---
title: "Cigna / Evernorth ABA coverage in Minnesota: the intake guide."
url: "https://carelu.com/payers/cigna-minnesota"
markdown_url: "https://carelu.com/payers/cigna-minnesota.md"
state: MN (Minnesota)
payer: Cigna / Evernorth in Minnesota
kind: Commercial insurance
description: "How Cigna / Evernorth covers ABA for Minnesota families: national policy EN0499, no PA on assessments, Minnesota’s large-employer autism mandate (children under 18), behavior analyst licensure, prompt-pay and utilization-review rules, and what intake should verify."
last_reviewed: October 2026
---

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

_Payer Guide · Cigna · Minnesota · Last updated October 2026 · 21 primary sources_

> Evernorth EN0499 + autism resource guide (no PA on assessments) + Minnesota’s large-employer mandate and BA licensure.

For a Minnesota intake team, a Cigna card means Evernorth’s national ABA policy EN0499 and the Cigna autism resource guide, Minnesota’s large-employer autism mandate, Minnesota’s behavior analyst license, and the plan’s funding type. Many Cigna members are on self-funded employer plans, so check funding first. Evernorth Behavioral Health is headquartered in Bloomington, Minnesota, and its administrative guidelines carry a Minnesota regulatory addendum for fully insured business.

## 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 (Cigna autism resource guide) [2]
- **Prior auth for treatment** _(plan-dependent)_: Required: complete the assessment and treatment plan and attach them to the Applied Behavior Analysis Prior Authorization Form; note Minnesota’s 2026 bar on prior authorization of "outpatient mental health treatment" for fully insured plans, whose reach to ABA is unsettled [2][9]
  - Ask the plan: Evernorth Provider Services, 800.926.2273: confirm whether the plan is Minnesota fully insured and whether ABA prior authorization still applies.
- **Autism diagnosis required?**: Yes: autism spectrum disorder under DSM-5-TR criteria (EN0499) [1]

## At a glance

- **Covers ABA?:** Yes, for ASD, per national policy EN0499
- **State mandate:** Minn. Stat. § 62A.3094 (Laws 2013, ch. 108)
- **Mandate age:** Children under 18
- **Mandate caps:** No dollar or visit cap in the statute; treatment-plan updates limited to once every six months
- **Exempt from mandate:** Small-group and individual plans (mandate binds large employers, 51+ employees) and self-funded ERISA plans
- **Licensure:** Licensed behavior analyst required since Jan. 1, 2025 (Board of Psychology), unless exempt
- **Fee schedule:** Not public — your ABA fee schedule is Exhibit A of your Evernorth Provider Agreement; Provider Services 800.926.2273

## The national policy, applied in Minnesota

Cigna, through Evernorth Behavioral Health, 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; treatment needs the completed assessment and treatment plan on the ABA Prior Authorization Form. Only one provider may bill a unit of time except 97153, 97154 and 97155 during direct supervision, non-credentialed staff bill under the supervising provider, and all ABA CPT codes are covered telehealth services. EN0499 and the resource guide contain no Minnesota-specific criteria. Evernorth’s Minnesota Regulatory Addendum (September 2026 guidelines) governs contract mechanics such as 45 days’ notice of fee-schedule changes, and "do[es] not apply with regard to Covered Services rendered to Participants covered under self-funded plans." [1][2][3]

## The Minnesota mandate: what it guarantees

Minnesota’s autism mandate, Minn. Stat. § 62A.3094, is narrower than most states’. It binds "A health plan issued to a large employer, as defined in section 62Q.18," which § 62Q.18 defines as an employer with "more than 50 current employees." Those plans "must provide coverage for the diagnosis, evaluation, multidisciplinary assessment, and medically necessary care of children under 18 with autism spectrum disorders," expressly including "early intensive behavioral and developmental therapy … including, but not limited to, all types of applied behavior analysis, intensive early intervention behavior therapy, and intensive behavior intervention," plus speech, occupational and physical therapy and medications. Treatment follows "an individualized treatment plan prescribed by the enrollee’s treating physician or mental health professional"; the carrier "may request an updated treatment plan only once every six months" unless both sides agree more is needed; and "An independent progress evaluation conducted by a mental health professional with expertise and training in autism spectrum disorder and child development must be completed." Medical necessity must be "consistent with generally accepted practice parameters as determined by physicians and licensed psychologists who typically manage patients who have autism spectrum disorders." The section sets no dollar or visit cap. It does not reach small-group or individual policies, or self-funded employer plans (ERISA); those fall back on the plan document plus parity law, and Minnesota’s parity statute (§ 62Q.47) applies to "All health plans … that provide coverage for … mental health" services. [4][5][6]

## Licensure, out-of-state BCBAs and rates

Minnesota now licenses behavior analysts. Laws 2024, ch. 127, art. 19 created a license under the Board of Psychology (Minn. Stat. §§ 148.9981–148.9995; the BACB’s licensure table lists Minnesota, 2024, MN Board of Psychology). Since January 1, 2025, "an individual must not engage in the practice of applied behavior analysis unless the individual is licensed … as a behavior analyst or is exempt"; licensed psychologists are exempt, and so are "unlicensed supervisee[s] or trainee[s]" working "under the authority and direction of a licensed behavior analyst," family members acting under that direction, school-district employees, and supervised students. The license requires "a current and active national certification as a board-certified behavior analyst" (or the equivalent requirements) plus a background check, and renews every two years. The exceptions list has no out-of-state or telehealth carve-out, so a BCBA licensed in another state should get a Minnesota license (or confirm an exemption with the Board of Psychology) before treating a Minnesota child, including remotely. For rates: commercial ABA rates are negotiated and unpublished; the public benchmark is Minnesota Medical Assistance’s EIDBI rate, $20.178 per 15-minute unit of intervention when delivered by a QSP or Level I provider (SPA MN-24-0010, effective January 1, 2024). [11][12][13][14][15][21]

## Claims operations in Minnesota

Evernorth "will only consider claims submitted within 90 days of the date of service or as otherwise defined in your Provider Agreement," unless "Applicable state law provides for a longer timely filing limit." Minnesota’s prompt-pay statute (§ 62Q.75) makes "All health plan companies and third-party administrators … pay or deny claims that are clean claims within 30 calendar days" of receipt, with interest at "1.5 percent per month," and, "Unless otherwise provided by contract," providers must submit charges "within six months from the date of service." Telehealth claims carry "Modifier 95 in Field 24-D" and "02 for Place of Service." Fee-schedule and contract questions go to Provider Services, 800.926.2273. [3][7]

Evernorth’s guidelines also set the secondary and resubmission clocks: 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]," Medicaid-primary claims get three years, and a timely claim returned for more information gets a new 90 days from the date of the request. No check-run or weekly cut-off schedule is published. [3][7]

## What a reauthorization must show

Evernorth’s EN0499 sets what a continued-treatment request must show: "current data" collected "within no more than 60 days prior to the start date of the continued treatment request, as well as collected within no more than 60 days prior to the date the authorization request is received," with collection dates, for every behavior and skill targeted; data showing "ongoing and sustained progress toward mastering the treatment goals"; measurable improvement on "a reliable, valid, and standardized assessment instrument completed no more than one year prior to the start date of the continued treatment request"; an account of barriers and plan changes where progress is not shown; and dated stakeholder (caregiver) training data. EN0499 does not require the data to be graphed. [1]

## Intake gates

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

- **Diagnosis recency**: No expiry on the diagnosis, but the request must give "The date on which the diagnosis was most recently made"; the standardized assessment instrument must be administered "within 60 days prior to the start of treatment," with quantitative baseline data from the same 60-day window (EN0499). [1]
- **Who may diagnose**: A healthcare professional licensed to practice independently whose board considers diagnosis within scope, applying DSM-5-TR criteria (EN0499). [1]
- **Diagnostic tools required**: No single instrument is mandated; it must be reliable, valid, standardized, current edition, and measure both DSM-5-TR ASD domains (EN0499). [1]
- **Referral required?**: EN0499 requires no referral; assessments need no PA with an autism diagnosis when the provider is independently licensed or a BCBA. For a Minnesota large-employer plan, § 62A.3094 ties covered treatment to "an individualized treatment plan prescribed by the enrollee’s treating physician or mental health professional," lets the carrier request an updated plan "only once every six months," and requires an independent progress evaluation by a mental health professional. [2][1][4]
- **Telehealth**: "All ABA CPT codes are covered telehealth services" (autism resource guide); bill modifier 95 with POS 02. For fully insured Minnesota plans the Minnesota Telehealth Act also requires parity in coverage and payment (§ 62A.673). Telehealth providers must hold the Minnesota license. [2][3][10]
- **Age limit** _(plan-dependent)_: EN0499 sets no age cap. For a Minnesota large-employer plan (more than 50 employees, fully insured), § 62A.3094 requires autism coverage "of children under 18"; it sets no dollar cap. Small-group, individual and self-funded plans sit outside that section, so the plan document governs. [1][4][5]
  - Ask the plan: Live benefits verification: establish group size and fully insured vs. self-funded first.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. Fully insured Minnesota plans fall under the Minnesota Utilization Review Act: a standard prior-authorization decision must be communicated "within five business days after receiving the request, regardless of how the request was received," once the reviewer has the information it reasonably needs (§ 62M.05, subd. 3a), and an expedited one "no later than 48 hours and must include at least one business day" (subd. 3b). An approved authorization may not be revoked or limited later except for fraud, misinformation or a conflict with law (§ 62M.07, subd. 3). For plans issued or renewed on or after January 1, 2026, "An authorization for treatment of a chronic health condition does not expire unless the standard of treatment for that health condition changes" (subd. 5), and no carrier may require prior authorization of "outpatient mental health treatment" (subd. 2(2)); the statute does not say whether it treats ABA as outpatient mental health treatment, so ask. Self-funded employer (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. Cigna/Evernorth publishes no Minnesota-specific ABA turnaround. [8][9][16]
  - Ask the plan: At benefits verification ask whether the plan is fully insured in Minnesota or self-funded.
- **Other insurance (who pays first)** _(plan-dependent)_: If the child also has Minnesota Medical Assistance, Cigna/Evernorth pays first: Medicaid is payer of last resort (42 CFR 433.139). For EIDBI, though, DHS runs "pay and chase": the EIDBI provider is "not required to bill a member’s commercial insurance before billing Medicaid," and MHCP or the MCO recovers from the commercial plan afterwards, so a Medicaid-enrolled EIDBI agency may see the commercial carrier come back for the money. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). We did not read Minnesota’s group coordination-of-benefits rule, so confirm the order between two parents’ plans (birthday rule or otherwise) with the carrier. [17][18][19][20]
  - Ask the plan: Ask Evernorth for the member’s coordination-of-benefits order and record every other coverage.

## Delivery and billing rules

Coverage decides whether Cigna / Evernorth in Minnesota 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, a Licensed Behavior Analyst, or an independently licensed mental health professional with ABA training; direct plus indirect case supervision of one to two hours per ten hours of direct treatment (at least one to two hours a week at 10 hours or less); supervisor’s name and credentials documented (EN0499). In Minnesota the supervisor must also hold a Minnesota behavior analyst license or be a licensed psychologist (§ 148.9986). [1][13]
- **Concurrent billing (97153 + 97155)**: "Only one provider can bill for a unit of time, with the exception of CPT codes 97153, 97154, and 97155" during direct supervision, when the BCBA or QHP directs the technician face-to-face with the patient. ABA at the same time as another treatment is not reimbursable. [2][1]
- **Daily limits / MUEs**: No per-day cap is published; all ABA codes bill in 15-minute units and intensity must reflect severity, goals and response. [2][1]
- **Session-note signature**: Each service needs its own record with date and time, location, focus, intervention, who was present, service type, and the name, credential and signature of the rendering provider (EN0499). [1]
- **Place of service**: Goals and data reported separately for each setting (home, clinic, school, community); primarily educational or vocational services are not covered (EN0499). [1]
- **Bill as provider**: "Evernorth does not credential nonlicensed/noncertified staff"; their services are billed under the supervising provider. On a CMS-1500 list "only a BCBA or other licensed provider in box 33"; payer ID 62308. In Minnesota the billing BCBA should hold the Minnesota license. [2][13]

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

- **Plan funding and group size:** Fully insured large-employer (§ 62A.3094 applies), small group/individual, or self-funded ERISA.
- **Member ID + card photo:** Enough to run a live benefits verification.
- **Diagnosis report:** Diagnosing clinician’s name, credentials and licensure type, and the date of the most recent diagnosis.
- **Standardized assessment timing:** Instrument administered within 60 days before treatment starts.
- **Treatment plan from the physician or mental health professional:** § 62A.3094 ties covered treatment to it; updates at most every six months.

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

## Common questions

### Does Cigna require graphs for ABA reassessments?

No. Evernorth’s EN0499 requires dated data collected within 60 days before both the requested start date and the request’s receipt, sustained progress, and a standardized assessment from the past year, but it does not require graphs.

### What are Cigna (Evernorth)’s claim filing deadlines for Minnesota ABA claims?

90 days from the date of service unless your provider agreement or a longer state limit applies; secondary claims get 90 days from the primary payer’s EOB/EOP date, and a claim returned for more information gets a new 90 days. No check-run schedule is published.

### Does Cigna cover ABA therapy in Minnesota?

Yes, under EN0499 for ASD. Minnesota’s mandate adds a floor for fully insured large-employer plans and children under 18.

### Does the Cigna ABA assessment need prior authorization in Minnesota?

No, for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed or a BCBA.

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

Evernorth’s default is 90 days from service unless the provider agreement or a longer state limit applies; Minnesota’s statute sets six months unless a contract provides otherwise. Check your agreement.

## Primary sources

1. [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)
2. [Cigna / Evernorth autism resource guide](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/autism-resource-guide.pdf)
3. [Evernorth Behavioral Health Administrative Guidelines (PCOMM-2026-191, September 2026; incl. Minnesota Regulatory Addendum)](https://static.evernorth.com/assets/evernorth/provider/pdf/resourceLibrary/behavioral/ebh-provider-admin-guide.pdf)
4. [Minn. Stat. § 62A.3094 — Coverage for autism spectrum disorders (large-employer plans, children under 18)](https://www.revisor.mn.gov/statutes/cite/62A.3094)
5. [Minn. Stat. § 62Q.18, subd. 1 — "Large employer" means more than 50 current employees](https://www.revisor.mn.gov/statutes/cite/62Q.18)
6. [Minn. Stat. § 62Q.47 — Mental health and substance use parity (all health plans)](https://www.revisor.mn.gov/statutes/cite/62Q.47)
7. [Minn. Stat. § 62Q.75 — Prompt payment: clean claims in 30 days, 1.5% monthly interest, six-month claim filing](https://www.revisor.mn.gov/statutes/cite/62Q.75)
8. [Minn. Stat. § 62M.05 — Review determinations: standard 5 business days, expedited 48 hours](https://www.revisor.mn.gov/statutes/cite/62M.05)
9. [Minn. Stat. § 62M.07 — Prior authorization (subd. 2 prohibited PA, subd. 3 no retroactive revocation, subd. 5 chronic conditions)](https://www.revisor.mn.gov/statutes/cite/62M.07)
10. [Minn. Stat. § 62A.673 — Minnesota Telehealth Act (commercial telehealth coverage and payment parity)](https://www.revisor.mn.gov/statutes/cite/62A.673)
11. [Minn. Stat. § 148.9981 — Behavior analyst licensure: definitions (Board of Psychology; practice of ABA)](https://www.revisor.mn.gov/statutes/cite/148.9981)
12. [Minn. Stat. § 148.9983 — Requirements for behavior analyst licensure](https://www.revisor.mn.gov/statutes/cite/148.9983)
13. [Minn. Stat. § 148.9986 — Prohibited practice or use of titles (license required from Jan. 1, 2025)](https://www.revisor.mn.gov/statutes/cite/148.9986)
14. [Minn. Stat. § 148.9987 — Exceptions to the behavior analyst license requirement](https://www.revisor.mn.gov/statutes/cite/148.9987)
15. [BACB — U.S. Licensure of Behavior Analysts (Minnesota: 2024 law, MN Board of Psychology)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
16. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
17. [42 CFR 433.139 — Medicaid third-party liability, incl. pay-and-recover for EPSDT (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
18. [MHCP Provider Manual — Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit (revised Sept. 14, 2026)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS16_195658)
19. [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)
20. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)
21. [CMS-approved Minnesota SPA MN-24-0010, Attachment 4.19-B — EIDBI rates (effective Jan. 1, 2024)](https://www.medicaid.gov/medicaid/spa/downloads/MN-24-0010.pdf)

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.