Intensive Behavioral Interventions - Cigna

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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. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations.

The individual has a confirmed diagnosis of autism spectrum disorder (ASD); (ICD-10-CM Diagnosis Codes F84.0 – F84.9, with the exception of F84.2, Rett syndrome) based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by a healthcare

  Interventions, Behavioral, Disorders, Intensive, Intensive behavioral interventions