---
title: "Cigna / Evernorth ABA coverage in Mississippi: the intake guide."
url: "https://carelu.com/payers/cigna-mississippi"
markdown_url: "https://carelu.com/payers/cigna-mississippi.md"
state: MS (Mississippi)
payer: Cigna / Evernorth in Mississippi
kind: Commercial insurance
description: "How Cigna / Evernorth covers ABA for Mississippi families: EN0499, no PA on assessment codes, Mississippi’s § 83-9-26 autism mandate (age 8 and 25 hours unless extended), telehealth, the Prior Authorization Reform Act and LBA licensure."
last_reviewed: October 2026
---

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

_Payer Guide · Cigna · Mississippi · Last updated October 2026 · 19 primary sources_

> EN0499 + autism resource guide (no PA on assessment codes) + Mississippi’s § 83-9-26 mandate and LBA licensure.

For a Mississippi intake team a Cigna card means Evernorth’s national ABA policy EN0499 and the Cigna autism resource guide, Mississippi’s autism mandate in § 83-9-26, and the plan’s funding type. Many Cigna members are on self-funded employer plans, which sit outside the state mandate, so check funding first. Cigna runs no MississippiCAN plan.

## 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) [2]
- **Prior auth for treatment**: Required: after the assessment, submit the Applied Behavior Analysis Prior Authorization Form with the treatment plan [2][1]
- **Autism diagnosis required?**: Yes: ASD under DSM-5-TR criteria, diagnosed by an independently licensed professional whose board allows diagnosis; provisional or educational identification does not count [1]

## At a glance

- **Covers ABA?:** Yes, for ASD, per national policy EN0499
- **State mandate:** Miss. Code Ann. § 83-9-26 (HB 885, 2015; policies issued or renewed from 1/1/2016)
- **Mandate age:** ABA not required beyond age 8, unless medical necessity for an extension is shown
- **Mandate caps:** 25 hours/week of ABA, no more than 10 hours/week of licensed behavior analyst time; extendable on medical necessity; no less favorable dollar limits than medical
- **Exempt from mandate:** Self-funded ERISA plans; non-grandfathered individual and small-group ACA plans; small employers (≤100) must only offer it
- **Licensure:** Mississippi Autism Board license (LBA/LABA); RBTs registered under the supervisor
- **Fee schedule:** Not public — Exhibit A of your Evernorth Provider Agreement; Evernorth Provider Services 800.926.2273

## The national policy, applied in Mississippi

Cigna, through Evernorth Behavioral Health, covers ABA under EN0499 (effective May 15, 2026). The autism resource guide says "Prior authorization is no longer required for assessment … codes 97151, 97152, or 0362T with a diagnosis of autism, as long as the provider is independently licensed or a Board Certified Behavior Analyst® and the patient’s policy covers ABA services"; treatment needs the completed assessment and treatment plan on the ABA Prior Authorization Form, ideally requested up to 30 days before or two weeks after the start date. A full-text check of EN0499 and the guide found no mention of Mississippi, so the national criteria apply. [1][2]

## The Mississippi mandate: what it guarantees

Mississippi’s autism mandate is Miss. Code Ann. § 83-9-26, enacted as HB 885 in 2015. A health insurance policy "shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder" for policies delivered, issued or renewed in the state (or outside it if insuring Mississippi residents) on or after January 1, 2016. Treatment means evidence-based care "prescribed or ordered" by a licensed physician or licensed psychologist who finds it medically necessary, and it includes "behavioral health treatment" (behavior modification and counseling programs "including applied behavior analysis"), pharmacy, psychiatric, psychological and therapeutic care. Behavioral health treatment must be "provided or supervised by a licensed behavior mental health professional," and a diagnosis of ASD means assessments "performed by a licensed psychologist or licensed physician." The limits sit in subsection (5): ABA coverage "shall be limited to twenty-five (25) hours per week, and shall not be required beyond the age of eight (8) years," and "no more than ten (10) hours per week shall be for the services of a licensed behavior analyst," with all services "under the supervision or direction of a licensed behavior analyst or licensed psychologist." Those limits can be exceeded under an ongoing treatment plan "if medical necessity for the extension is determined to exist," and otherwise the policy’s appeal rights govern. Dollar limits, deductibles and coinsurance may not be less favorable than for medical and surgical benefits. Except for inpatient care, the insurer may review the treatment plan every six months, at its own cost. Schools’ IEP, IFSP and IDEA obligations are not shifted to insurers. Subsection (8) exempts non-grandfathered individual and small-group plans that carry ACA essential health benefits, and subsection (9) requires small employers with 100 or fewer eligible employees only to offer the coverage (they may charge for it). Self-funded ERISA plans are outside state law. The Insurance Department’s autism page lists Blue Cross & Blue Shield of Mississippi, UnitedHealthcare and Ambetter of Magnolia as having "voluntarily removed all age restrictions" for ABA, and tells families to confirm with their plan. [4][5]

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

Mississippi licenses behavior analysts. The BACB’s licensure table lists Mississippi (2015) with the Mississippi Autism Board, which licenses Licensed Behavior Analysts and Licensed Assistant Behavior Analysts under Miss. Code Ann. § 73-75. To be licensed as a behavior analyst a person needs at least a master’s degree, "current and active certification" as a BCBA or BCBA-D, a fingerprint-based state and FBI background check, and the Board’s other requirements, which include an oral examination the Board gives at least quarterly (Rule 3.2); licenses run three years but never past the BACB certification. Assistant behavior analysts need a bachelor’s degree, BCaBA certification and proof of supervision by a licensed behavior analyst. Technicians are not licensed: the supervising licensee registers each Registered Behavior Technician with the Board, the technician "works solely under the license of the behavior analyst," and supervision follows the BACB’s policy (Rule 9). For a BCBA licensed in another state, the statute’s exemption list (§ 73-75-5: licensed psychologists, other licensed professionals within scope, supervised technicians, family members, trainees, school employees) does not include behavior analysts licensed elsewhere, and the Board’s rules contain no telehealth provision, so plan on a Mississippi license before treating a Mississippi patient in person or by telehealth. The route is licensure by reciprocity (Rule 3.4), which still requires meeting the Rule 3.1 and 3.2 requirements; a temporary license exists only for applicants awaiting exam scores or the next oral exam, restricts practice to Mississippi and requires supervision. The autism mandate ties into this: a "licensed behavior analyst" in § 83-9-26 is one licensed under § 73-75-13. [6][7][8][9][10][11][3]

For state-regulated plans, Miss. Code Ann. § 83-9-351 says "All health insurance and employee benefit plans in this state must provide coverage for telemedicine services to the same extent that the services would be covered if they were provided through in-person consultation," with cost sharing no higher than in person. Telemedicine other than remote monitoring and store-and-forward "must be 'real-time' audio visual capable," and the claim carries the procedure code "with the appropriate modifier indicating interactive communication was used." The section was set to lapse on July 1, 2025; SB 2415 (2025), as sent to the Governor, moves the repeal date to July 1, 2028. Self-funded employer plans are covered only to the extent federal law permits. [6][7][8][9][10][11][3]

Evernorth adds that providers "must meet all state requirements to provide virtual behavioral services, including any licenses and certifications." [6][7][8][9][10][11][3]

## What is Cigna’s fee schedule for ABA, and how fast must it pay?

Cigna publishes no ABA rates. Evernorth’s Administrative Guidelines (September 2026) say the Provider Agreement terms "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." Virtual services carry modifier 95, which "will not change the reimbursement." Mississippi’s prompt-pay law, Miss. Code Ann. § 83-9-5(1)(h), requires clean claims to be paid within 25 days of receipt of due written proof for electronic claims and 35 days for paper, with interest of 3% a month after that; a clean claim "requires no further information, adjustment or alteration by the provider." The public benchmark is Mississippi Medicaid’s fee schedule (July 2026 Mississippi Medicaid ASD fee schedule, per 15-minute unit: 97151 $34.18 (no PA), 97152 $41.74, 97153 $15.08, 97154 $9.42, 97155 and 97156 $24.35, 97157 and 97158 $12.17, 0362T $56.64, 0373T $41.49, ages 0–20). [3][13][19]

Evernorth’s Behavioral Health Administrative Guidelines (September 2026) set the filing limit: "We 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." 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. The Mississippi Regulatory Addendum adds no filing deadline; it gives Evernorth the same post-payment audit window as the provider’s filing period (12 months after payment where the agreement sets none). State addenda do not apply to self-funded plans. The guidelines publish no check-run or weekly cut-off schedule. [3][13][19]

## 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 Mississippi, and what they have to bring.

- **Diagnosis recency**: No expiry on the diagnosis, but the request needs the date it was most recently made; standardized instruments and baseline data must be within 60 days before treatment, current data within 60 days of a request (EN0499). [1]
- **Who may diagnose**: A healthcare professional licensed to practice independently whose licensure board considers diagnostics within scope (EN0499). For fully insured Mississippi plans, § 83-9-26 defines diagnosis as performed by a licensed psychologist or licensed physician. [1][4]
- **Diagnostic tools required**: No single instrument is mandated; it must be reliable, valid, standardized, measure both DSM-5-TR domains and be the current edition (Vineland-3, not Vineland-II). [1]
- **Referral required?**: EN0499 requires no referral; assessments need no PA with an autism diagnosis when the provider is independently licensed or a BCBA. Evernorth publishes no ABA order form or validity period. On the claim, Evernorth’s administrative guidelines (September 2026) define a complete CMS-1500 claim without a referring provider (they require the rendering provider’s name, NPI and license type and the billing provider’s name, address and NPI); any "Referring Provider" reported on an 837 claim "must include the name and NPI." Under § 83-9-26 the mandated treatment is care "prescribed or ordered" by a licensed physician or licensed psychologist, so keep that order on file for a fully insured Mississippi plan; the insurer may review the treatment plan every six months. [2][1][4][3]
- **Telehealth**: "All ABA CPT codes are covered telehealth services" (autism resource guide), and EN0499 allows in-person, telehealth or hybrid delivery. Evernorth bills virtual services with modifier 95 and requires the provider to meet the state’s licensure rules, which in Mississippi means a Mississippi license. [2][1][3]
- **Age limit** _(plan-dependent)_: EN0499 says access to focused intervention "should not be restricted by age"; age terms come from the benefit plan and any controlling mandate. For fully insured Mississippi plans, § 83-9-26(5) lets ABA coverage stop at age 8 and 25 hours a week unless medical necessity for an extension is shown under an ongoing treatment plan; non-grandfathered individual and small-group plans and self-funded ERISA plans are outside the mandate. [1][4]
  - Ask the plan: Live benefits verification: establish fully insured vs. self-funded and the market segment, then the plan’s ABA age terms.
- **Prior-auth decision time** _(plan-dependent)_: Fully insured plans fall under the Mississippi Prior Authorization Reform Act (SB 2140, effective July 1, 2024). It applies to health insurance issuers, health benefit plans and private review agents, "with the exception of employee or employer self-insured health benefit plans" under ERISA. A non-urgent decision is due "no later than seven (7) calendar days after obtaining all necessary information," an urgent one "no later than forty-eight (48) hours after receiving all information needed." A missed deadline means the services are "automatically deemed authorized." An approval stays valid for the lesser of six months, the length of treatment set by the clinician, or the plan’s renewal (12 months for chronic-condition treatment). 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, and at least 180 days to appeal a denial. Cigna/Evernorth publishes no Mississippi-specific ABA turnaround; its resource guide warns a late request "could delay the determination for up to 30 days." [12][15][2]
  - Ask the plan: At verification ask whether the plan is fully insured (Mississippi-regulated) or self-funded (ERISA).
- **Other insurance (who pays first)** _(plan-dependent)_: Mississippi’s coordination-of-benefits regulation (19 Miss. Admin. Code Pt. 3, R. 7.01) lets insurers file coordination provisions but sets no order-of-benefits rule of its own, so the order for a child on two parents’ plans comes from the plan documents (ask about the birthday rule at verification). The same regulation says "other health plans" for coordination "shall not include … Medicaid," and Medicaid is payer of last resort (42 CFR 433.139), so this plan pays before Mississippi Medicaid or a MississippiCAN plan. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). [14][16][17][18]
  - Ask the plan: Ask Cigna/Evernorth at verification for the member’s coordination-of-benefits order and record every other coverage the child has.

## Delivery and billing rules

Coverage decides whether Cigna / Evernorth in Mississippi 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, Licensed Behavior Analyst or independently licensed clinician with ABA training, at "one to two hours per ten hours of direct treatment"; at 10 hours a week or less, at least one to two hours a week of direct case supervision (EN0499). [1]
- **Concurrent billing (97153 + 97155)**: "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)." EN0499 also 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)." [2][1]
- **Daily limits / MUEs**: No per-day cap; ABA codes bill in 15-minute units only with 97151–97158, 0362T and 0373T. For fully insured Mississippi plans the mandate permits a 25-hour weekly ABA limit, extendable on medical necessity. [2][4]
- **Session-note signature**: Each service record needs the date and time, location, intervention, who was present, and the "Name, credential (if applicable), and signature of ABA provider who rendered the service" (EN0499). [1]
- **Place of service**: EN0499 excludes services "primarily educational or vocational in nature" and requires services in academic or vocational settings to meet the direct-treatment definition; § 83-9-26(7) leaves school IEP/IDEA services with the schools. [1][4]
- **Bill as provider**: "Evernorth does not credential nonlicensed/noncertified staff. Services for these staff members must be billed under the supervising provider." On a CMS-1500, list "only a BCBA or other licensed provider in box 33"; electronic claims use payer ID 62308. [2]

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

- **Plan funding and market:** Fully insured large group (mandate applies), small group or individual ACA plan (exempt), or self-funded ERISA (plan document governs).
- **Child’s age:** The mandate lets ABA stop at age 8 unless an extension is medically necessary; EN0499 itself sets no age cap.
- **Diagnosis report:** Diagnosing clinician’s name, credentials and license type, and the date of the most recent diagnosis.
- **Standardized assessment timing:** Instrument administered within 60 days before treatment starts.
- **Physician or psychologist order:** The mandate covers treatment prescribed or ordered by a licensed physician or psychologist.

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 Mississippi 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 Mississippi?

Yes, under EN0499 for ASD, with Mississippi’s § 83-9-26 mandate layered on fully insured large-group and grandfathered plans.

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

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

### Can a BCBA licensed in another state treat a Mississippi Cigna member by telehealth?

Cigna covers all ABA codes by telehealth, but Evernorth requires providers to meet the state’s licensure rules and Mississippi’s law has no exemption for behavior analysts licensed elsewhere, so get a Mississippi Autism Board license first.

### What does Cigna pay for ABA in Mississippi?

Cigna publishes no ABA rates; your fee schedule is Exhibit A of your Evernorth Provider Agreement. Mississippi Medicaid’s 97153 rate ($15.08 per 15 minutes) is the only public benchmark.

## 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 (March 2025)](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/autism-resource-guide.pdf)
3. [Evernorth Behavioral Health Administrative Guidelines (PCOMM-2026-191, September 2026)](https://static.evernorth.com/assets/evernorth/provider/pdf/resourceLibrary/behavioral/ebh-provider-admin-guide.pdf)
4. [Miss. Code Ann. § 83-9-26 — Screening, Diagnosis, and Treatment of Autism Spectrum Disorder (Mississippi Insurance Department copy)](https://www.mid.ms.gov/wp-content/uploads/2023/04/MissCodeAnn83-9-26.pdf)
5. [Mississippi Insurance Department — Autism (FAQ on the § 83-9-26 mandate; carriers that voluntarily removed ABA age limits)](https://www.mid.ms.gov/mississippi-insurance-department/healthcare/autism/)
6. [BACB — U.S. Licensure of Behavior Analysts (Mississippi: 2015, MS Autism Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
7. [Miss. Code Ann. § 73-75-13 — eligibility for licensure as a behavior analyst or assistant behavior analyst (FindLaw)](https://codes.findlaw.com/ms/title-73-professions-and-vocations/ms-code-sect-73-75-13/)
8. [Miss. Code Ann. § 73-75-5 — exemptions from the behavior analyst licensure chapter (FindLaw)](https://codes.findlaw.com/ms/title-73-professions-and-vocations/ms-code-sect-73-75-5/)
9. [Mississippi Autism Board — Title 30 Part 3301, Licensure of Behavior Analysts and Assistant Behavior Analysts (rules final 3/13/2024)](https://www.msautismboard.ms.gov/sites/autism/files/UploadedDocuments/2024/MAB%20R&R%20(Final)%203.13.2024.pdf)
10. [Miss. Code Ann. § 83-9-351 — Telemedicine coverage (FindLaw, current as of Jan. 1, 2025)](https://codes.findlaw.com/ms/title-83-insurance/ms-code-sect-83-9-351/)
11. [Mississippi SB 2415 (2025) — extends the § 83-9-351 telemedicine repealer to July 1, 2028 (as sent to the Governor)](https://billstatus.ls.state.ms.us/documents/2025/dt/SB/2400-2499/SB2415SG.pdf)
12. [Mississippi SB 2140 (2024), "Mississippi Prior Authorization Reform Act" — as sent to the Governor (eff. July 1, 2024)](https://billstatus.ls.state.ms.us/documents/2024/pdf/SB/2100-2199/SB2140SG.pdf)
13. [Miss. Code Ann. § 83-9-5(1)(h) — payment of clean claims (FindLaw, current as of Jan. 1, 2025)](https://codes.findlaw.com/ms/title-83-insurance/ms-code-sect-83-9-5/)
14. [19 Miss. Admin. Code Pt. 3, R. 7.01 — (88-102) Coordinating or Integrating Accident and Health Insurance Benefits (Cornell LII)](https://www.law.cornell.edu/regulations/mississippi/19-Miss-Code-R-SS-3-7-1)
15. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
16. [42 CFR 433.139 — Medicaid 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)
19. [Mississippi Division of Medicaid — Autism Spectrum Disorder Services Fee Schedule, July 2026 (.xlsx)](https://medicaid.ms.gov/wp-content/uploads/2026/07/ASD-FEE_SHEDULE-JULY-2026-fnl.xlsx)

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.