---
title: "Cigna / Evernorth ABA coverage in Oregon: the intake guide."
url: "https://carelu.com/payers/cigna-oregon"
markdown_url: "https://carelu.com/payers/cigna-oregon.md"
state: OR (Oregon)
payer: Cigna / Evernorth in Oregon
kind: Commercial insurance
description: "How Cigna / Evernorth covers ABA for Oregon families: coverage policy EN0499, Evernorth’s Oregon regulatory addendum, Oregon’s 2013 ABA mandate and ORS 743A.168 parity, Oregon licensure, and what intake should verify."
last_reviewed: October 2026
---

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

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

> Evernorth EN0499 (eff. 5/15/2026) + Oregon’s 2013 ABA mandate and ORS 743A.168 parity; Oregon addendum sets 90-day credentialing.

For an intake team in Oregon, a Cigna card means Evernorth Behavioral Health’s ABA policy (EN0499, effective May 15, 2026), Oregon’s ABA mandate and parity law, and the plan’s funding type. Evernorth’s administrative guidelines include an Oregon regulatory addendum that changes credentialing and precertification terms for Oregon providers.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment** _(plan-dependent)_: Plan-dependent: Evernorth says "Prior authorization is typically required for applied behavior analysis," and EN0499 sets separate medical-necessity criteria for the assessment [3][1]
  - Ask the plan: The behavioral health number on the member’s card: ask whether 97151/97152 need prior authorization on this plan.
- **Prior auth for treatment** _(plan-dependent)_: Typically required: requests go to Evernorth’s Autism Utilization Management team; benefit coverage "varies by plan and state mandates" [3][1]
  - Ask the plan: The behavioral health number on the card: confirm ABA prior authorization and the review interval for this plan.
- **Autism diagnosis required?**: Yes: a confirmed DSM-5-TR ASD diagnosis (F84.0–F84.9 except F84.2 Rett syndrome) with the diagnosing clinician’s name, credentials and the date it was most recently made [1]

## At a glance

- **Covers ABA?:** Yes, for ASD, per Evernorth EN0499
- **State mandate:** Oregon Laws 2013, ch. 771, §2 (SB 365; ABA mandate, compiled after ORS 743A.264, repeal date Jan. 2, 2030) + ORS 743A.168 parity + ORS 743A.190
- **Mandate age:** The ABA section applies when coverage is first requested before age 9 (treatment begun before 9); it does not limit ABA otherwise owed under ORS 743A.168 parity at older ages. ORS 743A.190 covers children under 18 with a pervasive developmental disorder
- **Mandate caps:** No dollar cap. The 2013 section covers ABA up to 25 hours/week and lets insurers require PA up to that level (decision within 30 days); hours above 25 are not limited by the section
- **Exempt from mandate:** Self-funded ERISA employer plans (outside state insurance law); IEP services, family-member services and DHS/OHA services are excluded from the 2013 section
- **Licensure:** Yes: Behavior Analysis Regulatory Board (HLO) licenses behavior analysts and assistant behavior analysts and registers interventionists (ORS 676.802–676.830)
- **Fee schedule:** Not public — Exhibit A of your Evernorth provider agreement

## The national policy, applied in Oregon

EN0499 covers ABA for a confirmed ASD diagnosis made by "a healthcare professional who is licensed to practice independently and whose licensure board considers diagnostics to be within their scope of practice," with the diagnosing clinician’s credentials and the date of the most recent diagnosis. The assessment must be done by a BCBA, Licensed Behavior Analyst or independently licensed clinician trained in ABA using a current, standardized instrument completed in its entirety; for treatment, the instrument must have been administered "within 60 days prior to the start of treatment," with baseline data collected in the same window. Case supervision runs at "one to two hours per ten hours of direct treatment," with at least one to two hours a week when treatment is 10 hours or less. ABA for non-ASD indications is not medically necessary, and ABA "delivered to the same individual, at the same time as any other treatment modality" is not covered. [1][3]

Evernorth’s administrative guidelines (September 2026) say prior authorization "is typically required" for ABA and that requests usually go to its Autism Utilization Management team. The Oregon Regulatory Addendum adds: credentialing decisions "no later than ninety (90) days after receiving a complete application," averaging no more than 60 days; payment under ORS 743B.450 and 743B.452; and coordination of benefits under OAR 836-020-0770 to 0801. The addendum does not apply to self-funded plans. [1][3]

## The Oregon mandate: what it guarantees

Oregon’s ABA mandate is not in the numbered ORS. It is section 2 of chapter 771, Oregon Laws 2013 (SB 365), printed as a note after ORS 743A.264 and set to be repealed January 2, 2030. It requires a health benefit plan to cover screening for and diagnosis of autism spectrum disorder "by a licensed neurologist, pediatric neurologist, developmental pediatrician, psychiatrist or psychologist, who has experience or training in the diagnosis of autism spectrum disorder," and "medically necessary treatment for autism spectrum disorder and the management of care, for an individual who begins treatment before nine years of age." Treatment "includes applied behavior analysis for up to 25 hours per week," and the section "applies to coverage for up to 25 hours per week of applied behavior analysis for an individual if the coverage is first requested when the individual is under nine years of age." It is not a ceiling: the section "does not limit coverage for any services that are otherwise available" under ORS 743A.168 or 743A.190, including ABA "for more than 25 hours per week" or ABA first requested at age nine or older. ORS 743A.168, Oregon’s behavioral health parity law, requires group and non-grandfathered individual plans to cover medically necessary behavioral health treatment "at the same level as, and subject to limitations no more restrictive than," other medical conditions; ORS 743A.190 separately requires coverage of medically necessary services for a child under 18 diagnosed with a pervasive developmental disorder. Under the 2013 law an insurer may require prior authorization "for coverage of a maximum of 25 hours per week" of ABA recommended in a treatment plan approved by one of the listed professionals, "as long as the insurer makes a prior authorization determination no later than 30 calendar days after receiving the request," may require an updated treatment plan "not more than once every six months," and must continue approved ABA while the child "continues to make progress toward the majority of the goals" and it remains medically necessary. It does not require coverage of services under an IEP, services by a family or household member, or "telemedicine" (a separate statute, ORS 743A.058, now requires telemedicine coverage generally). Covered settings include "the individual’s home or a licensed health care facility" or a setting approved by the licensed provider. The mandate reaches state-regulated plans only; self-funded employer plans answer to ERISA and federal parity. [4]

## Licensure and out-of-state BCBAs

Oregon licenses behavior analysts. ORS 676.806 creates the Behavior Analysis Regulatory Board within the Health Licensing Office; under ORS 676.810 it licenses behavior analysts and assistant behavior analysts (a fingerprint-based records check is required, and BACB certification may be), and under ORS 676.815 the Office registers behavior analysis interventionists, who must be 18, hold a diploma or equivalent, pass the fingerprint check, complete "at least 40 hours of professional training," and "receive ongoing training and supervision" by a licensed behavior analyst, licensed assistant behavior analyst or licensed health care professional. A provisional interventionist registration must issue within five business days of a complete application. Only licensees and registrants may use the titles "licensed behavior analyst," "licensed assistant behavior analyst" or "registered behavior analysis interventionist." OAR 824-040-0010 sets the interventionist supervision floor: direct and indirect supervision "for at least 5 percent of the interventionist’s service hours," with direct supervision at least once per calendar month. What that means for an out-of-state BCBA: the Oregon license rule (OAR 824-030-0010) has no reciprocity, temporary-permit or telehealth exemption; it asks applicants for "an affidavit of licensure from any state where the individual holds or has held a license." The payers’ own definitions point the same way. The commercial mandate defines ABA as provided by an Oregon-licensed health care professional, a behavior analyst or assistant licensed under ORS 676.810, or a registered interventionist; OHP pays directly only a Licensed Behavior Analyst, a licensed health care professional, or a declarant; and the telemedicine statute defines a "health professional" as one "licensed, certified or registered in this state." So plan on an Oregon license before treating an Oregon member, including by telehealth. The Health Licensing Office says it does not give individualized advice on how the law applies to a practice. ORS 676.830 lets each health plan set its own ABA credentialing requirements. [6][7][8][9][10][4][20]

## Claims, prior-authorization clocks and rates

Claims timing in Oregon’s commercial market is set by statute. ORS 743B.450 requires an insurer to "pay a clean claim or deny the claim not later than 30 days after the date on which the insurer receives the claim" (or within 30 days of receiving requested additional information), and ORS 743B.452 adds "simple interest of 12 percent per annum" on late payments. For utilization review, ORS 743B.423 generally requires a determination on a non-emergency request "no later than two business days after receipt," but the ABA mandate lets an insurer take up to 30 calendar days on an ABA prior authorization "notwithstanding ORS 743B.423." Approved treatment (other than drugs) is binding for the later of its reasonable duration or "Sixty days after the date that the treatment begins," and an insurer must give participating providers 60 days’ notice before adding new utilization review requirements. Self-funded employer plans follow ERISA instead. [18][3][5][4][13][3][17]

Evernorth publishes no ABA rate table: its guidelines send providers to "Exhibit A in your Provider Agreement" for the fee schedule and eligible ABA codes. For a public benchmark, Oregon’s OHP fee-for-service schedule pays 97153 at $14.70 per 15 minutes. [18][3][5][4][13][3][17]

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." [18][3][5][4][13][3][17]

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." [18][3][5][4][13][3][17]

## Does Cigna require a referring provider on the ABA claim (box 17)?

Cigna (Evernorth) publishes no referring-provider requirement for ABA. Its autism resource guide gives the ABA paper-claim instructions field by field and names only box 31 (your name), the claims mailing address and box 33 ("List only a BCBA or other licensed provider in box 33"); box 17 is not mentioned. The Evernorth administrative guidelines state for SureFit, Connect and HMO/POS plans alike that "Referrals are not required for behavioral health services." [18][3]

Leave box 17 blank unless a referral actually exists for the service. Bill technician time under the supervising provider: "Evernorth does not credential nonlicensed/noncertified staff. Services for these staff members must be billed under the supervising provider." [18][3]

## What must a Cigna ABA reauthorization request contain, and are graphs required?

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. [1]

## Intake gates

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

- **Diagnosis recency**: The request must give "The date on which the diagnosis was most recently made," and the standardized assessment and baseline data must be from within 60 days before treatment starts. [1]
- **Who may diagnose**: A healthcare professional licensed to practice independently whose licensure board considers diagnosis within scope. For fully insured Oregon plans the mandate covers diagnosis by a licensed neurologist, pediatric neurologist, developmental pediatrician, psychiatrist or psychologist experienced in ASD. [1][4]
- **Diagnostic tools required**: A reliable, valid, standardized instrument measuring the DSM-5-TR ASD domains, completed in its entirety, in its current version ("must be the Vineland-3 vs. Vineland-II"), with date, respondent and form type. [1]
- **Referral required?**: EN0499 requires no physician referral; Evernorth requires prior authorization in most cases. For a fully insured Oregon plan, the 2013 ABA section lets the insurer require an individualized treatment plan approved by a licensed neurologist, pediatric neurologist, developmental pediatrician, psychiatrist or psychologist, updated no more than once every six months, and a re-diagnosis by one of them if the original diagnosis was made by someone else. Self-funded ERISA plans sit outside the statute. [1][3][4]
- **Age limit** _(plan-dependent)_: EN0499 sets no age limit. For a fully insured Oregon plan, the 2013 ABA section (ch. 771, §2) applies to ABA first requested before age nine, up to 25 hours a week, and says it does not limit ABA otherwise owed under ORS 743A.168 parity (including at older ages or above 25 hours). Self-funded ERISA plans are outside the statute, so the funding type decides whether this binds. [1][4]
  - Ask the plan: Benefits verification on the member ID: establish fully insured vs. self-funded ERISA, then the plan’s terms.
- **Telehealth** _(plan-dependent)_: EN0499 allows services "delivered via telehealth modalities" if they still meet its definition of direct treatment, and drops the line-of-sight requirement for telehealth; it publishes no ABA telehealth code list. For a fully insured Oregon plan, ORS 743A.058 requires coverage of a health service delivered by telemedicine when the plan covers it in person, it is medically necessary, and it can be "safely and effectively provided using telemedicine"; the plan may not impose different prior authorization requirements or restrict originating sites, and must pay "the same reimbursement" as in person. The statute defines a "health professional" as one licensed, certified or registered in Oregon. Self-funded employer plans are outside it. [1][4]
  - Ask the plan: Evernorth Behavioral Health provider services: ask which ABA codes, POS and modifiers it pays by telehealth on this plan.
- **Prior-auth decision time** _(plan-dependent)_: Depends on how the plan is funded. For a fully insured Oregon plan, the ABA mandate lets the insurer require prior authorization of up to 25 hours a week of ABA "as long as the insurer makes a prior authorization determination no later than 30 calendar days after receiving the request, notwithstanding ORS 743B.423"; for other utilization review ORS 743B.423 requires a decision "no later than two business days after receipt," with the same two business days to ask for missing information. An approved treatment is binding for the later of its reasonable duration or 60 days after it begins. Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1: pre-service decisions "not later than 15 days after receipt of the claim," one 15-day extension, urgent care within 72 hours. Under Evernorth’s Oregon addendum, a coverage and medical-necessity precertification is binding if obtained no more than 30 days before the service, and an eligibility precertification if obtained no more than five business days before. [4][5][13][3]
  - Ask the plan: At benefits verification ask whether the plan is fully insured (Oregon-regulated) or self-funded (ERISA).
- **Other insurance (who pays first)** _(plan-dependent)_: For a child on two state-regulated group plans, Oregon’s coordination-of-benefits rule follows the birthday rule: for parents married or living together, "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (OAR 836-020-0785); for separated parents a court decree controls when the plan knows of it, and otherwise the custodial parent’s plan pays first, then the custodial parent’s spouse’s, then the non-custodial parent’s. A self-funded plan sets its own order. If the child also has OHP, the commercial plan pays first: OHA "shall be the payer of last resort" and providers "shall make reasonable efforts to obtain payment first from other resources" (OAR 410-120-1280; 42 CFR 433.139). TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). Evernorth’s Oregon addendum adds that if plans cannot agree on the order within 30 days of having the information, they pay the claim in equal shares. [11][3][12][14][15][16]
  - Ask the plan: Ask Cigna at benefits verification for the member’s coordination-of-benefits order.

## Delivery and billing rules

Coverage decides whether Cigna / Evernorth in Oregon 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, LBA or independently licensed clinician with ABA training, with direct and indirect supervision "consistent with the general accepted standard of care of one to two hours per ten hours of direct treatment," and at least one to two hours a week of direct case supervision when direct treatment is 10 hours a week or less. Direct case supervision means the BCBA is face to face with the patient and the RBT or BCaBA during treatment. In Oregon the interventionist must also be registered and supervised for at least 5 percent of service hours (OAR 824-040-0010). [1][8]
- **Daily limits / MUEs**: No numeric cap: "The planned intensity of treatment reflects the severity of the impairments, goals of treatment, and/or response to treatment." Services by multiple ABA agencies in the same authorization period are not medically necessary unless coordination is documented. [1]
- **Session-note signature**: EN0499’s session documentation must include the location, focus and description of the intervention, who was present, the specific service, and the "Name, credential (if applicable), and signature of ABA provider who rendered the service." [1]
- **Place of service**: Treatment may span home, clinic, school and community, with data reported separately by setting; ABA may not replace or replicate the setting’s own responsibilities (classroom aide, 1:1 teacher, tutor). Educational or vocational services are not covered. For fully insured Oregon plans, the mandate covers treatment at home, in a licensed facility, or in a setting the licensed provider approves, and excludes IEP services. [1][4]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: EN0499 bars ABA "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)," and defines direct case supervision as occurring concurrently with technician treatment, but does not say whether 97155 and 97153 may both be billed for the same minutes. [1]
  - Ask the plan: Evernorth Behavioral Health provider services or your provider agreement: ask whether 97155 may be billed concurrently with 97153.
- **Bill as provider** _(ask the plan)_: EN0499 requires the assessment and supervision to come from a BCBA, Licensed Behavior Analyst or independently licensed mental health clinician with documented ABA training, with the supervisor’s name and credentials documented. It does not state whose NPI goes on technician lines. [1]
  - Ask the plan: Evernorth Behavioral Health provider services or Exhibit A of your agreement: ask whether RBT services bill under the supervising BCBA’s or the group’s NPI.

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

- **Plan funding type:** Fully insured (Oregon law and the Evernorth Oregon addendum apply) vs. self-funded ERISA.
- **Diagnosis details:** Name, credentials and licensure of the diagnosing clinician and the date the diagnosis was most recently made.
- **Recent standardized assessment:** Administered within 60 days before treatment starts, with baseline data from the same window.
- **Other therapies schedule:** Cigna will not pay ABA delivered at the same time as speech or OT.
- **Oregon license numbers:** Behavior analyst license and interventionist registrations for the team.

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

## Common questions

### Does Cigna require graphs for ABA reassessments?

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.

### Does Cigna accept H0031 or H0032 for ABA?

CPT 97151–97158, 0362T and 0373T only; HCPCS H-codes such as H0031/H0032 are not billable for ABA (Evernorth autism resource guide).

### What is Cigna’s timely filing limit for ABA claims, and when does it pay?

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.

### Does Cigna cover ABA therapy in Oregon?

Yes, for ASD under Evernorth’s EN0499, with Oregon’s ABA mandate and ORS 743A.168 parity applying to state-regulated plans.

### How long does Cigna/Evernorth take to credential an Oregon ABA provider?

Its Oregon addendum commits to a decision no later than 90 days after a complete application, averaging no more than 60 days.

### Does Cigna require session notes to be signed?

Yes. EN0499 requires each session note to include the name, credential and signature of the ABA provider who rendered the service.

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

Oregon licenses behavior analysts and its license rule has no telehealth or reciprocity exemption; get an Oregon license, then credential with Evernorth.

### Does Cigna require a referring provider NPI on ABA claims?

No. Cigna's ABA billing instructions cover boxes 31 and 33 only, and Evernorth states that referrals are not required for behavioral health services.

## Primary sources

1. [Evernorth Coverage Policy EN0499 — Intensive Behavioral Interventions (eff. 5/15/2026): Criteria for Continued Treatment with ABA](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/en_mm_0499_coveragepositioncriteria_intensive_behavioral_interventions.pdf)
2. [Evernorth Coverage Policy 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)
3. [Evernorth Behavioral Health Administrative Guidelines incl. Oregon Regulatory Addendum (PCOMM-2026-191, September 2026)](https://static.evernorth.com/assets/evernorth/provider/pdf/resourceLibrary/behavioral/ebh-provider-admin-guide.pdf)
4. [ORS chapter 743A — ORS 743A.058 (telemedicine), 743A.168 (behavioral health parity), 743A.190 (pervasive developmental disorder), and Oregon Laws 2013, ch. 771, §2 (ABA mandate, compiled as a note after ORS 743A.264)](https://www.oregonlegislature.gov/bills_laws/ors/ors743A.html)
5. [ORS chapter 743B — ORS 743B.423 (utilization review), 743B.450 (prompt payment), 743B.452 (interest)](https://www.oregonlegislature.gov/bills_laws/ors/ors743B.html)
6. [ORS 676.802–676.830 — Applied behavior analysis: Behavior Analysis Regulatory Board, licensure, interventionist registration, titles, health plan credentialing](https://www.oregonlegislature.gov/bills_laws/ors/ors676.html)
7. [OAR 824-030-0010 — Licensing of Behavior Analyst (eff. 2/1/2023)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=824-030-0010)
8. [OAR 824-040-0010 — Training and Supervision of registered behavior analysis interventionists (eff. 2/1/2018)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=824-040-0010)
9. [Oregon Health Licensing Office — Behavior Analysis Regulatory Board](https://www.oregon.gov/oha/PH/HLO/Pages/Board-Behavior-Analysis-Regulatory.aspx)
10. [BACB — U.S. Licensure of Behavior Analysts (Oregon: 2013, OR Behavior Analysis Regulatory Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
11. [OAR 836-020-0785 — Rules for Coordination of Benefits (order of benefit determination; eff. 1/1/2014)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=836-020-0785)
12. [OAR 410-120-1280 — Billing (third-party resources; OHA as payer of last resort)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-120-1280)
13. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-29?part=2560&section=2560.503-1)
14. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?part=433&section=433.139)
15. [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)
16. [38 CFR 17.270 — CHAMPVA is the last payer (eCFR)](https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-38?part=17&section=17.270)
17. [OHA — OHP Fee-for-Service Behavioral Health Fee Schedule, Applied Behavior Analysis tab (update published 7/1/2026)](https://www.oregon.gov/oha/HSD/OHP/DataReportsDocs/bh-fee-schedule0726.xlsx)
18. [Cigna/Evernorth Autism Resource Guide (PCOMM-2025-225, March 2025)](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/autism-resource-guide.pdf)
19. [Evernorth Behavioral Health Administrative Guidelines (September 2026, PCOMM-2026-191)](https://static.evernorth.com/assets/evernorth/provider/pdf/resourceLibrary/behavioral/ebh-provider-admin-guide.pdf)
20. [OAR 410-172-0760 — Applied Behavior Analysis (OHA, eff. 01/09/2025)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0760)

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.