Cigna Rejects ABA Data More Than 60 Days Old, and It Checks the Dates

Evernorth Coverage Policy EN0499, the policy Cigna uses for ABA under its commercial plans, puts a 60-day clock on almost every piece of evidence in an authorization request. The current version took effect May 15, 2026, and the next review is due December 15. The 60-day rules have been in place since the January 2025 revision. They're the reason an otherwise complete Cigna request comes back pended.

The turn: the dates are what get reviewed

Most payers want recent data. EN0499 defines "recent" several times over and asks for the collection date next to every data point. A strong treatment plan still fails if its baseline is 75 days old.

The 60-day rules

• Initial assessment: "Administration of the assessment instrument has been completed within 60 days prior to the start of treatment." It must use the current edition: "must be the Vineland-3 vs. Vineland-II."
• Baseline: quantitative baseline data "collected within 60 days prior to the start of treatment, with dates reported from when the data were collected."
• Late requests: if services started more than 60 days before the request arrives, Cigna wants baseline, interim and current data. The current data must be no more than 60 days old at the date of the request.
• Continued treatment: current data from no more than 60 days before the start date of the continued treatment request and no more than 60 days before Cigna receives it. A standardized assessment "completed no more than one year prior" to that start date.
• Breaks in care: a new standardized assessment and updated data "following any break in treatment greater than 60 calendar days."

What else it asks for

• Data by setting. When treatment runs across home, clinic, school or community, data must be "clearly identified separately by location/setting."
• Caregiver goals need their own mastery criteria and dated baseline, interim and current data.
• Supervision: "one to two hours per ten hours of direct treatment." If direct treatment is 10 hours a week or less, the minimum is one to two hours a week.
• More hours need "quantitative data demonstrating how the increase in intensity would improve outcome."
• Not covered: 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)."
• AI: reimbursement depends on the service description, "regardless of the use of Artificial Intelligence (AI) based technologies."

The limits

EN0499 covers codes 97151–97158, 0362T and 0373T. It doesn't apply to Virginia fully insured business, and the member's plan document controls where it differs. The May 2026 revision lists "no clinical policy statement changes." The December 2025 annual review lists only "numerous policy statement revisions" without naming them, so we can't say which rules are newest.

What you must know or do

• Intake: for every new Cigna client, check the date of the Vineland-3 or other standardized assessment against the planned start date. More than 60 days apart means re-administering it before you submit.
• Before each reauthorization: check the date of the latest data point for every target against the date you'll submit. Anything older than 60 days fails on its own.
• Clients seen in more than one setting: check that your reports split the data by location. A combined graph doesn't meet the rule.
• Scheduling: look for Cigna clients whose ABA overlaps a speech or OT session in the same time block. That overlap isn't covered.
• Returning clients: flag any gap in service longer than 60 days. It triggers a new standardized assessment.