Intensive Behavioral Interventions

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Medical Coverage Policy Effective Date ........................................ ....12/15/2019. Next Review Coverage Policy Number .................................. 0499. Intensive Behavioral Interventions Table of Contents Related Coverage Resources Overview ........................................ ...................... 1 Attention-Deficit/Hyperactivity Disorder (ADHD): Coverage Assessment and Treatment General Background ........................................ ....3 Autism Spectrum Disorders/Pervasive Developmental Coding/Billing Information ..................................10 Disorders: Assessment and Treatment References ........................................ ................11. INSTRUCTIONS FOR USE. The following Coverage Policy applies to health benefit plans administered by Cigna Companies.

including applied behavioral analysis. Please refer to the applicable benefit plan document to determine terms, conditions and limitations of coverage. Medically Necessary . Criteria for Assessment for Applied Behavior Analysis (ABA) An assessment for applied behavior analysis (ABA) is considered medically necessary when ALL the

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