So you've gotten your first patient with a Cigna EAP. Here's everything you need to know — from getting the authorization to billing the claim correctly.
How Cigna EAP Authorizations Work
EAP is a pre-authorization system. You can't just see a patient and bill it to the EAP. Either the patient or their employer has to initiate the process through the EAP coordination system set up for them. They can request a specific provider or the system can assign one.
Once the request is processed, you can call the EAP team and they'll give you the authorization code over the phone. Officially, both you and the patient also receive a letter in the mail — but in practice, the phone call is how you'll get the code. Unlike Aetna, which has a portal where you can retrieve authorizations online, Cigna does not have an EAP portal. If you need to verify an existing authorization or a patient lost their code, call the EAP team directly — they can look it up using the patient's insurance information.
Requesting EAP Sessions on Behalf of a Patient
You don't have to wait for the patient to initiate the process. As the provider, you can request EAP sessions on the patient's behalf by calling (877) 622-4327. Your office staff can also make this call — they just need the general reason the patient is seeking treatment.
Important: You must have the authorization before the session takes place. Sessions conducted without a valid authorization number will not be paid under EAP.
The Email Shortcut: Skip the Phone Call
Instead of calling and waiting on hold, you can submit EAP authorization requests and coverage confirmations via email using an Excel form.
How to set it up
Get the Excel template. Contact Cigna/Evernorth provider services and ask for the "EBH Coverage Confirmation Grid with EAP." This is a standard spreadsheet they provide to billing offices.
Fill out the form. The template has two sheets:
- Request New EAP Authorization — use this when a patient needs a new authorization. You'll need: patient first and last name, date of birth, member ID, presenting problem (e.g., "Stress Management"), your provider name, and your Tax ID (TIN).
- Verify Existing EAP Authorization — use this when you already have an auth number and need to confirm coverage. Same fields as above, plus the authorization number.
Email it. Send the completed spreadsheet to EBHCoverageConfirmation@Evernorth.com with a subject line like "EAP Request - [Your Practice Name]" or "EAP Coverage Confirmation - [Your Practice Name]."
Evernorth processes these requests and responds via email, which means you have a paper trail instead of trying to remember what someone told you on a phone call.
How to Bill Cigna EAP Claims
The patient will receive a set number of sessions for a specific topic. Those sessions should be billed under CPT code 99404 (preventive medicine counseling, 60 minutes).
Once the authorized EAP sessions are used up, you can refer the patient to yourself or another therapist for continued treatment under their regular insurance plan, billed with your usual CPT codes.
Requesting Additional EAP Sessions
Most providers assume once the initial sessions are used up, that's it — the patient moves to regular insurance. That's not necessarily the case. You can request additional EAP sessions for the same patient as long as the presenting problem is different. Stress management, relationship issues, grief, workplace conflict — each qualifies as a separate reason. In practice, this means a patient can cycle through multiple rounds of EAP sessions over time if their treatment touches different areas, and most patients' situations do.
Common Mistakes
- Billing before you have the authorization number. The claim will be denied. Always confirm the auth is in place before the session.
- Not knowing about the 30-day backdating window. Cigna allows EAP claims to be backdated up to 30 days once the authorization is in place. If a patient assumed their EAP sessions were automatic and ended up paying a copay on a regular insurance claim, you can obtain the EAP authorization retroactively, resubmit under 99404, and get the copay refunded. Keep this between you and your billing team — if patients know there's a grace period, some will put off getting their authorization and you'll end up chasing it down yourself.
- Using the wrong CPT code. EAP sessions are billed under 99404, not your standard therapy codes (90834, 90837, etc.).
- Letting authorizations expire. EAP authorizations have a time limit. If the patient doesn't use their sessions within the authorized period, you'll need to request a new authorization.
- Not tracking the session count. EAP authorizations are for a specific number of sessions. If you go over, the extra sessions won't be covered under EAP.
Quick Reference
| Item | Details |
|---|---|
| EAP Provider Line | (877) 622-4327 |
| Email for Auth Requests | EBHCoverageConfirmation@Evernorth.com |
| Excel Template | Ask for "EBH Coverage Confirmation Grid with EAP" |
| Billing Code | CPT 99404 |
| Payer ID | 62308 |
Download the Cheat Sheet
Want a printable version? Download the one-page Cigna EAP cheat sheet (PDF) with all the numbers, codes, and tips from this guide.
Need Help with Cigna EAP Billing?
If you're new to insurance panels, start with our credentialing guide to make sure your setup is complete.
Need help managing Cigna EAP authorizations or other insurance billing for your practice? Contact me — I handle billing for mental health practices across Georgia.