Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut CG-BEH-15 Activity Therapy for Autism Spectrum Disorders and Rett Syndrome Form

Effective Date

01/03/2024

Last Reviewed

11/09/2023

Original Document

  Reference



This document addresses activity therapy (for example, music, dance, art or play therapies) when used to treat autism spectrum disorders (ASDs) and Rett syndrome. ASDs, as defined in the fifth edition text revision of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

Note: For information on other services that may be provided for autism spectrum disorders, see:

  • CG-BEH-02 Adaptive Behavioral Treatment

Clinical Indications

Not Medically Necessary:

Activity therapy, including but not limited to music, dance, art or play therapies, is considered not medically necessary for the treatment of Autism Spectrum Disorders and Rett syndrome.