parents, and with no decree the order is custodial parent, custodial parent's spouse, noncustodial parent, noncustodial parent's spouse. Kansas's COB rule (K.A.R. 40-4-34) governs fully insured plans: for a child whose parents are married or living together, "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (same birthday: the plan that has covered the parent longest); for divorced or separated parents a court decree naming the responsible parent controls. When Cigna is secondary, bill the primary first, then send the claim "along with a copy of the primary payer's EOP" (not needed if HIPAA-compliant COB data goes electronically to payer ID 62308). If the child also has Medicaid, this plan pays first: Medicaid is payer of last resort (42 CFR 433.139) — bill here, then send the EOB or denial to Medicaid, and get Medicaid's own prior auth too if the state requires it. TRICARE is secondary to this plan ("TRICARE shall be last pay," 32 CFR 199.8), and "CHAMPVA is the last payer to OHI" (38 CFR 17.276(d)).[7][14][15][16][17]
K.S.A. 40-2,194 limits the mandate to covered individuals under age 12, on fully-insured large-group coverage only (51+ employees since 2023's SB 24), with ABA capped at 1,300 hours a year for four years for a child diagnosed between birth and age 5 and 520 hours a year otherwise — caps a plan may exceed with prior approval when medically necessary. Advocacy analysis (not a regulator determination) treats the under-12 limit and the hour caps as unenforceable quantitative treatment limits under MHPAEA for parity-covered plans, so treat an age- or cap-based denial as appealable rather than final. The carrier's national ABA policy sets no age bound of its own.[3][1]
Ask the plan: Benefits verification on the specific plan — funding type first, then the ABA benefit terms.
Coverage decides whether Cigna / Evernorth in Kansas 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. EN0499 sets no caseload cap: it does not limit how many technicians or cases one BCBA may supervise, only the supervision hours per case.[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.[2]
No per-day or per-week unit cap is published. Evernorth’s autism resource guide says “All of the ABA CPT codes are in 15-minute increments” and “All ABA services must be billed with CPT codes 97151–97158, 0362T, and 0373T ONLY,” and adds that “Only one provider can bill for a unit of time,” except 97153, 97154 and 97155 during direct supervision. Neither the guide, EN0499 nor Evernorth’s Behavioral Health Administrative Guidelines (September 2026) sets a unit maximum or names an MUE table for ABA. The authorization, sized to the treatment plan under EN0499, is what bounds the day; ask Evernorth at authorization if a schedule needs more than eight hours of 97153 in a day.[2][1][7]
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 in the autism resource guide — no rule on who signs a session note or when. EN0499 does require the name and credentials of the supervising and stakeholder-training providers to be documented, and dates of administration on every assessment instrument.[1]
Blocked on: The Evernorth Behavioral Health provider administrative guide and your participation agreement.
Yes — under the carrier's national EN0499 policy for ASD (no prior auth on assessment codes; PA at the treatment step), layered on Kansas's mandate (K.S.A. 40-2,194) for fully-insured large-group plans. Self-funded plans are exempt from the mandate, so verify funding type first.
For large-group (51+) fully-insured plans: coverage for members under 12, with ABA capped at 1,300 hours/year for 4 years when diagnosed by age 5, otherwise 520 hours/year — exceedable with prior approval when medically necessary. Federal parity analysis questions the age limit and hour caps, so treat cap denials as appealable.
Cigna publishes no ABA rates. Evernorth says your fee schedule and the list of reimbursable autism services are in Exhibit A of your Provider Agreement; call Evernorth Provider Services (800.926.2273) with fee questions. KanCare's 97153 rate ($16.25 per 15 minutes, KMAP Bulletin 24125) is the public benchmark.
Kansas requires a Kansas license to practice ABA “in this state” (K.S.A. 65-7503). Evernorth (Cigna) requires providers to “meet all state requirements to provide virtual behavioral services, including any licenses”; confirm with Evernorth before a remote start.
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).
No. Cigna's ABA billing instructions cover boxes 31 and 33 only, and Evernorth states that referrals are not required for behavioral health services.
No. 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 the therapies back to back, not overlapping.
No. Evernorth’s autism resource guide requires all ABA services to be billed with CPT 97151–97158, 0362T and 0373T only, in 15-minute units.
No graph is required. EN0499 requires dated quantitative baseline, interim and current data for every behavior and skill (current data no older than 60 days at the request and the start date), a standardized assessment within the past year, and caregiver-goal data. Data may be reported as data points or averages.
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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