TL;DR: Cigna Healthcare modified MM 0231, its ADHD assessment and treatment coverage policy, effective September 26, 2025. Billing teams need to know that 23 CPT codes and six HCPCS codes are now explicitly designated as not medically necessary for ADHD-related services.
Cigna Healthcare updated its ADHD assessment and treatment coverage policy under policy code MM 0231 Cigna system, with an effective date of September 26, 2025. The revised policy draws a hard line around a broad set of services—EEG monitoring, transcranial magnetic stimulation, adaptive behavior treatment, and several education-related codes—declaring all of them not medically necessary when billed for ADHD. If your practice or billing team submits any of these 29 codes for ADHD diagnoses after September 26, expect claim denial.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Attention-Deficit/Hyperactivity Disorder (ADHD): Assessment and Treatment |
| Policy Code | MM 0231 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Psychiatry, Pediatrics, Neurology, Applied Behavior Analysis (ABA), Neuropsychology |
| Key Action | Audit your charge capture and claim templates for all 29 listed codes before September 26, 2025; do not bill these codes for ADHD diagnoses |
Cigna ADHD Coverage Criteria and Medical Necessity Requirements 2025
The Cigna ADHD coverage policy under MM 0231 focuses on what Cigna will not pay for—and the list is longer than most billing teams expect. The policy does not describe a set of covered services in detail. Instead, it defines medical necessity by exclusion, calling out specific procedures that Cigna considers inappropriate for ADHD assessment and treatment.
This matters for your ADHD billing workflow because many of these codes appear regularly in multi-specialty practices. Neurologists run EEGs. Behavioral health teams bill adaptive behavior codes. Some providers have experimented with TMS for ADHD symptoms. Cigna is now telling you, explicitly and in writing, that none of those services meet medical necessity for ADHD under this policy.
Prior authorization won't save you here either. These designations aren't "require prior auth"—they're "not medically necessary, full stop." Submitting with a prior auth for a code Cigna deems not medically necessary doesn't create a path to reimbursement. It just delays the denial.
If you treat ADHD patients with any of these services and believe clinical evidence supports coverage, talk to your compliance officer before the effective date of September 26, 2025. You'll want a clear documentation strategy and possibly a formal coverage dispute process in place.
Cigna ADHD Exclusions and Non-Covered Indications
This is where the policy does most of its work. Cigna has designated all 29 codes in MM 0231 as not medically necessary when used to report treatment of ADHD. That designation applies across three broad service categories.
EEG and Brain Monitoring
The largest code cluster covers electroencephalogram services—14 CPT codes in total. These include routine EEGs (95816, 95819), extended monitoring (95812, 95813), continuous recording variants (95717, 95718), and video EEG codes (95711, 95712, 95713), plus ambulatory or technologist-reviewed variants (95705, 95706). Cigna's position is straightforward: EEG is not an appropriate diagnostic or monitoring tool for ADHD under this coverage policy.
Some providers use EEG-based neurofeedback or qEEG mapping as part of ADHD assessment. Cigna is not covering that. If your neurology or neuropsychology practice bills these codes for ADHD patients, update your charge capture before September 26, 2025.
Transcranial Magnetic Stimulation
TMS codes 90867, 90868, and 90869 are all explicitly excluded for ADHD. TMS has FDA clearance for major depressive disorder and OCD. Its use in ADHD is still investigational. Cigna's position here isn't surprising, but it's now codified in MM 0231. If you're billing TMS for ADHD under any diagnosis code, stop before the effective date.
Adaptive Behavior Treatment
This is the section that will catch behavioral health and ABA providers off guard. The policy excludes CPT codes 0373T, 97153, 97154, 97155, 97156, 97157, and 97158—the full suite of adaptive behavior treatment codes. These codes are typically associated with autism spectrum disorder (ASD) services.
The real issue here is overlap. Many patients carry both an ASD diagnosis and an ADHD diagnosis. Cigna is not saying adaptive behavior treatment is never covered—it's saying these codes aren't covered when the purpose is ADHD treatment. If your documentation and claim submission tie these services to an ADHD primary diagnosis, you're exposed to denial. Review your diagnosis sequencing carefully.
Education and Psychoeducation Codes
Six HCPCS codes round out the exclusions: G0177 (training and educational services related to disabling mental health), H2027 (psychoeducational service), P2031 (hair analysis, excluding arsenic), S9445 and S9446 (individual education, non-physician provider), and T1018 (school-based IEP services, bundled).
The inclusion of T1018 and the education-adjacent codes signals that Cigna views school-based IEP services and psychoeducation as outside the scope of medical coverage for ADHD—even when a clinician coordinates those services. This affects practices that bill for care coordination or educational consultation tied to ADHD diagnoses.
The P2031 inclusion (hair analysis) is notable. Some practitioners use hair mineral analysis as part of an ADHD workup. Cigna is explicitly calling this out as not medically necessary for ADHD.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| EEG for ADHD assessment or monitoring | Not Covered | 95705, 95706, 95711, 95712, 95713, 95717, 95718, 95812, 95813, 95816, 95819 | All EEG variants excluded for ADHD |
| Transcranial magnetic stimulation (TMS) for ADHD | Not Covered | 90867, 90868, 90869 | Considered investigational for ADHD |
| Adaptive behavior treatment billed for ADHD | Not Covered | 0373T, 97153, 97154, 97155, 97156, 97157, 97158 | Check diagnosis sequencing for dual ASD/ADHD patients |
| Psychoeducational services for ADHD | Not Covered | H2027, G0177, S9445, S9446 | Educational services outside medical coverage scope |
| School-based IEP services for ADHD | Not Covered | T1018 | Not covered as medical benefit |
| Hair analysis for ADHD workup | Not Covered | P2031 | Explicitly listed as not medically necessary |
| Orthoptic training for ADHD | Not Covered | 92065, 92066 | Vision therapy not covered for ADHD |
Cigna ADHD Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture templates before September 26, 2025. Pull every superbill, charge capture form, and EHR order set that touches ADHD diagnoses. Flag any of the 29 codes in MM 0231. Remove them from ADHD-linked templates or add hard stops that prevent submission. |
| 2 | Review diagnosis sequencing for dual ASD/ADHD patients. If you bill adaptive behavior treatment codes (97153–97158 or 0373T) and your patients have both ASD and ADHD diagnoses, the primary diagnosis on the claim determines coverage. If ADHD is primary, Cigna denies under MM 0231. Work with your billing team to confirm correct sequencing for every affected account. |
| 3 | Pull your last 90 days of claims for these codes. Run a report of all Cigna claims from the past 90 days that include any of the 29 MM 0231 codes paired with an ADHD diagnosis. Identify any paid claims that may trigger recoupment, and flag any pending claims for review before they adjudicate under the new policy. |
| 4 | Stop billing TMS for ADHD immediately. If any provider in your group is billing 90867, 90868, or 90869 for ADHD-related treatment, that needs to stop now—not on September 26. These services have no path to reimbursement under MM 0231. |
| 5 | Update your denial management workflow. Add MM 0231 as a reference in your denial tracking system. When you receive a denial citing not-medically-necessary for any of these 29 codes on an ADHD claim, your team needs to know immediately whether it's a policy-driven denial or a documentation issue. |
| 6 | Talk to your compliance officer if you disagree with these exclusions. Some of these designations—particularly around psychoeducation and care coordination—may conflict with how your providers document ADHD treatment. If you believe a service is medically appropriate and covered under a different clinical rationale, your compliance officer needs to be involved before you appeal. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for ADHD Assessment and Treatment Under MM 0231
Not Covered CPT Codes — Considered Not Medically Necessary for ADHD
| Code | Type | Description |
|---|---|---|
| 0373T | CPT | Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face |
| 90867 | CPT | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping |
| 90868 | CPT | Therapeutic repetitive TMS treatment; subsequent delivery and management |
| 90869 | CPT | Therapeutic repetitive TMS treatment; subsequent motor threshold re-determination |
| 92065 | CPT | Orthoptic training; performed by a physician or other qualified health care professional |
| 92066 | CPT | Orthoptic training; under supervision of a physician or other qualified health care professional |
| 95705 | CPT | Electroencephalogram (EEG), without video, review of data, technical description by EEG technologist |
| 95706 | CPT | Electroencephalogram (EEG), without video, review of data, technical description by EEG technologist |
| 95711 | CPT | Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, 2–12 hours |
| 95712 | CPT | Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, 2–12 hours |
| 95713 | CPT | Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, 2–12 hours |
| 95717 | CPT | Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review |
| 95718 | CPT | Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review |
| 95812 | CPT | Electroencephalogram (EEG) extended monitoring; 41–60 minutes |
| 95813 | CPT | Electroencephalogram (EEG) extended monitoring; 61–119 minutes |
| 95816 | CPT | Electroencephalogram (EEG); including recording awake and drowsy |
| 95819 | CPT | Electroencephalogram (EEG); including recording awake and asleep |
| 97153 | CPT | Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or qualified health care professional |
| 97154 | CPT | Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or qualified health care professional |
| 97155 | CPT | Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional |
| 97156 | CPT | Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional |
| 97157 | CPT | Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional |
| 97158 | CPT | Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional |
Not Covered HCPCS Codes — Considered Not Medically Necessary for ADHD
| Code | Type | Description |
|---|---|---|
| G0177 | HCPCS | Training and educational services related to the care and treatment of individual's disabling mental health problems |
| H2027 | HCPCS | Psychoeducational service, per 15 minutes |
| P2031 | HCPCS | Hair analysis (excluding arsenic) |
| S9445 | HCPCS | Individual education, not otherwise classified, non-physician provider, individual, per session |
| S9446 | HCPCS | Individual education, not otherwise classified, non-physician provider, group, per session |
| T1018 | HCPCS | School-based individualized education program (IEP) services, bundled |
No ICD-10-CM codes are listed in MM 0231 policy data.
Get the Full Picture
Track this policy across versions, search 1,500+ policies by CPT code, and get real-time alerts when any payer changes coverage.