For an intake team in Maryland, a Cigna card means three layers at once: the carrier's national clinical policy, Maryland's habilitative-services mandate (Md. Code Ann., Insurance § 15-835, implemented by COMAR 31.10.39.03), and the plan's funding type deciding which of the two actually binds. Maryland's mandate is unusual — it carries hour FLOORS below which ABA can't be denied. This guide stacks the layers 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 Maryland is the legal floor underneath it: the state mandate below governs what fully-insured 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 Maryland.[1][2]
Maryland has no standalone "autism mandate" — ABA is covered as a habilitative service for children with ASD under Insurance § 15-835, with the ABA-specific rules in COMAR 31.10.39.03 (effective April 3, 2014). The statute requires Maryland-regulated insurers, nonprofit health service plans, and HMOs to cover habilitative services until at least the end of the month the enrollee turns 19. The COMAR layer is where the teeth are: ABA may not be denied solely on the basis of prescribed hours up to 25 hours/week for ages 18 months through 5 years and up to 10 hours/week for ages 6 through 18 — with additional hours authorized when medically necessary — and ABA may not be denied as experimental or investigational. There is no dollar cap. COMAR 31.10.39.03(C) lets a carrier’s review criteria require a comprehensive evaluation, a prescription with specific treatment goals from the PCP or a specialty physician, and annual review by the prescriber; it permits these gates rather than mandating them, and Cigna’s published ABA documents do not say it uses them. Carriers aren't required to reimburse services delivered through early intervention or the schools, and self-funded ERISA plans are exempt — for those, MHPAEA parity is the fallback lever, and the hour floors don't apply.[3][4]
We checked the current EN0499 (effective May 15, 2026) in full: it contains no Maryland entry, carve-out, or state-specific exhibit — only the generic clause that a controlling federal or state coverage mandate supersedes the policy. So for fully-insured Cigna members in Maryland, the § 15-835 / COMAR 31.10.39 protections layer directly on top of the national policy without any Cigna-published Maryland supplement, and benefits verification (funding type, mandate applicability) is where Maryland-specific answers come from — not a carrier document.[1]
Maryland has required licensure to practice behavior analysis since January 2015: the Licensed Behavior Analyst (LBA) credential, administered by the Behavior Analyst Advisory Committee of the State Board of Professional Counselors and Therapists (Health Occupations Title 17, Subtitle 6A; COMAR 10.58.16), built on current BACB certification, a qualifying master's degree, and a criminal-history check. The mandate's COMAR criteria likewise expect licensed delivery. On rates: Cigna does not publish commercial ABA fee schedules for Maryland (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement. Maryland's Medicaid fee schedule (effective February 1, 2026 — e.g., 97153 at $24.41/15-min BCBA tier) is the public benchmark to negotiate against.[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, Maryland Medicaid's fee schedule (eff. 2/1/2026, unchanged for FY27) pays 97153 at $24.41 per 15 minutes at the BCBA tier, $20.91 BCaBA and $19.17 RBT/BT.[7][8]
Maryland licenses the practice: “an individual shall be licensed by the Board before the individual may practice behavior analysis in the State” (Health Occupations § 17-6A-10(a)). Section 17-6A-10 itself exempts only students in a qualifying unpaid clinical educational experience, so plan on a Maryland license before treating a child located in Maryland remotely.[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 Maryland’s licensure law above and confirm with Evernorth before a remote start.[9][7]
Timely filing: Evernorth’s Administrative Guidelines (September 2026) set the national default at 90 days. Evernorth will “only consider claims submitted within 90 days of the date of service or as otherwise defined in your Provider Agreement,” and the first listed exception is where “Applicable state law provides for a longer timely filing limit.” Maryland’s does. The Maryland Regulatory Addendum in the same guide: “To the extent required by § 15-1005 of the Maryland Insurance laws, Provider shall submit claims … within one hundred and eighty (180) days of the date those services are rendered.” The addendum “do[es] not apply with regard to Covered Services rendered to Participants covered under self-funded plans,” so a self-funded Cigna plan stays at 90 days unless your agreement says otherwise. A resubmission requested by Evernorth resets the clock to the date of the request.[7][10][2][11]
Payment: under the same addendum, “within thirty (30) days after Payor’s receipt of a claim Payor shall pay any undisputed fee-for-service amounts” or send a notice of what is denied, disputed or missing. Interest on a claim still unpaid after 30 days runs at 1.5% a month for days 31–60, 2% for days 61–120 and 2.5% after that.[7][10][2][11]
Telehealth coding: “Modifier 95 in Field 24-D to specify telehealth. 02 for Place of Service in Field 24-B.” Cigna’s autism resource guide (March 2025) treats every ABA CPT code as a covered telehealth service.[7][10][2][11]
Who goes on the claim, and taxonomy: “the fully credentialed provider should be listed on the claim as the rendering provider” when supervisees deliver the service. Evernorth’s complete-claim list names the rendering provider’s name, NPI and license type, and the billing provider’s name, address and NPI. It does not name a taxonomy code, and Cigna’s 837P companion guide (version 1.18, February 2022) adds no taxonomy (PRV) requirement of its own.[7][10][2][11]
Appeals: payment disputes start with a call to Provider Services at 800-926-2273. Formal appeals “are to be initiated in writing within 180 calendar days of the date of the initial payment or denial decision” (or of the last payment adjustment). Appeals cannot be submitted by automation; each must be sent by a person. For a late-filing denial, attach the EDI transmission report or other proof. Most appeals are resolved within 60 calendar days, with notice within 75 days unless state law requires otherwise. Maryland law (§ 15-1005) also guarantees at least 90 working days after a denial to appeal. No Evernorth document we read requires electronic visit verification (EVV) for ABA.[7][10][2][11]
Not required. Evernorth’s Behavioral Health Administrative Guidelines (September 2026), which govern Cigna behavioral claims including ABA, say for 837 claims: “The ‘Billing Provider’ Taxpayer Identification Number (TIN) and NPI are required. Any additional provider identification on the claim, such as the ‘Rendering Provider’ or ‘Referring Provider,’ must include the name and NPI when submitted.” So box 17/17b is optional, but if you fill it in, give the referring clinician’s name and NPI together.[7]
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]
On a fully insured Maryland plan, Insurance § 15-1005(c) gives the carrier 30 days after it receives a claim to pay it or send a notice saying it refuses all or part of the claim (and why), that the claim is disputed and what information it needs, or that the claim is not clean and what is missing. Any undisputed portion must still be paid within 30 days of receipt, and once requested information arrives the 30-day clock starts again. The same section requires at least 180 days to file and at least 90 working days after a denial to appeal. It applies to a carrier acting as administrator of a self-funded plan only “To the extent consistent with” ERISA. Evernorth’s administrative guidelines publish no weekly check-run day or submission cutoff.[11][7]
The questions that decide whether a family can start with Cigna / Evernorth in Maryland, and what they have to bring. Each maps onto something intake should ask on the first call.
Cigna's recency rule attaches to the standardized assessment rather than to the diagnosis itself, and it is tight. Initiation requires a standardized, validated instrument in its current edition administered within 60 days before treatment start. Continued treatment needs an updated plan with current data no more than 60 days old, a repeat standardized assessment within a year, and a re-assessment after any break in service longer than 60 days. If the family's most recent testing is older than 60 days, plan to administer during your assessment window — which Cigna lets you open without prior authorization.[1]
A standardized, validated instrument in its current edition — the policy gives Vineland-3 as the example rather than a closed list — administered within 60 days before treatment start, with the deficits it measures mapped to DSM-5-TR ASD domains and carried through into the treatment plan's goals. Continued treatment requires a repeat standardized assessment within a year.[1]
The most permissive position in this directory: Cigna's March 2025 autism resource guide states that all ABA CPT codes are covered telehealth services, with the delivery model — in person, telehealth or hybrid — chosen on the individual's needs. On the claim, Evernorth’s 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.” The 25 percent in-person floor in PT 60-26 is a Medicaid rule and does not reach a Cigna commercial member. For a fully insured Maryland policy, Insurance § 15-139 requires coverage "for health care services appropriately delivered through telehealth regardless of the location of the patient," bars excluding a service "solely because it is provided through telehealth," requires reimbursement "on the same basis and at the same rate" as in person, and allows preauthorization only if appropriateness is judged "in the same manner" for both. Self-funded employer plans are outside the statute. 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.[6][2][7]
Two answers, and plan funding type picks between them. The carrier's national ABA policy states no age limit. Maryland's habilitative-services mandate does: for Maryland-regulated insurers, nonprofit health service plans and HMOs, habilitative services must be covered “until at least the end of the month the enrollee turns 19,” and COMAR 31.10.39.03 pins its no-denial hour floors to age bands — up to 25 hours/week for ages 18 months through 5 years and up to 10 hours/week for ages 6 through 18, with more when medically necessary. Self-funded ERISA plans are exempt from all of it, so establish funding type before quoting either bound.[3][4]
Ask the plan: Benefits verification on the specific plan, via the payer portal or the number on the member’s card — ask whether the plan is Maryland-regulated (an insurer, nonprofit health service plan or HMO, which the habilitative-services mandate and COMAR 31.10.39.03 age bands reach) or a self-funded ERISA plan (exempt). If it is self-funded, ask what age limit and weekly hour limit the plan document sets for ABA before you quote either bound to the family.
Cigna does not publish one. Neither EN0499 nor Evernorth’s Behavioral Health Administrative Guidelines, including the Maryland Regulatory Addendum, requires a referral, prescription or physician order for ABA. On a fully insured Maryland plan, COMAR 31.10.39.03(C) says a carrier’s review criteria “may require” three things: “A comprehensive evaluation of a child by the child’s primary care provider or specialty physician identifying the need for habilitative services,” “A prescription from a child’s primary care provider or specialty physician that includes specific treatment goals,” and an annual review by the prescriber in consultation with the ABA provider. Whether Cigna applies those gates is not in writing. Ask at authorization, and keep a PCP or specialist prescription with goals on file for a fully insured Maryland member in case it is requested.[1][7][12]
Ask the plan: Evernorth Behavioral Health provider services (800-926-2273, or the behavioral number on the card): confirm funding type, then ask whether a PCP/specialist prescription with treatment goals and an annual prescriber review are required for ABA on this fully insured Maryland plan, as COMAR 31.10.39.03(C) permits.
Evernorth (Cigna’s behavioral arm) makes “coverage determinations in accordance with the time frames required under applicable law,” so the clock depends on how the plan is funded. If the child’s plan is fully insured in Maryland, Insurance §15-10B-06 sets the clock: an initial request is decided “within 2 working days after receipt of the information necessary to make the determination,” “additional visits or days of care submitted as part of an existing course of treatment or treatment plan within 1 working day,” emergency requests within 24 hours, and a reviewer missing information must say so within 3 calendar days. Maryland’s teeth: “If a private review agent fails to make a determination within the time limits required under this section, the request shall be deemed approved.” Mental-health treatment plans must be accepted on the MIA uniform treatment plan form. If the employer self-funds, ERISA’s floor applies instead: pre-service decisions “not later than 15 days after receipt of the claim” (one 15-day extension allowed), urgent claims within 72 hours. Evernorth’s own lead time: “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.”[7][2][13][14]
Ask the plan: the Evernorth Autism Care Coordinator team (877-279-7603) or the ID-card number — ask whether the plan is fully insured in Maryland or self-funded
Evernorth follows “the National Association of Insurance Commissioners guidelines about the industry standard of order of benefit determination subject to applicable law and the terms of the benefit plan.” For a child of married parents living together, “The plan of the parent whose birthday falls earlier in the calendar year is primary to the plan of the parent whose birthday falls later in the year” (same birthday: the plan in effect longer); for separated or divorced parents, a court decree first, then the custodial parent’s plan, the custodial parent’s spouse’s, the non-custodial parent’s, and that parent’s spouse’s. Bill the primary first, then Cigna (payer ID 62308, or paper with the primary’s EOB). Maryland has not yet adopted a COB regulation: the Insurance Administration says contract COB provisions “have historically been reviewed for consistency with the NAIC Model, but the Model has not been formally adopted to date,” and its draft COMAR 31.10.53 (comments closed August 2026) would codify the NAIC birthday rule (“The plan of the parent whose birthday falls earlier in the calendar year is the primary plan”) and exclude Medicaid from the definition of a plan — so Maryland Medicaid always pays after the commercial plan.[7][15][16]
Ask the plan: the carrier’s eligibility response (Availity or the ID-card number) for an other-insurance record, and both parents’ birth dates and custody arrangements at intake; a self-funded plan follows its own plan document
EN0499 as quoted in this guide sets the credential bar for who performs the ABA assessment and supervises the case — an independently licensed provider or a BCBA — rather than naming who may make the ASD diagnosis. The diagnosis itself must be a DSM-5-TR autism spectrum diagnosis, with Rett syndrome (F84.2) excluded.[1][2]
Ask the plan: Evernorth Behavioral Health provider services (the behavioral health number on the member's card) — ask which diagnosing credentials EN0499 accepts before you rely on a diagnosis from a non-doctoral clinician.
Coverage decides whether Cigna / Evernorth in Maryland 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.
Assessment and case supervision must come from a BCBA, a licensed behavior analyst, or an independently licensed clinician with documented ABA training, with direct supervision at the standard 1–2 hours per 10 hours of direct treatment. Evernorth does not credential non-licensed staff. In Maryland the supervising analyst must additionally hold the state Licensed Behavior Analyst credential, required to practice behavior analysis since January 2015. 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][5]
Restrictive, and the restriction is about other therapies as much as about ABA codes. EN0499 does not cover ABA delivered at the same time as another therapy (speech, OT) to the same child, and only one provider may bill a unit of time, with the standard supervision exceptions. Where a family is transitioning between ABA agencies, overlapping authorization periods require documented coordination between the agencies — so the outgoing provider's details belong on the intake form.[1]
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]
Every session note needs the date, start and end times, location, focus, a detailed description of the intervention, the persons present, the service type, and the rendering provider's name, credential and signature. No countersignature requirement and no signing deadline are published.[1]
Evernorth does not credential non-licensed staff, so RBT-delivered services bill under the supervising provider. The treatment plan must name a credentialed supervisor. Evernorth’s Administrative Guidelines (September 2026) say where that provider goes on the claim: “We allow providers to bill for professional services, which are rendered by supervisees, as permitted by state licensing regulations. If you engage in supervisor (or supervisee) billing, the fully credentialed provider should be listed on the claim as the rendering provider.” A complete CMS-1500 carries the “Rendering provider’s name, NPI, and license type” and the “Billing provider’s name, address, and NPI.”[1][7]
Not published as a payable-settings list. Two sourced facts bear on setting nonetheless: the treatment plan must carry dated baseline data per setting, so settings are declared and measured rather than assumed; and every session note must record the location. Whether a given setting is payable is a plan-benefit question.[1]
Ask the plan: Benefits verification on the specific plan — ask which places of service are payable for ABA, and whether school-based delivery is excluded before you write school goals.
No. Evernorth’s September 2026 administrative guidelines require only the billing provider’s TIN and NPI; a referring provider is optional, but if you report one it "must include the name and NPI."
Yes — under the carrier's national policy for ASD (EN0499, with no PA on assessment codes), layered on Maryland's habilitative-services mandate for fully-insured plans. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.
For fully-insured plans: coverage of habilitative services through at least the month the enrollee turns 19, no denial of ABA solely on prescribed hours up to 25 hrs/week (ages 18 months–5) or 10 hrs/week (ages 6–18), no experimental/investigational denials, and no dollar cap. COMAR also lets a carrier require a comprehensive evaluation plus a physician prescription reviewed annually; Cigna’s published policies do not say whether it does, so ask.
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. Maryland Medicaid's published schedule (97153 $19.17–$24.41 per 15 minutes by credential tier) is the public benchmark.
For a fully insured Maryland plan, 180 days from the date of service. Evernorth’s Maryland Regulatory Addendum adopts § 15-1005’s 180-day minimum. Evernorth’s national default, which applies to self-funded plans unless your agreement says otherwise, is 90 days from the date of service. Under the addendum, undisputed amounts are paid within 30 days of receipt, with interest after that.
Yes. Evernorth’s Administrative Guidelines (September 2026): “Modifier 95 in Field 24-D to specify telehealth. 02 for Place of Service in Field 24-B.” Cigna’s autism resource guide lists every ABA CPT code as a covered telehealth service.
Not in any Cigna or Evernorth document we could read. Evernorth’s complete-claim list asks for the rendering provider’s name, NPI and license type and the billing provider’s name, address and NPI, and Cigna’s 837P companion guide (v1.18) adds no taxonomy requirement. If a claim rejects for taxonomy, call Evernorth Provider Services (800-926-2273) and ask which taxonomy it has on file for your group.
The supervising credentialed provider, listed as the rendering provider. Evernorth does not credential non-licensed staff, and its Administrative Guidelines say that for supervisee services “the fully credentialed provider should be listed on the claim as the rendering provider.”
Maryland requires a Maryland license to practice behavior analysis (Health Occupations § 17-6A-10). Evernorth (Cigna) requires providers to “meet all state requirements to provide virtual behavioral services, including any licenses”; confirm with Evernorth before a remote start.
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.
Within 30 days of receipt on a fully insured Maryland plan: Insurance § 15-1005 requires payment, or a notice of denial, dispute or missing information, within 30 days, with any undisputed portion paid in that window. Self-funded plans are covered only as far as ERISA allows.
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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