Does Anthem Cover CBT (Cognitive Behavioral Therapy)?
How Anthem covers CBT through Carelon Behavioral Health — typical copays, the benefits-verification script, and how to handle out-of-network superbills via the Sydney Health app.
The Short Answer
Yes, Anthem covers CBT. Cognitive Behavioral Therapy is the most widely studied form of psychotherapy and is covered by every standard Anthem commercial plan under outpatient mental health benefits. Anthem's behavioral health network is administered through Carelon Behavioral Health (formerly Beacon Health Options) and, under the Mental Health Parity and Addiction Equity Act, CBT must be reimbursed on par with comparable medical services.
CBT sessions are billed under the standard psychotherapy CPT codes (90834 or 90837). There is no CBT-specific code, benefit, or prior authorization on standard Anthem plans.
Key Takeaways
- Anthem covers CBT under outpatient mental health; administered through Carelon Behavioral Health.
- In-network copays typically run $20–$50 per session.
- Anthem's Sydney Health app handles benefits verification and claims submission.
- No prior authorization is required for standard outpatient CBT.
- Out-of-network PPO coverage is available; HMO plans generally do not cover OON.
What Anthem Covers for CBT
CPT codes
| CPT Code | Description |
|---|---|
| 90791 | Intake / diagnostic evaluation |
| 90834 | 45-minute psychotherapy |
| 90837 | 60-minute psychotherapy |
| 90853 | Group psychotherapy (CBT groups) |
Covered conditions
Anthem covers CBT for any diagnosed mental health condition supported by your plan: anxiety, depression, OCD, PTSD, insomnia (CBT-I), chronic pain (CBT-CP), and others.
Session count
Anthem commercial plans typically do not cap outpatient therapy sessions. Coverage continues as long as the treatment is medically necessary.
In-Network vs. Out-of-Network CBT
In-network
- Copay: $20–$50 per session on most plans
- Provider search: Anthem Find Care — filter by Behavioral Health. The Carelon directory is the same database.
- Carelon directory: Also accessible at carelonbehavioralhealth.com if your plan's BH is carved out through Carelon.
Out-of-network
- Full private-pay rates: $100–$250 per session
- PPO plans reimburse 50–80% of allowed amount after OON deductible
- HMO plans usually do not cover OON
- Submit superbills through the Sydney Health app — Anthem's mobile app accepts photo uploads of superbills for faster processing
Prior Authorization
Anthem does not require prior authorization for standard outpatient CBT. Prior auth applies only to higher levels of care (IOP, PHP, residential), psychological testing, and ABA.
How to Verify Your Anthem CBT Coverage
Call member services at 1-800-331-1476 or the number on your ID card, and ask for behavioral health benefits.
Script
- "What is my copay for in-network individual psychotherapy, CPT 90834?"
- "Is 90837 (60 min) reimbursed at the same rate?"
- "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 CBT sessions reimbursed at the same rate as in-person?"
- "Is my plan's behavioral health managed by Carelon, or directly by Anthem?"
Write down the reference number.
Typical Out-of-Pocket Costs
For a 12-session CBT course:
| Scenario | Per Session | 12-Session Course |
|---|---|---|
| In-network, $30 copay | $30 | $360 |
| In-network, $50 copay | $50 | $600 |
| In-network HDHP before deductible | ~$100–$150 | $1,200–$1,800 |
| OON PPO, 70% reimbursement | ~$50–$90 post-reimbursement | $2,000+ (year 1 OON deductible) |
| Cash pay | $150–$250 | $1,800–$3,000 |
See CBT therapy cost for the private-pay view.
What to Do If Anthem Denies a CBT Claim
- Get the denial EOB in writing.
- Ask your provider for peer review with Carelon.
- File a first-level appeal within 180 days through the Sydney Health app or by mail.
- Cite MHPAEA parity if the denial appears modality- or diagnosis-specific.
- External review is available after internal appeals.
Frequently Asked Questions
Does Anthem cover specialized CBT like CBT-I or CBT-CP? Yes. These variants are billed as standard psychotherapy; coverage depends on the diagnosis, not the specialization.
Does Anthem cover online CBT? Yes — telehealth psychotherapy is typically covered at the same rate as in-person on Anthem commercial plans.
Does Anthem cover Talkspace or BetterHelp? Some Anthem employer plans include these platforms through benefits add-ons. Confirm with member services.
Is my behavioral health managed by Anthem or Carelon? Most Anthem commercial plans route behavioral health through Carelon. Check the back of your member ID card for a specific BH number.