AOTA Success: Cigna/ASH updates OT coverage policy to remove restrictive language

After significant AOTA advocacy, Cigna, in conjunction with their national ancillary provider for therapy services, American Specialty Health (ASH), recently released an updated occupational therapy policy that eliminated language to prohibit services addressing behavioral conditions. During INSPIRE in Kansas City, several members approached AOTA staff with concerns that Cigna had denied payment for services provided to clients with non-physical diagnoses (e.g., autism spectrum disorder, sensory issues, cognitive dysfunction). AOTA communicated those concerns to ASH as part of a collaborative relationship developed over the last few years. In response, ASH staff worked with Cigna to update the occupational therapy policy. The policy now considers occupational therapy for "physical and/or functional impairment in one or more of the following areas: Sensory and/or motor, Cognitive/psychological, Cardiopulmonary status and circulation, [and] Skin" to be medically necessary and therefore reimbursable. While there is still some work to be done, the new policy represents a significant, positive change for occupational therapy practitioners and their clients. The revised policy was effective on September 15, 2023. Please contact AOTA's Regulatory Affairs department with any questions.