Does Anthem Cover EMDR Therapy?
How Anthem covers EMDR through Carelon Behavioral Health — billed as standard psychotherapy, typical costs for a 6–12 session course, and the benefits-verification script.
The Short Answer
Yes, Anthem covers EMDR. Eye Movement Desensitization and Reprocessing is recognized by the American Psychological Association as an evidence-based treatment for PTSD. Anthem, through its behavioral health manager Carelon Behavioral Health, covers EMDR under standard outpatient mental health benefits at parity with medical services per MHPAEA.
EMDR sessions are billed under standard psychotherapy CPT codes (90834 or 90837). There is no EMDR-specific code, benefit, or prior authorization.
Key Takeaways
- Anthem covers EMDR under outpatient mental health; administered by Carelon Behavioral Health.
- EMDR is billed as 90834 or 90837, not a special code.
- In-network copays are typically $20–$50 per session.
- Finding in-network EMDR-trained providers is the main friction; cross-reference with the EMDRIA directory.
- Prior authorization is not required for standard outpatient EMDR.
What Anthem Covers for EMDR
CPT codes
| CPT Code | Description |
|---|---|
| 90791 | Intake / diagnostic evaluation |
| 90834 | 45-minute psychotherapy |
| 90837 | 60-minute psychotherapy (often used for EMDR) |
Because EMDR needs time to close cleanly, many therapists bill 60-minute sessions. Confirm 90837 is reimbursed at the same rate as 90834 on your Anthem plan.
Covered conditions
EMDR is most commonly billed for PTSD, complex PTSD, trauma-related anxiety, depression, and adjustment disorders.
Session count
Typical EMDR courses: 6–12 sessions for single-incident trauma, longer for complex presentations. Anthem does not impose a fixed session cap.
In-Network vs. Out-of-Network EMDR
In-network
- Start at Anthem Find Care; filter by Behavioral Health
- Cross-reference with the EMDRIA directory to confirm EMDR training
- Call the provider's office to verify Anthem network status for your specific plan
Out-of-network
- Full private-pay rates: $150–$300 per session
- PPO plans reimburse 50–80% of allowed amount after OON deductible
- HMO plans: no OON coverage
- Submit superbills through Sydney Health app
Prior Authorization
Not required for standard outpatient EMDR. Prior auth applies only to IOP, PHP, residential, psychological testing, and ABA.
How to Verify Your Anthem EMDR Coverage
Call 1-800-331-1476 or the BH number on your ID card.
Script
- "What is my copay for individual psychotherapy CPT 90834?"
- "Is 90837 reimbursed at the same rate as 90834?"
- "Is prior authorization required for outpatient therapy?"
- "Do I have out-of-network benefits, and what is the allowed amount for 90834?"
- "Are telehealth EMDR sessions reimbursed at the same rate?"
- "Is my behavioral health managed by Carelon?"
Note the reference number.
Typical Out-of-Pocket Costs for an 8-Session EMDR Course
| Scenario | Per Session | 8-Session Course |
|---|---|---|
| In-network, $30 copay | $30 | $240 |
| In-network, $50 copay | $50 | $400 |
| In-network HDHP before deductible | ~$100–$150 | $800–$1,200 |
| OON PPO, 70% reimbursement | ~$60–$120 post-reimbursement | $2,500+ (year 1 OON deductible) |
| Cash pay | $150–$300 | $1,200–$2,400 |
See EMDR therapy cost for the private-pay view.
What to Do If Anthem Denies an EMDR Claim
- Get the denial in writing.
- Ask your provider to call Carelon for peer review.
- File a first-level appeal within 180 days.
- Cite MHPAEA parity if denial appears inconsistent with how comparable medical services are covered.
- External review after internal appeals.
Frequently Asked Questions
Does Anthem cover EMDR for conditions other than PTSD? Yes. EMDR for anxiety, depression, phobias, and adjustment disorders is covered when provided by a licensed therapist for a diagnosed condition.
Does Anthem cover online EMDR? Yes — telehealth EMDR is covered at the same rate as in-person on most Anthem plans. See can you do EMDR online?
Is EMDR more expensive than CBT under Anthem? Per session, no. Total course cost is often lower because single-incident EMDR can resolve in fewer sessions.
Does my Anthem plan use Carelon, or does it handle BH directly? Most Anthem commercial plans use Carelon. The BH phone number on the back of your ID card will tell you.