For an intake team in Nevada, a Cigna card means three layers: Evernorth’s national ABA policy EN0499 with the Cigna autism resource guide, Nevada’s autism mandate, and the plan’s funding type. Many Cigna members are on self-funded employer plans, which sit outside the mandate, so check funding first. Evernorth’s administrative guidelines carry a Nevada Regulatory Addendum for contracted providers. Cigna is not a Nevada Medicaid plan.
Cigna, through Evernorth Behavioral Health, covers ABA under EN0499 (effective May 15, 2026). Per the autism resource guide (March 2025), “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.” After the assessment and treatment plan, the provider completes the ABA Prior Authorization Form; Evernorth encourages requests “up to 30 days in advance of or two weeks after the start date of service.” EN0499 and the resource guide do not mention Nevada, so the national criteria apply, subject to the mandate.[5][6]
Nevada’s autism mandate is written separately into each insurance chapter. For group policies, NRS 689B.0335 says a health benefit plan “must provide coverage for screening for and diagnosis of autism spectrum disorders and for treatment of autism spectrum disorders to persons covered by the policy of group health insurance under the age of 18 years or, if enrolled in high school, until the person reaches the age of 22 years.” HMOs (NRS 695C.1717) and small-employer plans (NRS 689C.1655) carry the same text. Individual policies are different: NRS 689A.0435 only requires the plan to “provide an option of coverage,” with a maximum benefit “of not less than” the same amount. The cap is set in subsection 2: coverage is subject to “A maximum benefit of the actuarial equivalent of $72,000 per year for applied behavior analysis treatment,” plus the policy’s ordinary cost sharing. Inside that cap the insurer “shall not limit the number of visits,” may not charge higher cost sharing or impose a longer wait than for other outpatient care, and “shall accept as dispositive any diagnosis of an autism spectrum disorder that is rendered in accordance with the statewide standard” set under NRS 427A.872. Treatment “must be identified in a treatment plan” prescribed and provided by a provider acting within scope, and the insurer “may request a copy of and review a treatment plan.” The statute defines behavioral therapy as therapy “provided by a licensed psychologist, licensed behavior analyst, licensed assistant behavior analyst or registered behavior technician,” and it does not require an insurer to reimburse a school for school services. The current text was last amended in 2025 and binds policies “delivered, issued for delivery or renewed on or after January 1, 2026.” It reaches state-regulated plans only; self-funded employer plans answer to ERISA.[1][3][10][2]
Nevada licenses behavior analysts. Under NRS Chapter 641D a “behavior analyst” is a person with current BCBA or BCBA-D certification “and is licensed as a behavior analyst pursuant to this chapter”; an assistant behavior analyst is a licensed BCaBA; and a registered behavior technician must be BACB-certified and “registered as such pursuant to this chapter.” The Board of Applied Behavior Analysis (NRS 641D.200) issues those credentials, and the BACB’s licensure table lists Nevada with the NV Applied Behavior Analysis Board. Practicing ABA without the license or registration is prohibited (NRS 641D.900) and is a gross misdemeanor (NRS 641D.910); exemptions cover physicians, psychologists and certain other licensed professionals, family members acting at a behavior analyst’s direction, and school-district employees serving pupils (NRS 641D.110). An assistant behavior analyst or RBT may practice only under supervision by a licensed behavior analyst or a BCBA-certified licensed psychologist (an RBT may also be supervised by a qualified licensed assistant behavior analyst), and supervisors must follow BACB supervision rules (NRS 641D.610). Expect every payer to credential against the Nevada license number, not just the BACB number.[13][15][6]
Evernorth bills non-credentialed staff only through the supervising provider: it “does not credential nonlicensed/noncertified staff. Services for these staff members must be billed under the supervising provider.”[13][15][6]
Not without a Nevada license. NRS 641D.900 bars anyone from engaging “in the practice of applied behavior analysis unless he or she is licensed or registered as required by the provisions of this chapter.” Telehealth does not get around that: NRS 629.031 counts “A behavior analyst, assistant behavior analyst or registered behavior technician” as a provider of health care, and NRS 629.515 says that before a provider at a distant site “may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State,” the provider “must hold a valid license or certificate to practice his or her profession in this State.” A BCBA directing a Nevada child’s program from another state is therefore treated as practicing in Nevada and is “subject to the laws and jurisdiction of the State of Nevada.” The fast path is licensure by endorsement under NRS 641D.340: a behavior analyst who holds “a corresponding valid and unrestricted license as a behavior analyst” in another state or D.C. may apply, and unless the Board denies for good cause it must issue the license within 45 days of the application or 10 days after the fingerprint background report, whichever is later. Payers add their own layer: credential the clinician with each plan before billing.[13][14][4]
Evernorth’s guidelines say providers “must meet all state requirements to provide virtual behavioral services, including any licenses.”[13][14][4]
Cigna publishes no ABA rate table. Evernorth’s Administrative Guidelines (September 2026) say the Provider Agreement and 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.” The Nevada Regulatory Addendum lets Evernorth amend the fee schedule “by providing forty-five (45) days’ prior written notice,” and a provider who does not object in writing within those 45 days is treated as accepting; the addendum does not apply to self-funded plans. Virtual services are billed with modifier 95, which Evernorth says “will not change the reimbursement.” Claims timing for state-regulated group policies is set by NRS 689B.255: the insurer “shall approve or deny a claim … within 21 days after the insurer receives the claim, if the claim is submitted electronically, or 30 days” on paper, and must pay an approved claim within the same period or owe interest “at a rate of 10 percent per annum.” A request for more information must come “within 20 working days” of receipt, and the clock restarts at 21 or 30 days from the additional information. A denial must state the reasons and the criteria the insurer applied. Self-funded plans follow their own documents and ERISA. For a public benchmark, Nevada Medicaid’s 07/2026 schedule pays 97153 at $30.10 per 15 minutes when billed by a BCBA.[4][1][20]
No. Evernorth’s administrative guidelines (September 2026) define a complete CMS-1500 claim as the patient’s ID number, name, address and date of birth; the subscriber’s name and address; release of information and assignment of benefits; diagnosis codes and pointer; date and place of service; CPT/HCPCS code and modifier; billed charge, units, TIN and total charge; the “Rendering provider’s name, NPI, and license type”; and the “Billing provider’s name, address, and NPI.” No referring or ordering provider is on that list. If you do report one on an 837, “Any additional provider identification on the claim, such as the “Rendering Provider” or “Referring Provider,” must include the name and NPI when submitted.”[4][6]
The ABA-specific paper-claim rules sit in the autism resource guide: use Form CMS-1500, “Print your name in box 31,” and “List only a BCBA or other licensed provider in box 33.” Evernorth does not credential non-licensed or non-certified staff, so their services are billed under the supervising provider.[4][6]
Nevada sets the payment clock for state-regulated plans. A group or blanket insurer "shall approve or deny a claim ... within 21 days after the insurer receives the claim, if the claim is submitted electronically, or 30 days after the insurer receives the claim, if the claim is not submitted electronically," must pay an approved claim within the same period, and owes interest at 10 percent a year after that (NRS 689B.255; the individual-market rule, NRS 689A.410, is the same). A request for more information must come within 20 working days, and the clock restarts on receipt of it. The HMO section that used to carry the same rule (NRS 695C.185) is shown as repealed in 2025, so for an HMO product check the contract. Self-funded employer plans follow ERISA instead.[6][1][2][3][4]
Cigna’s ABA claims run through Evernorth Behavioral Health, whose administrative guidelines (September 2026) set the filing rules. Initial claims: Evernorth "will only consider claims submitted within 90 days of the date of service or as otherwise defined in your Provider Agreement," and a longer state-law limit applies where one exists. Secondary claims: for coordination of benefits the 90 days run from "the primary payer’s processing date as stated on an explanation of benefits [EOB] or explanation of payment [EOP]," and the primary payer’s EOP goes in with the claim unless the COB data is sent electronically; Medicaid gets three years. A claim returned for more information gets a fresh 90 days from the date of the request. Corrected or replacement claims carry frequency code 7 (replace) or 8 (void) in box 22, not a "Corrected Claim" stamp; no separate corrected-claim deadline is published. Appeals are due in writing within 180 calendar days of the initial payment or denial decision. Evernorth publishes no weekly payment cycle or submission cutoff; it offers ERA and EFT "to help reduce your payment cycle."[6][1][2][3][4]
Which codes: Evernorth’s autism resource guide (March 2025) says "All ABA services must be billed with CPT codes 97151–97158, 0362T, and 0373T ONLY," so state HCPCS ABA codes such as H0031, H0032, H2014 or H2019 are not billable to Cigna for ABA. The same guide says "All ABA CPT codes are covered telehealth services."[6][1][2][3][4]
Evernorth’s EN0499 (effective May 15, 2026) sets what a continued-treatment request must show: an updated treatment plan covering current deficits and progress in every targeted area; "Quantitative baseline, interim and current data ... with dates reported from when the data were collected" for every behavior and skill, across all settings; current data collected "within no more than 60 days prior to the start date of the continued treatment request" and within 60 days before the request is received; data showing "ongoing and sustained progress"; and a reliable, valid, standardized assessment completed no more than one year before the continued-treatment start date. Where progress is not shown, the request must name the barriers and the protocol changes made. EN0499 asks for dated quantitative data, not for graphs as such; graphs are a common way to present it, but the policy does not require them.[5]
The questions that decide whether a family can start with Cigna / Evernorth in Nevada, and what they have to bring. Each maps onto something intake should ask on the first call.
No expiry on the diagnosis, but the request needs “The date on which the diagnosis was most recently made,” the assessment instrument must be administered within 60 days before treatment starts, and baseline data must be within 60 days.[5]
A professional “licensed to practice independently and whose licensure board considers diagnostics to be within their scope of practice,” applying DSM-5-TR. The assessment is by a BCBA, Licensed Behavior Analyst or independently licensed clinician with ABA training.[5]
No single instrument is named; assessments must use current editions (“e.g., must be the Vineland-3 vs. Vineland-II”), be standardized, and report dates, respondent and scores.[5]
EN0499 requires no referral; assessments 97151, 97152 and 0362T need no PA with an autism diagnosis when the provider is independently licensed or a BCBA. For a state-regulated Nevada plan, autism treatment “must be identified in a treatment plan” and be prescribed by a provider of health care acting within scope, and the insurer “may request a copy of and review a treatment plan” (NRS 689B.0335(5)). Self-funded ERISA plans sit outside the statute.[6][5][1]
“All ABA CPT codes are covered telehealth services,” and EN0499 allows in-person, telehealth or hybrid delivery chosen on clinical factors; virtual services carry modifier 95 with no change in reimbursement. For a state-regulated group policy, NRS 689B.0369 requires coverage of services “provided to an insured through telehealth to the same extent as though provided in person,” bars the insurer from requiring prior authorization for a telehealth service “that is not required for that service when provided in person,” and forbids refusing coverage because of the originating site (the home counts) or the technology used; pay parity in the same amount applies to mental health treatment, including audio-only. NRS 629.515 separately requires the clinician to hold a Nevada license. Self-funded employer plans are outside the state statute.[6][5][4][1][14]
EN0499 sets no age cap; it says access to intervention “should not be restricted by age.” For state-regulated Nevada group, small-employer and HMO plans, the mandate covers members “under the age of 18 years or, if enrolled in high school, until the person reaches the age of 22 years,” with ABA capped at the actuarial equivalent of $72,000 a year (NRS 689B.0335, 689C.1655, 695C.1717). Individual policies need only offer the coverage as an option (NRS 689A.0435). Self-funded ERISA plans are outside the statute.[5][1][3][10][2]
Ask the plan: Live benefits verification: establish Nevada-insured vs. self-funded first.
Depends on how the plan is funded. State-regulated plans fall under Nevada’s prior-authorization statute: unless a shorter period applies, a health carrier must respond “within: (1) Two business days after it receives the request; or (2)” any longer period the CAQH CORE Prior Authorization and Referrals Operating Rules allow, and in any case “within 7 calendar days after receiving the request” (NRS 687B.970). If the carrier violates that section for a particular request, “the request shall be deemed approved” (NRS 687B.990). The procedure “may not discriminate among persons licensed to provide the covered care.” 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 Nevada-specific ABA turnaround or reauthorization lead time.[12][16]
Ask the plan: At benefits verification ask whether the plan is Nevada-insured or self-funded (ERISA) and what reauthorization lead time Evernorth expects.
For a child on two group policies, Nevada uses the birthday rule: when parents are not divorced or separated, “the primary policy is the policy of the parent whose birthday falls earlier in the year”; for divorced or separated parents the custodial parent’s policy pays first, then the custodial parent’s spouse’s, then the non-custodial parent’s, unless a court decree assigns responsibility (NRS 689B.064). A policy that does not coordinate is always primary. That rule binds state-regulated group policies; a self-funded plan sets its own order. If the child also has Nevada Medicaid, Cigna/Evernorth pays first: Medicaid is the payer of last resort (42 CFR 433.139), and Nevada Medicaid tells providers to “Always follow other payers’ billing requirements. If the other payer denies a claim because you did not follow their requirements, Medicaid will also deny the claim.” TRICARE pays after this plan (10 U.S.C. 1079(i)(1)).[1][17][18][19]
Ask the plan: Ask Cigna/Evernorth at benefits verification for the member’s coordination-of-benefits order, and record every other coverage the child has.
Coverage decides whether Cigna / Evernorth in Nevada 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.
Case supervision is by a BCBA, Licensed Behavior Analyst, or independently licensed clinician with ABA training; direct plus indirect case supervision runs “one to two hours per ten hours of direct treatment,” and at 10 hours a week or less at least one to two hours a week of direct case supervision. In Nevada, BCaBAs and RBTs may practice only under supervision meeting NRS 641D.610.[5][13]
“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).” Speech, OT and other therapies are a separate rule: EN0499 says ABA "is not covered or reimbursable when delivered to the same individual, at the same time as any other treatment modality (e.g., ABA and speech therapy, or ABA and occupational therapy)." Schedule ABA and other therapies in separate time blocks. ABA built into a speech or OT session is not billable.[6][5]
No per-day cap is published; all ABA codes bill in 15-minute units and only with 97151–97158, 0362T and 0373T. For state-regulated Nevada plans the mandate caps ABA at the actuarial equivalent of $72,000 a year and bars visit limits within it.[6][1]
Each service needs a record with start and end date and time, location, focus, a description of the intervention, who was present, the service delivered, and the “Name, credential (if applicable), and signature of ABA provider who rendered the service.”[5]
EN0499 excludes services “primarily educational or vocational in nature,” and services in academic settings must meet the direct-treatment definition. Nevada’s mandate does not require reimbursing a school for school services (NRS 689B.0335(7)).[5][1]
Evernorth “does not credential nonlicensed/noncertified staff. Services for these staff members must be billed under the supervising provider.” On a CMS-1500, the provider’s name goes in box 31 and “only a BCBA or other licensed provider” in box 33; electronic claims use payer ID 62308.[6]
Not graphs as such. EN0499 requires dated quantitative baseline, interim and current data (current data no more than 60 days old), an updated plan and a standardized assessment no more than a year old; graphs are a common way to show the data, but the policy does not require them.
CPT 97151–97158, 0362T and 0373T only; HCPCS H-codes such as H0031/H0032 are not billable for ABA (Evernorth autism resource guide).
A group or individual insurer must approve or deny within 21 days of an electronic claim (30 days on paper) and pay within the same period, with 10% annual interest after that (NRS 689B.255, 689A.410). Self-funded employer plans follow ERISA instead.
Ninety days from the date of service under Evernorth’s administrative guidelines (or your agreement or a longer state-law limit); secondary claims get 90 days from the primary payer’s EOB/EOP date. Corrected claims use frequency code 7 or 8; no weekly payment cutoff is published.
No, for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed or a BCBA and the policy covers ABA. PA starts at treatment.
Yes, for 97155 with 97153 (or 97154) when the BCBA is directing the technician and both are face-to-face with the patient at the same time.
Rates are in Exhibit A of your Evernorth Provider Agreement. Evernorth’s Nevada addendum requires 45 days’ written notice before it changes your fee schedule (not for self-funded plans).
Yes. Nevada requires behavior analysts to be licensed by the Board of Applied Behavior Analysis, including for telehealth to a child in Nevada, and Evernorth requires providers to meet state licensure requirements.
No. Evernorth’s complete-claim definition for the CMS-1500 lists the rendering and billing providers but no referring provider. If you report a referring provider on an electronic claim, include both the name and the NPI.
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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