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Intensive Behavioral Interventions

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. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard 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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