What Changed in Cigna's 2026 ABA Policy

Cigna (now operating behavioral health services through Evernorth) updated its ABA clinical payment and coding policy effective January 1, 2026. The key changes affect documentation requirements, concurrent review timelines, and the criteria for high-intensity authorizations.

Change 1: Diagnostic Evaluation Validity Reduced to 18 Months

Previously, Cigna accepted diagnostic evaluations up to 24 months old for authorization requests. As of 2026, the validity window has been reduced to 18 months. Practices with clients who have older evaluations will need to schedule re-evaluations sooner than anticipated.

Action required: Audit your Cigna client list for diagnostic evaluations dated before September 2024. These clients will need updated evaluations before their next authorization renewal.

Change 2: Concurrent Review Now Required at 6 Months (Down from 12)

Cigna previously required concurrent review at 12-month intervals. The 2026 policy requires concurrent review every 6 months for clients receiving more than 20 hours per week of ABA services.

For clients receiving 20 hours/week or fewer, the 12-month concurrent review cycle remains in effect.

Action required: Update your authorization tracking system to flag Cigna authorizations for concurrent review at 6 months for high-intensity clients.

Change 3: New Documentation Requirements for High-Intensity Authorizations

For authorizations of 30+ hours per week, Cigna now requires:

  • A letter of medical necessity from the supervising BCBA and a licensed physician or psychologist
  • Documented evidence that the client has not made sufficient progress at lower intensity levels, or clinical justification for why high-intensity services are appropriate as an initial level of care
  • A specific discharge plan with measurable criteria for stepping down to lower intensity

    • What Did Not Change

    The following Cigna ABA policies remain unchanged for 2026:

  • Prior authorization required for all ABA CPT codes (97151–97158)
  • Initial authorization duration: 6 months
  • Renewal authorization duration: 6 months
  • Submission deadline: 90 days from date of service
  • FBA required for all initial authorization requests
  • BCBA supervision ratio requirements

    • Cigna's Authorization Submission Process

    Cigna/Evernorth accepts prior authorization requests through:

  • myCigna Provider Portal (preferred)
  • Availity Essentials
  • Phone (behavioral health line on member ID card)

    • Required Documentation Checklist

    For initial authorizations:

  • DSM-5/DSM-5-TR ASD diagnosis (within 18 months)
  • Standardized assessment scores
  • Functional Behavior Assessment (within 6 months)
  • Treatment plan with measurable goals and baseline data
  • Proposed weekly hours by CPT code
  • BCBA credentials and NPI
  • For 30+ hrs/week: physician/psychologist letter of medical necessity

    • For renewal authorizations:

  • Progress notes showing measurable progress
  • Updated treatment plan
  • Continued medical necessity justification
  • For 30+ hrs/week: updated physician/psychologist letter

    • Common Cigna Denial Reasons

    "Experimental/Investigational": Cigna covers ABA for ASD diagnoses. If you receive this denial, it typically means the diagnosis code on the claim does not match the covered diagnosis in the authorization. Verify that the ICD-10 code on the claim matches the authorization exactly.

    "Exceeds authorized amount": Unlike Anthem, Cigna tracks units on a total authorization basis. This denial means the claim date of service falls within the authorization period but the total units billed exceed the authorized amount. Review your authorization tracking system.

    "Provider not eligible": The rendering provider's NPI or credentials are not on file with Cigna. Verify that the rendering BCBA is credentialed with Cigna and that their NPI is correctly listed on the claim.