The autism evaluation report is often 10 to 30 pages long, full of test names and scores, and it arrives at a time when you are already tired. It is also one of the most important papers you will ever hold for your child. Your health plan, school district and Florida programs will all ask for it. This guide walks through what each section of a typical report means, then compares what the plans Florida families most often have actually check before they approve ABA (applied behavior analysis). Reports vary by evaluator, so treat the outline below as a common pattern, not a template every clinician follows.
What sections does a typical autism evaluation report have?
Most reports follow a similar order. Here is what each part usually holds and why it matters later.
1. Identifying information
Your child's name, date of birth, age at testing, the date or dates of the evaluation, the date of the report, and the evaluator's name and credentials. This is the part insurers check first. A missing date or an unsigned report is one of the easiest reasons for a request to be sent back.
2. Reason for referral
Who asked for the evaluation (you, the pediatrician, a school) and what the concerns were. This frames everything that follows.
3. Background and developmental history
Pregnancy and birth, milestones, medical history, family history, school or daycare, and earlier therapies. Much of this comes from your interview and questionnaires. Read it carefully: if a milestone or a medical fact is wrong, ask the evaluator to correct it now.
4. Tests and procedures used
A list of the tools the evaluator used. Common examples include direct observation tools (such as the ADOS-2), structured parent interviews, cognitive or developmental tests, and adaptive behavior scales (such as the Vineland). The list tells a reader the diagnosis rests on standardized methods, not only an impression.
5. Behavioral observations
What the evaluator saw: how your child played, communicated, responded to their name, handled transitions, and used eye contact, gestures and language. Parents sometimes find this section hard to read because it describes their child in clinical terms. It is written for other professionals, not as a judgment of your child.
6. Results and interpretation
Scores and what they mean. Many reports compare scores to children of the same age using standard scores or percentiles. Ask the evaluator to explain any number you do not understand. You can request a feedback meeting if one was not offered.
7. Diagnostic impressions
The core of the report. If your child meets the criteria, it should say autism spectrum disorder under the DSM-5 (the current version is the DSM-5-TR). Many reports also list:
- a support level (Level 1, 2 or 3) for social communication and for restricted, repetitive behaviors;
- specifiers, such as with or without accompanying intellectual impairment, or with or without accompanying language impairment;
- an ICD-10 code, usually in the F84 family, which is the code insurers bill against;
- any other diagnoses, such as ADHD, anxiety or a language disorder.
The CDC's summary of the DSM-5 criteria lists two core areas: persistent differences in social communication and interaction across settings (criterion A), and restricted, repetitive patterns of behavior, interests or activities (criterion B, at least two of four types). A strong report shows how your child meets each, with examples. See autism levels explained for what the support levels mean.
8. Recommendations
What the evaluator suggests next: often ABA, speech therapy, occupational therapy, school supports, medical follow-up or a re-evaluation date. If the evaluator recommends ABA, that line helps when your provider asks the plan for authorization. Some plans also want a prescription or order from your child's physician; that is a separate paper (see below).
9. Signature
The evaluator's signature, printed name, credentials and license number. Check it is there.
What do insurers look for before approving ABA?
Each plan writes its own rules, and the plan document controls for your family. Here is what the published policies of three plans Florida families often have say about the diagnosis, as of October 2026.
| Payer and document | Diagnosis requirement | Who may diagnose | Report age |
|---|---|---|---|
| Cigna / Evernorth, Coverage Policy EN0499 (effective 5/15/2026) | Confirmed autism spectrum disorder under DSM-5-TR (ICD-10 F84.0 to F84.9, except F84.2, Rett syndrome) | A professional licensed to diagnose independently; the request must state the diagnostician's name, credentials, licensure and the date of diagnosis | Not stated for the diagnosis; the ABA assessment must be done within 60 days before treatment starts |
| Aetna, Applied behavior analysis medical necessity guide (2026) | A DSM-5 autism diagnosis (ICD-10 F84.0; F84.3 to F84.9) | Follow the plan's terms; ask member services | Not stated for the diagnosis; impairment on a standardized scale within the past 12 months |
| UMR (self-funded employer plans), form UMF0035 | Proof of an autism diagnosis; "IEPs and school evaluations are NOT acceptable as the sole proof of diagnosis" | Not specified on the form | If the diagnostic report is more than 4 years old, current documentation is also needed |
Florida Blue and other plans publish their own guidelines. If your plan is not listed, ask member services for its ABA medical policy and read the diagnosis section before you send anything.
Which report problems most often cause delays?
Use this checklist when the report arrives. Every "no" is worth fixing before the report goes to a provider or a plan.
- Is the diagnosis stated clearly? Phrases like "features of autism," "rule out ASD" or "provisional" can stall a request. If the evaluator did diagnose autism spectrum disorder, the report should say so plainly.
- Is it dated? Both the evaluation date and the date of diagnosis.
- Does it name the evaluator with credentials and license? Cigna's policy asks for name, credentials, licensure and date.
- Is it signed?
- Is there an ICD-10 code? Not every plan requires it on the report, but it removes guesswork.
- Is it the full report? Send all pages, not a one-line letter or the summary page alone.
- Is it a school evaluation only? A school eligibility determination is not a medical diagnosis. UMR says school evaluations and IEPs are not enough on their own.
- Is it old? Some plans ask for updated documentation after a few years. See when insurers ask for an updated diagnosis.
- Are your child's name and date of birth correct? A typo can make a plan question whether the report belongs to your child.
If something is missing, call the evaluator's office and ask for a corrected report or a signed addendum. Most offices handle these requests routinely.
Does Florida law say what the diagnosis must look like?
Florida's autism insurance law, the Steven A. Geller Autism Coverage Act (s. 627.6686), applies to fully insured large-group plans, group HMOs and the state employee plan. It does not list report requirements. It does say coverage is limited to treatment "prescribed by the insured's treating physician in accordance with a treatment plan," and that the treatment plan must include "a diagnosis" and "the signature of the treating physician." So for those plans, two papers usually travel together: the diagnostic report, and your child's physician's prescription or order for treatment. Self-funded plans, like those UMR administers, follow their own plan documents instead. The guide on whether ABA needs a doctor's prescription explains the difference.
Other Florida programs have their own rules about whose diagnosis they accept. Florida's Agency for Persons with Disabilities (APD), for example, lists specific types of diagnosing professionals in its eligibility rule. The guide on who can diagnose autism in Florida compares them side by side.
Can I share the report with the school, and should I?
That is your decision. A medical diagnosis and school eligibility for exceptional student education are separate. Florida's school rule for autism eligibility (Rule 6A-6.03023) requires the district's own evaluation components, and the student must also need special education. Many families share the private report because it gives the school useful information. Some share only parts. The guide on sharing a private evaluation with the school walks through the trade-offs.
How do I use the report to start ABA?
- Make several copies (paper and PDF). Keep the original.
- Check it against the checklist above and fix gaps with the evaluator.
- Ask your pediatrician for a prescription or order for ABA if your plan requires one.
- Call member services and ask which documents the plan needs for ABA authorization. The insurance call script has the exact questions.
- Send the full report to the ABA provider along with your insurance cards. See the diagnosis paperwork you need before ABA.
Who decides whether the report is enough? Your plan does, through its review. The evaluator decides what the report says. Your ABA provider can tell you what the plan has sent back before and help you ask for the right fix.
How Hope Center can help
At Hope Center for Behavior Change, your child's diagnostic report is one of the first documents we collect at intake, before benefits verification and the initial assessment, because the insurance request depends on it. Returning documents quickly is the single biggest thing that keeps a start date short. We also offer a free benefits check, so you know whether ABA is covered and what your share is likely to be before you commit. If your child does not yet have a diagnosis, Hope Center offers diagnostic evaluations through our clinical director with a supervising licensed psychologist. We work with Blue Cross Blue Shield (Florida Blue), Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East, and we offer self-pay with a sliding scale. Visit insurance at Hope Center, request a free benefits check, or call 561-337-8865.