Attention-Deficit/Hyperactivity Disorder (ADHD): Assessment and Treatment - (0231)

Cigna covers ADHD assessment and treatment when DSM‑5 criteria are met and recognizes FDA‑approved stimulant and non‑stimulant medications (medications billed through the pharmacy benefit), but specifically excludes intensive behavioral programs (EIBI/ABA), TMS/cranial electrical stimulation, computerized/QEEG tests (e.g., NEBA/QbTest), hair analysis, vision therapy, many school/educational interventions, and other complementary/unproven therapies. Coverage requires clinical documentation of a DSM‑5 diagnosis with history, physical exam, parent/teacher reports showing symptoms in ≥2 settings with onset before age 12, and an EEG or neurology consult only if focal neurologic signs suggest seizure/degenerative disease.

"This Coverage Policy addresses services for the assessment and treatment of attention-deficit hyperactivity disorder."

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