Does Anthem Cover ACT (Acceptance and Commitment Therapy)?
How Anthem covers ACT through Carelon Behavioral Health — billed as standard psychotherapy, typical copays, and how to find ACT-trained providers in-network.
The Short Answer
Yes, Anthem covers ACT. Acceptance and Commitment Therapy — a "third-wave" behavioral therapy developed by Steven Hayes — is evidence-based for anxiety, depression, chronic pain, OCD, and more. Anthem, through Carelon Behavioral Health, covers ACT under outpatient mental health benefits at parity with medical services.
ACT sessions are billed using standard psychotherapy codes (90834 or 90837). There is no ACT-specific billing code or benefit structure.
Key Takeaways
- Anthem covers ACT under outpatient mental health; administered by Carelon.
- ACT is billed as standard psychotherapy; no special code.
- In-network copays typically $20–$50 per session.
- ACT-trained therapists are scarcer than CBT therapists; cross-reference with the ACBS directory.
- Prior authorization is not required for outpatient ACT.
What Anthem Covers for ACT
CPT codes
Standard psychotherapy codes — 90791 (intake), 90834 (45 min), 90837 (60 min), 90853 (group).
Covered conditions
ACT's strongest evidence base is for chronic pain, anxiety, depression, OCD, and substance use disorders.
Session count
Typical ACT course: 12–20 sessions for anxiety or depression, 8–16 for chronic pain. No Anthem-imposed session cap.
In-Network vs. Out-of-Network ACT
In-network
- Anthem Find Care — filter by Behavioral Health
- Cross-reference with the ACBS find-a-therapist directory to find ACT-trained clinicians
- Copay: typically $20–$50 per session
Out-of-network
- Cash-pay rates: $130–$250 per session
- PPO plans reimburse 50–80% of allowed amount after OON deductible
- HMO plans: no OON coverage
- Submit superbills through Sydney Health
Prior Authorization
Not required for standard outpatient ACT.
How to Verify Your Anthem ACT Coverage
Call 1-800-331-1476 or the BH number on your ID card.
Script
- "What is my copay for individual psychotherapy (90834, 90837)?"
- "Do I have a separate mental health deductible?"
- "Is prior authorization required for outpatient therapy?"
- "Do I have out-of-network benefits, and what is the allowed amount for 90834?"
- "Are telehealth sessions reimbursed at the same rate?"
- "Is my plan's BH managed by Carelon?"
Typical Out-of-Pocket Costs for a 12-Session ACT Course
| Scenario | Per Session | 12-Session Course |
|---|---|---|
| In-network, $30 copay | $30 | $360 |
| In-network, $50 copay | $50 | $600 |
| HDHP before deductible | ~$100–$150 | $1,200–$1,800 |
| OON PPO, 70% reimbursement | ~$55–$100 post-reimbursement | $1,800–$2,500 (year 1) |
| Cash pay | $130–$250 | $1,560–$3,000 |
See ACT therapy cost for the private-pay view.
What to Do If Anthem Denies an ACT Claim
ACT denials are rare because billing is identical to any psychotherapy. If denied:
- Get EOB in writing.
- Ask provider to peer-review with Carelon.
- Appeal within 180 days.
- Cite MHPAEA parity if the denial is modality- or diagnosis-specific.
Frequently Asked Questions
Is ACT the same cost as CBT under Anthem? Per-session, yes. Total course cost is similar (12–20 sessions).
Does Anthem cover ACT for chronic pain? Yes — this is one of ACT's strongest indications. Pair with a chronic pain or mental health diagnosis.
Does Anthem cover ACT groups? Yes, billed as 90853; typically at a lower copay than individual sessions.
Does Anthem cover online ACT? Yes — telehealth psychotherapy is covered at the same rate as in-person.