Prior authorization codes
Cigna Corporation
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 0001M | prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0001U | from 11 blood groups, utilizing whole blood, common RBC alleles reported | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0002M | steatohepatitis (ASH) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0003M | steatohepatitis (NASH) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0005U | SPDEF), urine, algorithm reported as risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0006M | carcinoma tumor tissue, with alpha-fetoprotein level, algorithm reported as a risk classifier | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0007M | index | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0007U | buccal DNA, per date of service | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0009M | maternal plasma, algorithm reported as a risk score for each trisomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0011M | prostate cancer risk | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0012M | as a risk score for having urothelial carcinoma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0013M | as a risk score for having recurrent urothelial carcinoma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0016M | luminal infiltrated, basal, basal claudin-low, neuroendocrine-like) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0016U | detected or detected with quantitation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0017M | algorithm reported as cell of origin | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0017U | detected | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0018M | as a rejection risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0018U | malignancy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0019T | energy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0019U | therapeutic agents | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0022U | presence or absence of variants and associated therapy(ies) to consider | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0023U | mutation and indication for or against the use of midostaurin | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0026U | probability of malignancy" or "Negative, low probability of malignancy") | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0027U | analysis exons 12-15 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0028U | analysis, copy number variants, common variants with reflex to targeted sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0029U | rs1277 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0030U | VKORC1, rs12777823) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0031U | analysis, common variants (ie, *1F, *1K, *6, *7) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0032U | variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0033U | >C], HTR2C rs3813929 [c.-759C>T] and rs1414334 [c.551- >G]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0034U | NUDT15 *3, *4, *5) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0036U | normal specimen, sequence analyses | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0037U | microsatellite instability and tumor mutational burden | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0040U | breakpoint, quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0042T | Mean | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0045U | tissue, algorithm reported as recurrence score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0046U | (ITD) variants, quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0047U | reported as a risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0048U | tissue, report of clinically significant mutation(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0049U | NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0050U | genes, interrogation for sequence variants, copy number variants or rearrangements | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0051T | Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0052T | Replacement/repair of thoracic unit of a total replacement heart system (artificial heart) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 00530 | Anesthesia, Permanent Transvenous Pacemaker Insertion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0053T | heart) excl thoracic unit | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0053U | needle biopsy specimen, algorithm reported as probability of higher tumor grade | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0055U | nucleotide polymorphism targets and two control targets), plasma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 00580 | Anesthesia, Heart Transplant/Heart & Lung Transplant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0058T | Cryopreservation; reproductive tissue, ovarian | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0059T | Cryopreservation; oocyte(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0062U | serum, algorithm reported with a risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0069U | paraffin-embedded tissue, algorithm reported as an expression score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0070U | *12, *13, *14A, *14B, *15, *17, *29, *35, *36, *41, *57, *61, *63, *68, *83, *xN) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0071T | Ultrasound Ablation of Uterine Leioomyomata inc MR Guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0071U | analysis, full gene sequence (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0072T | Ultrasound Ablation of Uterine Leioomyomata inc MR Guidance; Vol>=200 CC | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0072U | to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0073U | to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0074U | is trans) (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0075U | addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0076U | addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0078T | renal artery[s]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0078U | or negative risk of opioid-use disorder | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 00796 | Anesthesia, Intraperitoneal Proc, Upper Abdomen, W/Laparoscopy; Liver Transplant, Recipient | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0079U | urine and buccal DNA, for specimen identity verification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0080T | renal artery[s]), radiological supervision and interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0080U | reported as a categorical probability of malignancy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0085T | Breath test for heart transplant rejection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 00868 | Recipient | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0087U | transplant biopsy tissue, allograft rejection and injury algorithm reported as a probability score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0088U | rejection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0089U | superficial collection using adhesive patch(es) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0090T | interspace (other than for decompression) cervical; single interspace | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0090U | algorithm reported as a categorical result (ie, benign, intermediate, malignant) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0092U | technology, plasma, algorithm reported as risk score for likelihood of malignancy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0094U | analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0095T | interspace, cervical (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0098T | each additional interspace, cervical (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0099T | Implantation of intrastromal corneal ring segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0100T | implantation of intra-ocular retinal electrode array, with vitrectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0101T | Extracorporeal shock wave involving musculoskeletal system, not otherwise specified | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0101U | EPCAM and GREM1 [deletion/duplication only]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0102T | and involving the lateral humeral epicondyle | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0102U | unknown significance when indicated (17 genes [sequencing and deletion/duplication]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0103U | genes [sequencing and deletion/duplication], EPCAM [deletion/duplication only]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0104U | EPCAM and GREM1 [deletion/duplication only]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0105U | score for rapid kidney function decline (RKFD) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0106T | pressure stimuli to assess large diameter sensation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0107T | stimuli to assess large diameter fiber sensation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0108T | stimuli to assess small nerve fiber sensation and hyperalgesia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0109T | stimuli to assess small nerve fiber sensation and hyperalgesia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0110T | to assess sensation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0111U | and 61) gene analysis utilizing formalin-fixed paraffin-embedded tissue | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0112U | genes) with drug-resistance gene | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0113U | algorithm reported as risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0117U | with likelihood of atypical biochemical function associated with pain | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0118U | the total cell-free DNA | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0120U | the latter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0124T | not include supply of medication) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0129U | analysis panel (ATM, BRCA1, BRCA2, CDH1, CHEK2, PALB2, PTEN, and TP53) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0130U | addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0131U | (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0132U | (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0134U | separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0135U | (12 genes) (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0136U | separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0138U | code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0141U | technique, each target reported as detected or not detected | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0142U | target reported as detected or not detected | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0152U | plasma, untargeted next-generation sequencing, report for significant positive pathogens | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0153U | negative breast cancer clinical subtype(s) with information on immune cell involvement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0154U | alteration status | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0155U | gene mutation status | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0156U | Copy number (eg, intellectual disability, dysmorphology), sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0163T | in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0164T | interspace, lumbar (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0164U | vinculin antibodies, utilizing plasma, algorithm for elevated or not elevated qualitative results | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0165T | each additional interspace, lumbar (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0166U | necroinflammatory activity, and steatosis with a summary interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0169T | including computerized stereotactic planning and burr hole(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0169U | metabolism) gene analysis, common variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0170U | algorithmic analysis, and results reported as predictive probability of ASD diagnosis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0171T | or ligament for insertion and imaging guidance), lumbar; single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0171U | presence/absence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0172U | quantifying tumor genomic instability score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0173U | gene | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0174U | benefit of 39 chemotherapy and targeted therapeutic oncology agents | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0175U | Psychiatry (eg, depression, anxiety), genomic analysis panel, variant analysis of 15 genes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0176U | Cytolethal distending toxin B (CdtB) and vinculin IgG antibodies by immunoassay (ie, ELISA) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0177U | gene mutation status | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0179U | partner/breakpoint, copy number variations), with report of significant mutation(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0182T | High dose rate electronic brachytherapy, per fraction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0183T | performed, wound assessment, and instruction(s) for ongoing care, per day | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0186T | Suprachoroidal delivery of pharmacologic agent (does not include supply of medication) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0191T | approach, into the trabecular meshwork | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0192T | approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 01937 | spine or spinal cord; cervical or thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 01938 | spine or spinal cord; lumbar or sacral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 01939 | spine or spinal cord; cervical or thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 01940 | spine or spinal cord; lumbar or sacral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 01941 | kyphoplasty, vertebroplasty) on the spine or spinal cord; cervical or thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 01942 | kyphoplasty, vertebroplasty) on the spine or spinal cord; lumbar or sacral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0195T | instrumentation, with image guidance, includes bone graft when performed; L5-S1 interspace | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0197T | therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 01991 | performed by a different physician or other qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 01992 | performed by a different physician or other qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0199T | frequency and amplitude), including interpretation and report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0200T | balloon or mechanical device, when used, 1 or more needles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0201T | balloon or mechanical device, when used, 2 or more needles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0202T | facetectomy, laminectomy, foramin | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0203U | risk score and classification of inflammatory bowel disease aggressiveness | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0204U | reported as detected or not detected | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0205U | neovascular age-related macular-degeneration risk associated with zinc supplements | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0206U | cultured skin fibroblasts, each reported as positive or negative for Alzheimer disease | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0207T | Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0207U | code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0208U | carcinoma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0209U | number, structural changes and areas of homozygosity for chromosomal abnormalities | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0211U | paraffin-embedded tissue, interpretative report for single nucleotide variants, copy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0212U | identification and categorization of genetic variants, proband | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0213T | nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0213U | sequence analysis, including small sequence changes, deletions, duplications, short tand | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0214T | separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0214U | identification and categorization of genetic variants, proband | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0215T | additional level(s) (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0215U | sibling) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0216T | nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0216U | genetic variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0217T | separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0217U | genetic variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0218T | additional level(s) (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0218U | saliva, identification and characterization of genetic variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0219T | placement of bone graft(s) or synthetic device(s), single level; cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0220T | placement of bone graft(s) or synthetic device(s), single level; thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0221T | placement of bone graft(s) or synthetic device(s), single level; lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0222T | placement of bone graft(s) or synthetic device(s), single level; each additional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0228T | guidance, cervical or thoracic; single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0228U | morning voided urine, algorithm reported as likelihood of prostate cancer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0229T | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0229U | (eg, colorectal cancer) promoter methylation analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0230T | guidance, lumbar or sacral; single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0230U | mobile element insertions, and variants in non-uniquely mappable regions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0231T | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0231U | gene analysis, including small sequence changes in exonic and intronic regions, deletions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0232T | preparation when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0232U | full gene analysis, including small sequence changes in exonic and intronic region | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0233T | spectroscopy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0233U | mobile element insertions, and variants in non-uniquely mappable regions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0234U | insertions, and variants in non-uniquely mappable regions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0235U | mappable regions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0236U | changes in exonic and intronic regions, duplications, deletions, and mobile element insertions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0237U | mobile element insertions, and variants in non-uniquely mappable regions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0238U | duplications, mobile element insertions, and variants in non-uniquely mappable regions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0239T | of extracellular fluid differences between the limbs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0239U | deletions, select rearrangements, and copy number variations | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0242U | amplifications, and gene rearrangements | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0243U | preeclampsia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0244U | fixed paraffin-embedded tumor tissue | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0245T | Open treatment of rib fracture requiring internal fixation, unilateral; 1-2 ribs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0245U | associated risk of malignancy expressed as a percentage | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0246T | Open treatment of rib fracture requiring internal fixation, unilateral; 3-4 ribs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0247T | Open treatment of rib fracture requiring internal fixation, unilateral; 5-6 ribs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0247U | birth | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0248T | Open treatment of rib fracture requiring internal fixation, unilateral; 7 or more ribs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0248U | metastasis-response prediction for each drug | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0249U | includes laser capture microdissection, with algorithmic analysis and interpretative report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0250U | mutation burden | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0253T | approach, into the suprachoroidal space | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0253U | endometrial window of implantation (eg, pre-receptive, receptive, post-receptive) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0254U | deletion/duplication, mosaicism, and segmental aneuploidy, per embryo tested | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0255U | capacitated sperm and probability of generating a pregnancy score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0258U | response to psoriasis biologics | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0260U | inversions, insertions, translocations, and other structural variants by optical genome mapping | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0261U | tumor core), tissue, reported as immune response and recurrence-risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0262T | Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0262U | reported as gene pathway activity score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0263T | including unilateral or bilateral bone marrow harvest | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0264T | excluding bone marrow harvest | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0264U | inversions, insertions, translocations, and other structural variants by optical genome mapping | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0265T | bone marrow harvest only for intramuscular autologous bone marrow cell therapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0265U | buccal swabs or cell lines, identification of single nucleotide and copy number variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0266T | interrogation, programming, and repositioning, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0266U | splicing or expression changes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0267T | (includes intra-operative interrogation, programming, and repositioning, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0267U | and whole genome sequencing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0268T | (includes intra-operative interrogation, programming, and repositioning, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0268U | genes, blood, buccal swab, or amniotic fluid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0269T | programming, and repositioning, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0269U | of 14 genes, blood, buccal swab, or amniotic fluid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0270T | intra-operative interrogation, programming, and repositioning, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0270U | blood, buccal swab, or amniotic fluid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0271T | (includes intra-operative interrogation, programming, and repositioning, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0271U | swab, or amniotic fluid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0272T | mode, therapy start/stop times each day) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0272U | buccal swab, or amniotic fluid, comprehensive | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0273T | mode, therapy start/stop times each day); with programming | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0273U | array comparative genomic hybridization), blood, buccal swab, or amniotic fluid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0274T | multiple levels, unilateral or bilateral; cervical or thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0274U | buccal swab, or amniotic fluid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0275T | multiple levels, unilateral or bilateral; lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0276U | buccal swab, or amniotic fluid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0277U | blood, buccal swab, or amniotic fluid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0278T | Treatment Session (Includes Placement Of Electrodes) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0278U | swab, or amniotic fluid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0281T | appendage angiography, radiological supervision and interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0282T | cervical, thoracic or lumbar; for trial, including removal at the conclusion of trial period | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0283T | cervical, thoracic or lumbar; permanent, with implantation of a pulse generator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0284T | performed, including addition of new electrodes, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0285T | with reprogramming when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0285U | amplification, plasma, reported as a radiation toxicity score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0286U | methyltransferase) (eg, drug metabolism) gene analysis, common variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0287U | cancer recurrence, reported as a categorical risk result (low, intermediate, high) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0288T | incontinence) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0288U | reported as a recurrence risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0289U | genes, whole blood, algorithm reported as predictive risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0290U | blood, algorithm reported as predictive risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0291U | genes, whole blood, algorithm reported as predictive risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0292U | whole blood, algorithm reported as predictive risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0293T | performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0293U | genes, whole blood, algorithm reported as predictive risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0294T | pacing cardioverter-defibrillator pulse generator including radiological supervision | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0294U | whole blood, algorithm reported as predictive risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0296U | as positive or negative for signature associated with malignancy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0297U | comparative sequence analyses and variant identification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0298U | comparative sequence analyses and expression level and chimeric transcript identification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0299U | variant identification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0300U | sequence analyses and variant identification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0302T | programming when performed; complete system (includes device and electrode) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0303T | programming when performed; electrode only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0304T | programming when performed; device only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0305T | iterative adjustment of programmed values, with analysis, review, and report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0306U | comparisons to evaluate for MRD | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0307U | analyzed patient specimens to evaluate for MRD | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0312U | SLE-likelihood assessment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0313U | neoplasia) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0314U | algorithm reported as a categorical result (ie, benign, intermediate, malignant) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0315U | (FFPE) tissue, algorithm reported as a categorical risk result (ie, Class 1, Class 2A, Class 2B) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0317U | cancer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0318U | microarray for 50 or more genes, blood | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0319U | pretransplant peripheral blood, algorithm reported as a risk score for early acute rejection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0320U | posttransplant peripheral blood, algorithm reported as a risk score for acute cellular rejection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0321U | antibiotic-resistance genes, multiplex amplified probe technique | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0323U | pathogenic bacteria, viruses, parasites, or fungi | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0326U | amplifications, gene rearrangements, microsatellite instability and tumor mutational burden | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0329U | instability and tumor mutational burden utilizing DNA and RNA from tumor with DNA from | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0330T | Tear film imaging, unilateral or bilateral, with interpretation and report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0331T | Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0331U | significant alterations | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0332T | with tomographic SPECT | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0332U | probability of responding to immune checkpoint-inhibitor therapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0333U | reported as normal or abnormal result | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0334U | tumor mutational burden | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0335T | Insertion of sinus tarsi implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0335U | expansions, fetal sample, identification and categorization of genetic variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0336U | comparator genome (eg, parent) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0337U | blood | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0338T | performed; unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0338U | expressing cells, peripheral blood | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0339T | puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0339U | algorithm reported as probability of high-grade cancer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0340U | if appropriate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0342T | Therapeutic apheresis with selective HDL delipidation and plasma reinfusion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0342U | positive, negative, or borderline | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0343U | molecular evidence of no-, low-, intermediate- or high-risk of prostate cancer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0344U | reported as at-risk for nonalcoholic steatohepatitis (NASH) or not NASH | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0345T | Transcatheter mitral valve repair percutaneous approach via the coronary sinus | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0345U | analysis panel, variant analysis of 15 genes, including deletion/duplication analysis of CYP2D6 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0346U | MS/MS), ratio, plasma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0347T | Placement of interstitial device(s) in bone for radiostereometric analysis (RSA) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0347U | analysis, 16 gene report, with variant analysis and reported phenotypes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0348T | and lumbosacral, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0348U | analysis, 25 gene report, with variant analysis and reported phenotypes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0349T | shoulder, elbow and wrist, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0349U | gene-drug interactions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0350T | proximal femur, knee and ankle, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0350U | analysis, 27 gene report, with variant analysis and reported phenotypes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0351T | specimen; real time intraoperative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0352T | specimen; interpretation and report, real time or referred | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0353T | Optical coherence tomography of breast, surgical cavity; real time intraoperative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0354T | referred | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0355U | APOL1 (apolipoprotein L1) (eg, chronic kidney disease), risk variants (G1, G2) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0356U | (ddPCR), cell-free DNA, algorithm reported as a prognostic risk score for cancer recurrence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0358U | positive, or negative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0359U | by phase separation and immunoassay, plasma, algorithm reports risk of cancer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0360U | categorical result for risk of malignancy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0361U | Neurofilament light chain, digital immunoassay, plasma, quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0362T | is customized to the patient's behavior | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0362U | molecular subtypes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0363U | score for having urothelial carcinoma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0364U | disease burden, when appropriate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0368U | cell-free DNA (cfDNA), plasma, report of risk score for advanced adenoma or colorectal cancer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0369U | resistance genes, multiplex amplified probe technique | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0370U | amplified probe technique, wound swab | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0372U | amplified probe technique, urine, reported as an antimicrobial stewardship risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0373T | physician or other qualified health care professional who is on site; with the assistance of two | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0373U | technique, upper or lower respiratory specimen | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0374U | antibiotic-resistance genes, multiplex amplified probe technique, urine | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0375T | microdissection), cervical, three or more levels | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0376U | appropriate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0377U | 23 variables) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0378T | and interpretation with report by a physician or other qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0378U | repeat-primed PCR, blood, saliva, or buccal swab | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0379T | professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0379U | burden | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0380U | phenotype | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0388U | 37 cancer-related genes, plasma, with report for alteration detection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0389U | transcription polymerase chain reaction (RT-qPCR), blood, reported as a risk score for KD | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0390U | binding protein 4 (RBP4), by immunoassay, serum, algorithm reported as a risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0391U | splice-site variants, insertions/deletions, copy number alterations, gene fusions, tumor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0392U | CYP2D6, reported as impact of gene-drug interaction for each drug | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0396U | single-gene germline conditions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0398T | placement when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0400U | positive or negative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0401U | blood, saliva, or buccal swab, algorithm reported as a genetic risk score for a coronary event | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0403U | reported as percentage of likelihood of detecting clinically significant prostate cancer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0405U | plasma, reported as cancer signal detected or not detected | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0407U | data, plasma, algorithm reported as risk for progressive decline in kidney function | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0408T | parameters; pulse generator with transvenous electrodes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0409T | parameters; pulse generator only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0409U | clinical actionability | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0410T | parameters; atrial electrode only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0410U | enrichment, whole blood or plasma, algorithm reported as cancer detected or not detected | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0411T | parameters; ventricular electrode only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0411U | analysis panel, variant analysis of 15 genes, including deletion/duplication analysis of CYP2D6 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0412T | Removal of permanent cardiac contractility modulation system; pulse generator only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0412U | with tandem mass spectrometry (LC-MS/MS) and qualitative ApoE isoform-specific | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0413T | or ventricular) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0413U | marrow, report of clinically significant alterations | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0414T | generator only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0414U | for each biomarker | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0415T | (atrial or ventricular lead) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0415U | history of diabetes, blood, algorithm reported as a 5-year (deleted risk) score for ACS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0416T | Relocation of skin pocket for implanted cardiac contractility modulation pulse generator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0417T | analysis, including review and report, implantable cardiac contractility modulation system | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0417U | disorder-associated genetic variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0418T | contractility modulation system | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0419U | of 13 genes, saliva or buccal swab, report of each gene phenotype | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0420U | as a risk score for urothelial carcinoma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0422U | quantitative change from baseline, including specific alterations, if appropriate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0423U | genes, buccal swab, report including metabolizer status and risk of drug toxicity by condition | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0424T | implantable pulse generator) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0424U | molecular evidence, low-, moderate- or elevated-risk of prostate cancer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0425T | sensing lead only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0425U | analysis, each comparator genome (eg, parents, siblings) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0426T | stimulation lead only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0426U | sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0427T | pulse generator only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0428T | Removal of neurostimulator system for treatment of central sleep apnea; pulse generator only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0428U | mutation burden | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0429T | Removal of neurostimulator system for treatment of central sleep apnea; sensing lead only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0430T | Removal of neurostimulator system for treatment of central sleep apnea; stimulation lead only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0430U | elastase and reducing substances, feces, quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0431T | pulse generator only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0432T | only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0433T | only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0433U | including prostate-specific antigen, reported as likelihood of cancer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0434T | sleep apnea | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0434U | analysis of 25 genes with reported phenotypes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0435T | central sleep apnea; single session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0435U | cytotoxicity percentage observed, minimum of 14 drugs or drug combinations | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0436T | central sleep apnea; during sleep study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0437U | biomarkers, whole blood, algorithm reported as predictive risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0438U | including reported phenotypes and impacted gene-drug interactions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0445U | pathology | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0449T | subconjunctival space; initial device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0450T | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0472T | training, with review and report by a qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0473T | review and report by a qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0474T | internal approach, into the supraciliary space | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0481T | including image guidance, harvesting and preparation, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0483T | percutaneous approach, including transseptal puncture, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0484T | transthoracic exposure (eg, thoracotomy, transapical) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0489T | and dilution of regenerative cells | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0490T | injections in one or both hands | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0494T | cold preservation of the allograft prior to implantation, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0495T | in sterile field | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0505T | performed, with crossing of the occlusive lesion in an extraluminal fashion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0510T | Removal of sinus tarsi implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0511T | Removal and reinsertion of sinus tarsi implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0512T | dressing care; initial wound | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0515T | complete system (includes electrode and generator [transmitter and battery]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0516T | electrode only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0517T | both components of pulse generator (battery and transmitter) only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0518T | component only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0519T | transmitter) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0520T | pacing, including device interrogation and programming; battery component only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0521T | for left ventricular pacing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0522T | analysis, including review and report, wireless cardiac stimulator for left ventricular pacing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0524T | diagnostic imaging, imaging guidance and monitoring | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0525T | complete system (electrode and implantable monitor) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0526T | electrode only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0527T | implantable monitor only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0528T | iterative adjustment of programmed values, with analysis, review, and report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0529T | analysis, review, and report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0530T | interpretation; complete system (electrode and implantable monitor) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0531T | interpretation; electrode only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0532T | interpretation; implantable monitor only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0537T | for development of genetically modified autologous CAR-T cells, per day | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0538T | for transportation (eg, cryopreservation, storage) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0539T | administration | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0540T | Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0544T | reconstruction device, percutaneous approach including transseptal puncture | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0545T | reconstruction device, percutaneous approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0546T | partial mastectomy, with report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0552T | physician or other qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0563T | treatment devices and manual gland expression, bilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0564T | of cytotoxicity observed, a minimum of 14 drugs or drug combinations | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0565T | the knees; tissue harvesting and cellular implant creation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0566T | the knees; injection of cellular implant into knee joint including ultrasound guidance, unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0569T | Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0581T | when performed, unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0584T | percutaneous | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0585T | laparoscopic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0586T | including guidance, and radiological supervision and interpretation, when performed; open | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0587T | including analysis, programming, and imaging guidance when performed, posterior tibial nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0588T | including analysis, programming, and imaging guidance when performed, posterior tibial nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0596T | urethral measurement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0597T | Temporary female intraurethral valve-pump (ie, voiding prosthesis); replacement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0600T | when performed, percutaneous | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0601T | ultrasound guidance, when performed, open | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0607T | attended surveillance center; set-up and patient education on use of equipment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0608T | physician or other qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0615T | interpretation and report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0616T | intraocular lens | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0617T | performed; with removal of crystalline lens and insertion of intraocular lens | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0618T | performed; with secondary intraocular lens placement or intraocular lens exchange | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0620T | performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0627T | unilateral or bilateral injection, with fluoroscopic guidance, lumbar; first level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0629T | unilateral or bilateral injection, with CT guidance, lumbar; first level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0633T | contrast material | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0634T | contrast material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0635T | contrast, followed by contrast material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0636T | contrast material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0637T | contrast material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0638T | contrast, followed by contrast material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0646T | and selective right ventricular or right atrial angiography, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0648T | (eg, organ, gland, tissue, target structure) during the same session; single organ | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0652T | specimen(s) by brushing or washing, when performed (separate procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0653T | Esophagogastroduodenoscopy, flexible, transnasal; with biopsy, single or multiple | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0654T | catheter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0655T | guidance, with MR-fused images or other enhanced ultrasound imaging | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0656T | Anterior lumbar or thoracolumbar vertebral body tethering; up to 7 vertebral segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0657T | Anterior lumbar or thoracolumbar vertebral body tethering; 8 or more vertebral segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0658T | score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0659T | supervision and interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0664T | Donor hysterectomy (including cold preservation); open, from cadaver donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0665T | Donor hysterectomy (including cold preservation); open, from living donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0666T | Donor hysterectomy (including cold preservation); laparoscopic or robotic, from living donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0667T | from cadaver or living donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0668T | of uterine vein(s) and uterine artery(ies), as necessary | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0669T | venous anastomosis, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0670T | arterial anastomosis, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0671T | external reservoir, and without concomitant cataract removal, one or more | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0672T | the female bladder neck and proximal urethra for urinary incontinence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0673T | Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0687T | and initial session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0688T | calendar month | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0689T | organ, gland, tissue, target structure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0690T | gland, tissue, target structure) (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0692T | Therapeutic ultrafiltration | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0700T | Molecular fluorescent imaging of suspicious nevus; first lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0704T | and patient education on use of equipment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0705T | 30 days | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0706T | physician or other qualified health care professional, per calendar month | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0717T | incubation with cell dissociation enzymes, filtration, washing and concentration of ADRCs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0718T | tear; injection into supraspinatus tendon including ultrasound guidance, unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0720T | Percutaneous electrical nerve field stimulation, cranial nerves, without implantation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0736T | insertion of rectal catheter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0738T | data from previously performed magnetic resonance imaging (MRI) examination | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0739T | activation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0745T | identification of areas of avoidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0746T | treatment plan | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0747T | arrhythmia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0748T | preparation (eg, removal of setons, fistula curettage, closure of internal openings) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0766T | performed; first nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0771T | physiological status; initial 15 minutes of intraservice time, patient age 5 years or older | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0773T | initial 15 minutes of intraservice time, patient age 5 years or older | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0778T | function | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0783T | of equipment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0786T | neurostimulator, including imaging guidance, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0787T | Revision or removal of neurostimulator electrode array, sacral, with integrated neurostimulator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0790T | lumbar vertebral body tethering, including thoracoscopy, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0795T | performed; complete system (ie, right atrial and right ventricular pacemaker components) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0796T | leadless pacemaker exists to create a dual-chamber leadless pacemaker system) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0797T | pacemaker system) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0798T | pacemaker components) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0799T | femoral venography), when performed; right atrial pacemaker component | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0800T | dual-chamber leadless pacemaker system) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0801T | pacemaker components) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0802T | including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0803T | chamber leadless pacemaker system) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0804T | pacemaker system in dual cardiac chambers | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0810T | Subretinal injection of a pharmacologic agent, including vitrectomy and 1 or more retinotomies | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0813T | bariatric balloon | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0816T | subcutaneous | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0817T | subfascial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0818T | analysis, programming, and imaging, when performed, posterior tibial nerve; subcutaneous | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0819T | analysis, programming, and imaging, when performed, posterior tibial nerve; subfascial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0823T | interrogation or programming), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0824T | and/or right ventriculography, femoral venography, cavography), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0825T | evaluation (eg, interrogation or programming), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0826T | pacemaker system in single-cardiac chamber | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0861T | components (battery and transmitter) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0862T | including device interrogation and programming; battery component only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0863T | including device interrogation and programming; transmitter component only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 0864T | Low-intensity extracorporeal shock wave therapy involving corpus cavernosum, low energy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 1108G | p.G370C [c. >T], p.Y373C [c. >G], FGFR3-TACC3v1, and FGFR3-TACC3v3) utilizing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 1118A | p.G370C [c. >T], p.Y373C [c. >G], FGFR3-TACC3v1, and FGFR3-TACC3v3) utilizing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 11920 | Tattooing To Correct Color Defects; 6.0 Sq Cm/< | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 11921 | Tattooing To Correct Color Defects; 6.1-20.0 Sq Cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 11950 | Subq Injection, Filling Matl; 1 Cc/< | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 11951 | Subq Injection, Filling Matl; 1.1 To 5.0 Cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 11952 | Subq Injection, Filling Matl; 5.1 To 10.0 Cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 11954 | Subq Injection, Filling Matl; > 10.0 Cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 1298C | Analysis, Common Variants (Eg, 677T, ) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 14040 | 10 Sq Cm/< | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 14041 | Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet;10.1-30.0sqcm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 14060 | Adjacent Tissue Transfer/Rearrangement, Eyelids/Nose/Ears/Lips; Defect 10 Sq Cm/< | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 14061 | Adjacent Tissue Transfer/Rearrangement, Eyelids/Nose/Ears/Lips; Defect 10.1-30.0 Sq Cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15150 | Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15155 | feet, and/or multiple digits; first 25 sq cm or less | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15271 | cm; first 25 sq cm or less wound surface area | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15273 | children | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15275 | less wound surface area | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15277 | cm; first 100 sq cm wound surface area, or 1% of body area of infants and children | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15756 | Free muscle or myocutaneous flap with microvascular anastomosis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15771 | and/or legs; 50 cc or less injectate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15773 | ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15775 | Punch Graft, Hair Transplant; 1-15 Punch Grafts | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15776 | Punch Graft, Hair Transplant; > 15 Punch Grafts | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15777 | breast, trunk) (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15780 | Dermabrasion; Total Face | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15781 | Dermabrasion; Segmental, Face | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15782 | Dermabrasion; Regional, Other Than Face | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15783 | Dermabrasion; Superficial, Any Site | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15786 | Abrasion; Single Lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15788 | Chemical Peel, Facial; Epidermal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15789 | Chemical Peel, Facial; Dermal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15792 | Chemical Peel, Nonfacial; Epidermal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15793 | Chemical Peel, Nonfacial; Dermal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15819 | Cervicoplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15820 | Blepharoplasty, Lower Eyelid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15821 | Blepharoplasty, Lower Eyelid; W/Extensive Herniated Fat Pad | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15822 | Blepharoplasty, Upper Eyelid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15823 | Blepharoplasty, Upper Eyelid; W/Excessive Skin Weighting Down Lid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15824 | Rhytidectomy; Forehead | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15825 | Rhytidectomy; Neck W/Platysmal Tightening (Platysmal Flap, P-Flap) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15826 | Rhytidectomy; Glabellar Frown Lines | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15828 | Rhytidectomy; Cheek, Chin, & Neck | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15829 | Rhytidectomy; Superficial Musculoaponeurotic System (Smas) Flap | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15830 | infraumbilical panniculectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15832 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15833 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15834 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15835 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15836 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15837 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15838 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15839 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15840 | Graft, Facial Nerve Paralysis; Free Fascia Graft (W/Obtaining Fascia) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15841 | Graft, Facial Nerve Paralysis; Free Muscle Graft (W/Obtaining Graft) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15842 | Graft, Facial Nerve Paralysis; Free Muscle Flap, Microsurgical Technique | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15845 | Graft, Facial Nerve Paralysis; Regional Muscle Transfer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15876 | Suction Assisted Lipectomy; Head & Neck | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15877 | Suction Assisted Lipectomy; Trunk | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15878 | Suction Assisted Lipectomy; Upper Extremity | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 15879 | Suction Assisted Lipectomy; Lower Extremity | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 1635G | p.E545D [g. >T only], p.E545G, p.E545K, p.Q546E, p.Q546R, p.H1047L, p.H1047R | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 16879 | 5. Standard Requests Approved - not extended 84.8% | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 17106 | Destruction, Cutaneous Vascular Proliferative Lesions; < 10 Sq Cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 17107 | Destruction, Cutaneous Vascular Proliferative Lesions; 10.0-50.0 Sq Cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 17108 | Destruction, Cutaneous Vascular Proliferative Lesions; > 50.0 Sq Cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 17380 | Electrolysis epilation, each 30 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19105 | Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19296 | guidance; on date separate from partial mastectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19298 | subsequent to) partial mastectomy, includes imaging guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19300 | Mastectomy for gynecomastia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19303 | Mastectomy , simple, complete | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19316 | Mastopexy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19318 | Breast reduction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19325 | Breast augmentation with implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19328 | Removal of intact breast implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19330 | Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19340 | Insertion of breast implant on same day of mastectomy (ie, immediate) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19342 | Insertion or replacement of breast implant on separate day from mastectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19350 | Nipple/Areola Reconstruction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19355 | Correction, Inverted Nipples | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19357 | Tissue expander placement in breast reconstruction, including subsequent expansion(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19361 | Breast reconstruction; with latissimus dorsi flap | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19364 | Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19366 | Breast reconstruction with other technique | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19367 | (TRAM) flap | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19368 | (TRAM) flap, requiring separate microvascular anastomosis (supercharging) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19369 | flap | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19380 | tissue excision in implant-based reconstruction) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19396 | Preparation, Moulage, Custom Breast Implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 19910 | B. Total Standard Requests - not extended 100% | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20555 | radioelement application (at the time of or subsequent to the procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20560 | Needle insertion(s) without injection(s); 1 or 2 muscle(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20561 | Needle insertion(s) without injection(s); 3 or more muscles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20605 | Arthrocentesis, Aspiration &/Or Injection; Intermediate Joint/Bursa | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20606 | ultrasound guidance, with permanent recording and reporting | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20930 | separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20931 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20932 | code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20933 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20934 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20936 | or laminar fragments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20937 | skin or fascial incision) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20938 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20939 | incision (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20974 | Electrical Stimulation To Aid Bone Healing; Noninvasive (Nonoperative) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20979 | Low Intensity Ultrasound Stimulation To Aid Bone Healing; Noninvasive | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20982 | Guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 20983 | imaging guidance when performed; cryoablation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21010 | Arthrotomy, Temporomandibular Joint | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21050 | Condylectomy, Temporomandibular Joint (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21060 | Meniscectomy, Partial/Complete, Temporomandibular Joint (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21073 | (ie, general or monitored anesthesia care) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21083 | Impression & Custom Preparation; Palatal Lift Prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21086 | Impression & Custom Preparation; Auricular Prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21087 | Impression & Custom Preparation; Nasal Prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21110 | Application, Interdental Fixation Device, Non-Fx/Dislocation, W/Removal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21116 | Injection Proc, Temporomandibular Joint Arthrography | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21120 | Genioplasty; Augmentation (Autograft, Allograft, Prosthetic Matl) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21121 | Genioplasty; Sliding Osteotomy, Single Piece | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21122 | reversal for asymmetrical chin) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21123 | Genioplasty; Sliding, Augmentation W/Interpositional Bone Grafts W/Obtaining Autograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21125 | Augmentation, Mandibular Body/Angle; Prosthetic Matl | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21127 | Autograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21137 | Reduction Forehead; Contouring Only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21138 | Reduction Forehead; Contouring/Prosthesis/Bone Graft W/Obtaining Autograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21139 | Reduction Forehead; Contouring & Setback, Anterior Frontal Sinus Wall | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21141 | Reconstruction Midface, Lefort I; 1 Piece, W/O Bone Graft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21142 | graft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21143 | without bone graft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21145 | Reconstruction Midface, Lefort I; 1 Piece, W/Bone Grafts | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21146 | bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21147 | multiple osteotomies) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21150 | Reconstruction Midface, Lefort Ii; Anterior Intrusion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21151 | Reconstruction Midface, Lefort Ii; W/Bone Grafts | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21154 | Reconstruction Midface, Lefort Iii, W/Bone Grafts; W/O Lefort I | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21155 | Reconstruction Midface, Lefort Iii, W/Bone Grafts; W/Lefort I | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21159 | Reconstruction Midface, Lefort Iii, (Extra/Intracranial), W/Bone Grafts, W/O Lefort I | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21160 | Reconstruction Midface, Lefort Iii, (Extra/Intracranial), W/Bone Grafts, W/Lefort I | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21172 | Reconstruction Superior-Lateral Orbital Rim & Lower Forehead | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21175 | Reconstruction, Bifrontal,Superior-Lateral Orbital Rims & Lower Forehead | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21179 | Reconstruction, Majority, Forehead & Supraorbital Rims; W/Grafts (Allograft/Prosthetic) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21180 | Reconstruction, Majority, Forehead & Supraorbital Rims; W/Autograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21182 | Sq Cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21183 | Sq Cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21184 | Sq Cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21188 | Reconstruction, Midface, Osteotomies (Non-Lefort Type), W/Grafts, W/Obtaining Autografts | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21193 | Reconstruction, Mandibular Rami, Horizontal, Vertical, "C"/"L" Osteotomy; W/O Bone Graft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21194 | Reconstruction, Mandibular Rami, Horizontal, Vertical, "C"/"L" Osteotomy; W/Bone Graft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21195 | Reconstruction, Mandibular Rami &/Or Body, Sagittal Split; W/O Int Rigid Fixation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21196 | Reconstruction, Mandibular Rami &/Or Body, Sagittal Split; W/Int Rigid Fixation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21198 | Osteotomy, Mandible, Segmental | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21199 | Osteotomy, Mandible, Segmental; W/Genioglossus Advancement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21206 | Osteotomy, Maxilla, Segmental | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21208 | Osteoplasty, Facial Bones; Augmentation (Autograft, Allograft/Prosthetic Implant) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21209 | Osteoplasty, Facial Bones; Reduction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21210 | Graft, Bone; Nasal, Maxillary/Malar Areas (Includes Obtaining Graft) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21215 | Graft, Bone; Mandible (Includes Obtaining Graft) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21230 | Graft; Rib Cartilage, Autogenous, Face/Chin/Nose/Ear (Includes Obtaining Graft) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21235 | Graft; Ear Cartilage, Autogenous, Nose/Ear (Includes Obtaining Graft) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21240 | Arthroplasty, Temporomandibular Joint, W/Wo Autograft (Includes Obtaining Graft) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21242 | Arthroplasty, Temporomandibular Joint, W/Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21243 | Arthroplasty, Temporomandibular Joint, W/Prosthetic Joint Replacement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21244 | Reconstruction, Mandible, Extraoral, W/Transosteal Bone Plate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21245 | Reconstruction, Mandible/Maxilla, Subperiosteal Implant; Partial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21246 | Reconstruction, Mandible/Maxilla, Subperiosteal Implant; Complete | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21247 | Reconstruction, Mandibular Condyle W/Bone & Cartilage Autografts | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21255 | Autografts) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21256 | Reconstruction, Orbit W/Osteotomies & Bone Grafts (Includes Obtaining Autografts) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21270 | Malar Augmentation, Prosthetic Matl | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21275 | Secondary Revision, Orbitocraniofacial Reconstruction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21685 | Hyoid Myotomy and Suspension | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21740 | Reconstructive Repair, Pectus Excavatum/Carinatum; Open | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21742 | Thoracoscopy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21743 | W/Thoracoscopy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21811 | when performed, unilateral; 1-3 ribs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21812 | when performed, unilateral; 4-6 ribs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 21813 | when performed, unilateral; 7 or more ribs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 2211T | >C], HTR2C rs3813929 [c.-759C>T] and rs1414334 [c.551- >G]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22206 | pedicle/vertebral body subtraction); thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22207 | pedicle/vertebral body subtraction); lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22208 | addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22210 | Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22212 | Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22214 | Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22216 | Osteotomy, Spine, Posterior/Posterolateral Approach, 1 Vertebral Segment; Add'l Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22220 | cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22222 | thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22224 | lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22226 | additional vertebral segment (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22505 | Manipulation, Spine, Requiring Anesthesia, Any Region | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22510 | unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22511 | unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22512 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22513 | unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22514 | unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22515 | biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22526 | fluoroscopic guidance; single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22527 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22532 | interspace (other than for decompression); thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22533 | interspace (other than for decompression); lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22534 | interspace (other than for decompression); thoracic or lumbar, each additional vertebral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22548 | excision of odontoid process | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22551 | osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22552 | each additional interspace (List separately in addition to code for separate procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22554 | (other than for decompression); cervical below C2 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22556 | (other than for decompression); thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22558 | (other than for decompression); lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22585 | for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22586 | S1 interspace | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22590 | Arthrodesis, posterior technique, craniocervical (occiput-C2) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22595 | Arthrodesis, posterior technique, atlas-axis (C1-C2) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22600 | segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22610 | transverse technique, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22612 | transverse technique, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22614 | interspace (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22630 | prepare interspace (other than for decompression), single interspace; lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22632 | interspace (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22633 | than for decompression), single interspace, lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22634 | separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22800 | Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22802 | Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22804 | segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22808 | Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22810 | Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22812 | Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22818 | Kyphectomy, Exposure Of Spine & Resection Vertebral Segments; 1-2 Segs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22819 | Kyphectomy, Exposure Of Spine & Resection Vertebral Segments; 3 / More | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22830 | Exploration of Spinal Fusion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22836 | vertebral segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22837 | vertebral segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22838 | body tethering, including thoracoscopy, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22840 | screw fixation) (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22841 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22842 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22843 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22844 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22845 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22846 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22847 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22848 | than sacrum (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22849 | Reinsertion, Spinal Fixation Device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22852 | Removal, Posterior Segmental Instrumentation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22853 | addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22854 | code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22856 | microdissection); single interspace, cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22857 | interspace (other than for decompression); single interspace, lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22858 | preparation (includes osteophytectomy for nerve root or spinal cord decompres | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22859 | arthro | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22860 | addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22861 | single interspace; cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22862 | single interspace; lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22864 | cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22865 | Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22867 | including image guidance when performed, with open decompression, lumbar; single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22868 | (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22869 | decompression or fusion, including image guidance when performed, lumbar; single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 22870 | (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23105 | Arthrotomy; Glenohumeral Joint, W/Synovectomy, W/Wo Bx | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23107 | Arthrotomy, Glenohumeral Joint, W/Exploration, W/Wo Loose/Fb Removal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23120 | Claviculectomy; Partial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23130 | Acromioplasty/Acromionectomy, Partial, W/Wo Coracoacromial Ligament Release | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23410 | Repair, Ruptured Musculotendinous Cuff, Open; Acute | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23412 | Repair, Ruptured Musculotendinous Cuff; Chronic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23415 | Coracoacromial Ligament Release, W/Wo Acromioplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23420 | Reconstruction, Complete Shoulder (Rotator) Cuff Avulsion, Chronic (Includes Acromioplasty) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23430 | Tenodesis, Long Tendon, Biceps | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23440 | Resection/Transplantation, Long Tendon, Biceps | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23450 | Capsulorrhaphy, Anterior; Putti-Platt Proc/Magnuson Type Operation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23455 | Capsulorrhaphy, Anterior; W/Labral Repair | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23460 | Capsulorrhaphy, Anterior, Any Type; W/Bone Block | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23462 | Capsulorrhaphy, Anterior, Any Type; W/Coracoid Process Transfer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23465 | Capsulorrhaphy, Glenohumeral Joint, Posterior, W/Wo Bone Block | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23466 | Capsulorrhaphy, Glenohumeral Joint, Any Type Multi-Directional Instability | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23470 | Arthroplasty, Glenohumeral Joint; Hemiarthroplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23472 | Arthroplasty, Glenohumeral Joint; Total Shoulder | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23473 | component | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23474 | glenoid component | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 23700 | Dislocation) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 24300 | Manipulation, Elbow, Under Anesthesia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 25259 | Manipulation, Wrist, Under Anesthesia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 25312 | Concurrent) (Total of A, B, C, D & F) N/A | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 26340 | Manipulation, Finger Joint, Under Anesthesia, Each Joint | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27096 | or CT) including arthrography when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27120 | Acetabuloplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27122 | Acetabuloplasty; Resection, Femoral Head | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27125 | Hemiarthroplasty, Hip, Partial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27130 | Arthroplasty, Acetabular/Proximal Femoral Prosthetic Replacement, W/Wo Autograft/Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27132 | Conversion, Previous Hip Surgery To Total Hip Arthroplasty, W/Wo Autograft/Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27134 | Revision, Total Hip Arthroplasty; Both Components, W/Wo Autograft/Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27137 | Revision, Total Hip Arthroplasty; Acetabular Component Only, W/Wo Autograft/Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27138 | Revision, Total Hip Arthroplasty; Femoral Component Only, W/Wo Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27275 | Manipulation, Hip Joint, Requiring General Anesthesia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27279 | transfixation device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27331 | Arthrotomy, Knee; W/Joint Exploration, Bx/Removal, Loose/Fb | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27332 | Arthrotomy, W/Excision, Semilunar Cartilage (Meniscectomy) Knee; Medial/Lateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27333 | Arthrotomy, W/Excision, Semilunar Cartilage (Meniscectomy) Knee; Medial & Lateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27334 | Arthrotomy, W/Synovectomy Knee; Anterior/Posterior | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27335 | Arthrotomy, W/Synovectomy Knee; Anterior & Posterior W/Popliteal Area | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27345 | Excision, Synovial Cyst, Popliteal Space | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27403 | Arthrotomy W/Meniscus Repair, Knee | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27405 | Repair, Primary, Torn Ligament &/Or Capsule, Knee; Collateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27407 | Repair, Primary, Torn Ligament &/Or Capsule, Knee; Cruciate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27409 | Repair, Primary, Torn Ligament &/Or Capsule, Knee; Collateral & Cruciate Ligaments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27412 | Autologous Chondrocyte Implantation, Knee | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27415 | Rep Ligaments Knee+pes Anserin Tran | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27416 | Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27425 | Lateral Retinacular Release Open | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27427 | Ligamentous Reconstruction (Augmentation), Knee; Extra-Articular | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27428 | Ligamentous Reconstruction (Augmentation), Knee; Intra-Articular, (Open) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27429 | Ligamentous Reconstruction (Augmentation), Knee; Intra-Articular, (Open) & Extra-Articular | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27437 | Arthroplasty, Patella; W/O Prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27438 | Arthroplasty, Patella; W/Prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27440 | Arthroplasty, Knee, Tibial Plateau | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27441 | Arthroplasty, Knee, Tibial Plateau; W/Debridement & Partial Synovectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27442 | Arthroplasty, Femoral Condyles/Tibial Plateau(S), Knee | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27443 | Synovectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27445 | Arthroplasty, Knee, Hinge Prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27446 | Arthroplasty, Knee, Condyle & Plateau; Medial/Lateral Compartment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27447 | Resurfacing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27486 | Revision, Total Knee Arthroplasty, W/Wo Allograft; 1 Component | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27487 | Revision, Total Knee Arthroplasty; Femoral & Entire Tibial Component | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27488 | Removal, Knee Prosthesis, Methylmethacrylate W/Wo Spacer Insertion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27570 | Manipulation, Knee Joint Under General Anesthesia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27702 | Arthroplasty, Ankle; W/Implant (Total Ankle) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27703 | Arthroplasty, Ankle; Revision, Total Ankle | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27704 | Removal, Ankle Implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27860 | Manipulation, Ankle Under General Anesthesia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 27870 | Arthrodesis, Ankle, Open | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28110 | Ostectomy, Partial Excision, 5th Metatarsal Head (Bunionette) (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28285 | Correction, Hammertoe | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28286 | Correction, Cock-Up Fifth Toe, W/Plastic Skin Closure | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28289 | metatarsophalangeal joint; without implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28291 | metatarsophalangeal joint with implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28292 | resection of proximal phalanx base, when performed, any method | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28295 | proximal metatarsal osteotomy, any method | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28296 | distal metatarsal osteotomy, any method | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28297 | metatarsal and medial cuneiform joint arthrodesis, any method | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28298 | proximal phalanx osteotomy, any method | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28299 | double osteotomy, any method | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28306 | Osteotomy, Metatarsal, W/Wo Lengthening/Shortening/Ang Correction; 1st Metatarsal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28307 | W/Autograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28308 | Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28310 | Osteotomy, Shortening, Angular/Rotational Correction; Proximal Phalanx, 1st Toe (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28312 | Osteotomy, Shortening, Angular/Rotational Correction; Other Phalanges, Any Toe | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28315 | Sesamoidectomy, 1st Toe (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28446 | Open osteochondral autograft, talus (includes obtaining grafts) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28750 | Arthrodesis, Great Toe; Metatarsophalangeal Joint | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 28890 | involving the plantar fascia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29800 | Arthroscopy, Temporomandibular Joint, Dx W/Wo Synovial Bx (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29804 | Arthroscopy, Temporomandibular Joint, Surgical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29805 | Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29806 | Arthroscopy, shoulder, surgical; capsulorrhaphy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29807 | Arthroscopy, shoulder, surgical; repair of SLAP lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29819 | Arthroscopy, shoulder, surgical; with removal of loose body or foreign body | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29820 | Arthroscopy, shoulder, surgical; synovectomy, partial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29821 | Arthroscopy, shoulder, surgical; synovectomy, complete | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29822 | of the rotator cuff, subacromial bursa, foreign body[ies]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29823 | bursal side of the rotator cuff, subacromial bursa, foreign body[ies]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29824 | (Mumford procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29825 | manipulation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29826 | separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29828 | Arthroscopy, shoulder, surgical; biceps tenodesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29860 | Arthroscopy, Hip, Dx W/Wo Synovial Bx (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29861 | Arthroscopy, Hip, Surgical; W/Removal, Loose/Foreign Body | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29862 | Arthroscopy, Hip, Surgical; W/Chondroplasty/Arthroplasty, &/Or Resection, Labrum | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29863 | Arthroscopy, Hip, Surgical; W/Synovectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29866 | harvesting of the autograft[s]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29867 | Arthroscopy, Knee, Surgical; Osteochondral Allograft (Eg, Mosaicplasty) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29868 | Insertion), Medial Or Lateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29870 | Arthroscopy, Knee, Dx, W/Wo Synovial Bx (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29871 | Arthroscopy, Knee, Surgical; Infection, Lavage & Drainage | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29873 | Arthroscopy, Knee, Surgical; W/Lateral Release | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29874 | Arthroscopy, Knee, Surgical; Removal, Loose/Fb | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29875 | Arthroscopy, Knee, Surgical; Synovectomy, Limited (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29876 | lateral) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29877 | Arthroscopy, Knee, Surgical; Debridement/Shaving, Articular Cartilage (Chondroplasty) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29879 | Drilling/Microfx | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29880 | separate compartment(s), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29881 | separate compartment(s), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29882 | Arthroscopy, Knee, Surgical; W/Meniscus Repair, Medial/Lateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29883 | Arthroscopy, Knee, Surgical; W/Meniscus Repair, Medial & Lateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29884 | Arthroscopy, Knee, Surgical; W/Lysis, Adhesions, W/Wo Manipulation (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29885 | Fixation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29886 | Arthroscopy, Knee, Surgical; Drilling, Intact Osteochondritis Dissecans Lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29887 | Arthroscopy, Knee, Surgical; Drilling, Intact Osteochondritis Dissecans Lesion W/Int Fixation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29888 | Arthroscopically Aided Anterior Cruciate Ligament Repair/Augmentation/Reconstruction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29889 | Arthroscopically Aided Posterior Cruciate Ligament Repair/Augmentation/Reconstruction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29892 | Arthroscopically Aided Repair, Osteochondritis/Talar Dome Fx/Tibial Plafond Fx | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29914 | Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29915 | Arthroscopy, subtalar joint, surgical; with acetabuloplasty (ie, treatment of pincer lesion) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 29916 | Arthroscopy, hip, surgical; with labral repair | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 3008C | >C], HTR2C rs3813929 [c.-759C>T] and rs1414334 [c.551- >G]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 30117 | Excision/Destruction, Intranasal Lesion; Int Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 30120 | Excision/Surgical Planing, Skin, Nose, Rhinophyma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 30400 | Rhinoplasty, Primary; Lateral & Alar Cartilages &/Or Elevation, Nasal Tip | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 30410 | Nasal Tip | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 30420 | Rhinoplasty, Primary; W/Major Septal Repair | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 30430 | Rhinoplasty, Secondary; Minor Revision (Small Amount, Nasal Tip Work) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 30435 | Rhinoplasty, Secondary; Intermediate Revision (Bony Work W/Osteotomies) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 30450 | Rhinoplasty, Secondary; Major Revision (Nasal Tip Work & Osteotomies) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 30468 | Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 30469 | subcutaneous/submucosal remodeling | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 31242 | nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 31243 | Nasal/sinus endoscopy, surgical; with destruction by cryoablation, posterior nasal nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 31525 | LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 31574 | unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 31643 | placement of catheter(s) for intracavitary radioelement application | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 31660 | bronchial thermoplasty, 1 lobe | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 31661 | bronchial thermoplasty, 2 or more lobes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 32701 | particle beam), entire course of treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 32850 | Donor pneumonectomy(s) (including cold preservation), from cadaver donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 32851 | Lung Transplant, Single; W/O Cardiopulmonary Bypass | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 32852 | Lung Transplant, Single; W/Cardiopulmonary Bypass | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 32853 | Lung Transplant, Double (Bilat Sequential/En Bloc); W/O Cardiopulmonary Bypass | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 32854 | Lung Transplant, Double (Bilat Sequential/En Bloc); W/Cardiopulmonary Bypass | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 32855 | Backbench Standard Preparation Of Cadaver Donor Lung Allograft; Unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 32856 | Backbench Standard Preparation Of Cadaver Donor Lung Allograft; Bilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 32994 | when performed, unilateral; cryoablation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 32998 | when performed, unilateral; radiofrequency | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33140 | Transmyocardial Laser Revascularization, By Thoracotomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33202 | subxiphoid approach) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33203 | endoscopic approach (eg, thoracoscopy, pericardioscopy) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33206 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33207 | ventricular | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33208 | and ventricular | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33212 | Insertion of pacemaker pulse generator only; with existing single lead | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33213 | Insertion of pacemaker pulse generator only; with existing dual leads | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33214 | Repositioning, Previously Implanted Transvenous Electrode/Pacing Cardiovert-Defib Electrode | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33215 | Defibrillator Electrode | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33216 | Insertion of a single transvenous electrode, permanent pacemaker or cardioverter-defibrillator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33217 | Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter-defibrillator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33218 | defibrillator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33220 | defibrillator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33222 | Relocation of skin pocket for pacemaker | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33224 | (including revision of pocket, removal, insertion, and/or replacement of existing generator) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33225 | chamber system) (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33226 | (including removal, insertion and/or replacement of existing generator) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33227 | Generator; Single Lead System | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33228 | Generator; Dual Lead System | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33229 | Generator; Multiple Lead System | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33230 | Insertion Of Pacing Cardioverter-Defibrillator Pulse Generator Only; With Existing Dual Leads | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33231 | Leads | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33233 | Removal of permanent pacemaker pulse generator only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33234 | Removal, Transvenous Pacemaker Electrode(S); Single Lead System, Atrial/Ventricular | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33235 | Removal, Transvenous Pacemaker Electrode(S); Dual Lead System | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33240 | Insertion of pacing cardioverter-defibrillator pulse generator only; with existing single lead | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33249 | transvenous lead(s), single or dual chamber | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33263 | Cardioverter-Defibrillator Pulse Generator; Dual Lead System | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33264 | Cardioverter-Defibrillator Pulse Generator; Multiple Lead System | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33267 | oversewing, ligation, plication, clip) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33269 | stapling, oversewing, ligation, plication, clip) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33270 | sensing or therapeutic parameters, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33271 | Insertion of subcutaneous implantable defibrillator electrode | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33274 | venography) and device evaluation (eg, interrogation or programming), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33275 | performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33276 | diagnostic mode activation, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33277 | code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33278 | lead(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33279 | lead(s) only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33280 | and interrogation and programming, when performed; pulse generator only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33281 | Repositioning of phrenic nerve stimulator transvenous lead(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33285 | Insertion, subcutaneous cardiac rhythm monitor, including programming | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33287 | imaging guidance, and interrogation and programming, when performed; pulse generator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33288 | stimulation or sensing lead(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33289 | interpretation, and pulmonary artery angiography, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33340 | interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33361 | femoral artery approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33362 | approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33363 | approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33364 | approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33365 | approach (eg, median sternotomy, mediastinotomy) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33366 | (eg, left thoracotomy) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33418 | when performed; initial prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33477 | of the valve delivery site, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33548 | ventricular remodeling, SVR, SAVER, Dor procedures) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33927 | Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33928 | Removal and replacement of total replacement heart system (artificial heart) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33930 | Donor Cardiectomy-Pneumonectomy, W/Preparation & Maintenance, Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33933 | Backbench Standard Preparation Of Cadaver Donor Heart/Lung Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33935 | Heart-Lung Transplant W/Recipient Cardiectomy-Pneumonectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33940 | Donor Cardiectomy, W/Preparation & Maintenance, Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33944 | Backbench Standard Preparation Of Cadaver Donor Heart Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33945 | Heart Transplant, W/Wo Recipient Cardiectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33975 | Insertion, Ventricular Assist Device; Extracorporeal, Single Ventricle | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33976 | Insertion, Ventricular Assist Device; Extracorporeal, Biventricular | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33979 | Insertion, Ventricular Assist Device, Implantable Intracorporeal, Single Ventricle | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33981 | single or each pump | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33982 | without cardiopulmonary bypass | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33983 | with cardiopulmonary bypass | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33990 | interpretation; left heart, arterial access only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33991 | interpretation; left heart, both arterial and venous access, with transseptal puncture | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33993 | guidance at separate and distinct session from insertion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 33995 | interpretation; right heart, venous access only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36465 | incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36466 | incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36468 | Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36470 | Injection of sclerosant; single incompetent vein (other than telangiectasia) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36471 | Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36473 | and monitoring, percutaneous, mechanochemical; first vein treated | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36475 | First Vein Treated | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36478 | Treated | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36482 | guidance and monitoring, percutaneous; first vein treated | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36511 | Therapeutic Apheresis; White Blood Cells | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36512 | Therapeutic Apheresis; Red Blood Cells | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36513 | Therapeutic Apheresis; Platelets | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36514 | Therapeutic Apheresis; Plasma Pheresis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 36516 | selective filtration and plasma reinfusion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37220 | with transluminal angioplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37221 | performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37222 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37223 | vessel, when performed (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37224 | unilateral; with transluminal angioplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37225 | unilateral; with atherectomy, includes angioplasty within the same vessel, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37226 | when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37227 | the same vessel, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37228 | initial vessel; with transluminal angioplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37229 | initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37230 | vessel, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37231 | within the same vessel, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37232 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37233 | performed (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37234 | same vessel, when performed (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37235 | each additional vessel; with transluminal stent placement(s) and atherectomy, includes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37241 | capillary hemangiomas, varices, varicoceles) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37242 | arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 37243 | for tumors, organ ischemia, or infarction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38204 | Management, Recipient Hematopoietic Progenitor Cell Donor Search & Cell Acquisition | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38205 | Allogenic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38206 | Autologous | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38207 | Transplant Preparation, Hematopoietic Progenitor Cells; Cryopreservation & Storage | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38208 | without washing, per donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38209 | with washing, per donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38210 | Deplete | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38211 | Transplant Preparation, Hematopoietic Progenitor Cells; Tumor Cell Deplete | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38212 | Transplant Preparation, Hematopoietic Progenitor Cells; Red Blood Cell Removal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38213 | Transplant Preparation, Hematopoietic Progenitor Cells; Platelet Depletion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38214 | Transplant Preparation, Hematopoietic Progenitor Cells; Plasma (Volume) Depletion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38215 | Transplant Prep, Hematoiepotic Progenitor Cells; Cell Conc, Plasma/Mononuclear/Buffy Coat | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38230 | Bone marrow harvesting for transplantation; allogeneic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38232 | Bone Marrow Harvesting For Transplantation; Autologous | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38240 | Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38241 | Hematopoietic progenitor cell (HPC); autologous transplantation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38242 | Allogeneic lymphocyte infusions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 38243 | Hematopoietic progenitor cell (HPC); HPC boost | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 41019 | (percutaneous, transoral, or transn | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 41512 | Tongue base suspension, permanent suture technique | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 41530 | Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 42145 | Palatopharyngoplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43192 | Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43201 | Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43210 | or complete, includes duodenoscopy when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43229 | (includes pre- and post-dilation and guide wire passage, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43233 | mm diameter or larger) (includes fluoroscopic guidance, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43235 | specimen(s) by brushing or washing, when performed (separate procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43236 | substance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43241 | catheter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43243 | esophageal/gastric varices | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43244 | varices | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43245 | stricture(s) (eg, balloon, bougie) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43246 | gastrostomy tube | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43247 | Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43248 | passage of dilator(s) through esophagus over guide wire | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43249 | esophagus (less than 30 mm diameter) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43250 | lesion(s) by hot biopsy forceps or bipolar cautery | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43251 | lesion(s) by snare technique | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43254 | Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43255 | Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43257 | reflux disease | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43266 | (includes pre- and post-dilation and guide wire passage, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43270 | lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43280 | Laparoscopy, Surgical, Esophagogastric Fundoplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43281 | performed; without implantation of me | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43282 | performed; with implantation of mesh | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43284 | augmentation device (i.e., magnetic band), including cruroplasty when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43285 | Removal of esophageal sphincter augmentation device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43290 | balloon | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43291 | balloon(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43497 | Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy [POEM]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43631 | Gastrectomy, Partial, Distal; W/Gastroduodenostomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43632 | Gastrectomy, Partial, Distal; W/Gastrojejunostomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43633 | Gastrectomy, Partial, Distal; W/Roux-En-Y Reconstruction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43644 | Gastroenterostomy (Roux Limb <= 150 Cm) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43645 | reconstruction to limit absorption | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43770 | device (eg, gastric band and subcutaneous port components) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43771 | device component only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43772 | device component only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43773 | gastric restrictive device component only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43774 | device and subcutaneous port components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43775 | gastrectomy) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43842 | Gastric Restrictive Proc, W/O Gastric Bypass, Morbid Obesity; Vertical-Banded Gastroplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43843 | Gastroplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43845 | Gastric Stapling Morbid Obesity | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43846 | Gastroenterostmy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43847 | Gastric Restrictive Proc, W/Gastric Bypass, Morbid Obesity; W/Small Bowel Reconstruction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43848 | gastric restrictive device (separate procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43886 | Gastric restrictive procedure, open; revision of subcutaneous port component only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43887 | Gastric restrictive procedure, open; removal of subcutaneous port component only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43888 | component only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 43999 | Unlisted Proc, Stomach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 44132 | Donor Enterectomy, Open, W/Prep & Maintenance, Allograft; Cadaver Donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 44133 | Donor Enterectomy, Open With Prep & Maintenance, Allograft; Partial, Living Donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 44135 | Intestinal Allotransplantation; From Cadaver Donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 44136 | Intestinal Allotransplantation; From Living Donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 44715 | Backbench Standard Preparation Of Cadaver Or Living Donor Intestine Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 44720 | Anastomosis, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 44721 | Anastomosis, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 45560 | Repair, Rectocele (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 46505 | Chemodenervation of internal anal sphincter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 46601 | brushing or washing, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 46607 | and chemical agent enhancement, with biopsy, single or multiple | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 46707 | Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [SIS]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 46948 | hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 47133 | Donor Hepatectomy, W/Preparation & Maintenance, Allograft; Cadaver Donor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 47135 | Liver Allotransplantation; Orthotopic, Partial/Whole, Cadaver/Living Donor, Any Age | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 47140 | Segment Only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 47141 | Lobectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 47142 | Lobectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 47143 | Lobe Split | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 47144 | segment [segments II and III] and right trisegment [segments I and IV through VIII]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 47145 | II, III, and IV] and right lobe [segments I and V through VIII]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 47146 | Venous Anastomosis, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 47147 | Arterial Anastomosis, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 48160 | Pancreatectomy, Total/Subtotal W/Autologous Transplantation Pancreas/Pancreatic Islets | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 48550 | Donor Pancreatectomy, W/Prep & Maintenance, Cadaver Donor, W/Wo Duodenal Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 48551 | Backbench Standard Preparation Of Cadaver Donor Pancreas Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 48552 | Venous Anastomosis, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 48554 | Transplantation, Pancreatic Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 48556 | Removal, Transplanted Pancreatic Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 49906 | Free Omental Flap W/Microvascular Anastomosis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50250 | ultrasound guidance and monitoring, if performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50300 | Donor Nephrectomy; Cadaver Donor, Unilat/Bilat W/Prep & Maintenance, Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50320 | Donor Nephrectomy, Open, Living Donor W/O Allograft Preparation & Maintenance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50323 | Backbench Standard Preparation Of Cadaver Donor Renal Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50325 | Backbench Standard Preparation Of Living Donor Renal Allograft (Open Or Laparoscopic) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50327 | Transplantation; Venous Anastomosis, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50328 | Transplantation; Arterial Anastomosis, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50329 | Transplantation; Ureteral Anastomosis, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50340 | Recipient Nephrectomy (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50360 | Renal Allotransplantation, Implantation, Graft; W/O Donor & Recipient Nephrectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50365 | Renal Allotransplantation, Implantation, Graft; W/Recipient Nephrectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50370 | Removal, Transplanted Renal Allograft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50542 | guidance and monitoring, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50547 | Laparoscopy, Surgical; Donor Nephrectomy, Living Donor W/O Allograft Prep & Maintenance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50592 | Ablation, 1 or more renal tumor(s), percutaneous, unilateral, radiofrequency | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 50593 | Ablation, renal tumor(s), unilateral, presutaneous cryotherapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 51715 | Endoscopic Injection, Implant Matl Into Submucosal Tissues, Urethra &/Or Bladder Neck | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53445 | Cuff | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53446 | Removal, Inflatable Urethral/Bladder Neck Sphincter W/Pump/Reservoir/Cuff | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53447 | Removal & Replacement, Inflatable Sphincter W/Pump, Reservoir, Cuff, Same Session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53448 | Remov & Replace Inflatable Sphincter W/Pump/Reservoir/Cuff, Infected, W/Irrig & Debride | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53449 | Repair, Inflatable Urethral/Bladder Neck Sphincter Device, Incl Pump/Reservoir/Cuff | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53451 | cystourethroscopy and imaging guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53452 | cystourethroscopy and imaging guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53453 | Periurethral transperineal adjustable balloon continence device; removal, each balloon | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53454 | balloon(s) fluid volume | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53850 | Transurethral Destruction, Prostate Tissue; Microwave Thermotherapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53852 | Transurethral Destruction, Prostate Tissue; Radiofrequency Thermotherapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 53860 | urethra for stress urinary incontinence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 54125 | Amputation, Penis; Complete | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 54360 | Plastic Operation, Penis To Correct Angulation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 54400 | Insertion, Penile Prosthesis; Non-Inflatable (Semi-Rigid) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 54401 | Insertion, Penile Prosthesis; Inflatable (Self-Contained) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 54405 | Insertion, (Multi-Component) Inflatable Penile Prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 54440 | Plastic Operation, Penis, Injury | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 54520 | Orchiectomy, Simple, W/Wo Prosthesis, Scrotal/Inguinal Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 54660 | Insertion, Testicular Prosthesis (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 54690 | Laparoscopy, Surgical; Orchiectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 55180 | Scrotoplasty; Complicated | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 55706 | including imaging guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 55860 | Exposure, Prostate, Any Approach, Radiation Insertion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 55862 | Lymphadenect) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 55865 | Exposure, Prostate, Any Approach, Radiation Insertion; W/Bilat Pelvic Lymphadenectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 55873 | Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 55874 | injection(s), including image guidance, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 55875 | application, with or without cystoscopy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 55920 | subsequent interstitial radioelement application | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 56625 | Vulvectomy Simple; Complete | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 56800 | Plastic Repair, Introitus | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 56805 | Clitoroplasty, Intersex State | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 56810 | Perineoplasty, Repair, Perineum, Nonobstetrical (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57110 | Vaginectomy, Complete Removal, Vaginal Wall | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57155 | Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57156 | Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57240 | cystourethroscopy, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57250 | Posterior Colporrhaphy, Repair, Rectocele W/Wo Perineorrhaphy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57260 | Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57265 | enterocele repair | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57268 | Repair, Enterocele, Vaginal Approach (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57270 | Repair, Enterocele, Abdominal Approach (Sep Proc) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57280 | Colpopexy, Abdominal Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57282 | Sacrospinous Ligament Fixation, Prolapse, Vagina | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57283 | Colpopexy, Vaginal; Intra-Peritoneal Approach (Uterosacral, Levator Myorrhaphy) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57284 | approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57285 | Paravaginal defect repair (including repair of cystocele, if performed) ;vaginal approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57291 | Construction, Artificial Vagina; W/O Graft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57292 | Construction, Artificial Vagina; W/Graft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57295 | Revision (including removal) of prosthetic vaginal graft, vaginal approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57296 | Revision (including removal) of prosthetic vaginal graft; open abdominal approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57335 | Vaginoplasty, Intersex State | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57423 | Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 57425 | Laparoscopy, Surgical, Colpopexy (Suspension of Vaginal Apex) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58150 | Total Abdominal Hysterectomy W/Wo Removal Tube(S)/Ovary(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58293 | Marchetti-Krantz type, Pereyra type) with or without endoscopic control | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58346 | Insertion, Heyman Capsules, Clinical Brachytherapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58552 | Ovary(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58554 | Ovary(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58570 | Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58571 | and/or ovary (s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58572 | Laparoscopy; surgical, with total hysterectomy, for uterus greater than 250 g | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58573 | tube(s) and/or ovary (s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58580 | monitoring, radiofrequency | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 58674 | guidance and monitoring, radiofrequency | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 59076 | Fetal Shunt Placement, Including Ultrasound Guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61736 | magnetic resonance imaging guidance, when performed; single trajectory for 1 simple lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61737 | complex lesion(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61790 | Creation, Lesion, Stereotactic, Percutaneous, Neurolytic Agent; Gasserian Ganglion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61791 | Creation, Lesion, Stereotactic, Percutaneous, Neurolytic Agent; Trigeminal Medullary Tract | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61796 | lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61798 | lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61850 | Twist Drill/Burr Hole(S), Implantation, Neurostimulator Electrodes, Cortical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61860 | Craniectomy/Craniotomy, Implantation, Neurostimulator Electrodes, Cerebral, Cortical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61863 | Microelectrode Recording; First Array | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61867 | Microelectrode Recording; First Array | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61885 | Electrod Array | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61886 | Electrode Arrays | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61889 | connection to depth and/or cortical strip electrode array(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 61891 | with connection to depth and/or cortical strip electrode array(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62263 | Days/> | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62264 | Day | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62281 | Cervical/Thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62282 | Injection/Infusion Neurolytic Substance; Epidural, Lumbar/Caudal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62287 | treated level(s), when performed, single or multiple levels, lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62290 | Injection, Diskography, Each Level; Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62291 | Injection, Diskography, Each Level; Cervical/Thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62320 | guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62321 | (ie, fluoroscopy or CT) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62322 | guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62323 | guidance (ie, fluoroscopy or CT) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 62380 | interspace, lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63001 | segments; cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63003 | Laminectomy, W/O Facetectomy/Foraminotomy/Diskectomy, 1/2 Segments; Thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63005 | Laminectomy W/O Facetectomy/Foraminotomy/Diskectomy, 1/2 Segments; Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63012 | Laminectomy W/Removal, Abnormal Facets, Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63015 | Laminectomy W/O Facetectomy/Foraminotomy/Diskectomy, > 2 Segments; Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63016 | Laminectomy W/O Facetectomy/Foraminotomy/Diskectomy, > 2 Segments; Thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63017 | Laminectomy W/O Facetectomy/Foraminotomy/Diskectomy, > 2 Segments; Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63020 | cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63030 | lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63035 | interspace, cervical or lumbar (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63040 | Interspc; Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63042 | Interspc; Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63043 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63044 | primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63045 | vertebral segment; cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63046 | vertebral segment; thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63047 | vertebral segment; lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63048 | separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63050 | Segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63051 | Reconstruction Of Posterior Bony Elements | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63052 | spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis] | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63053 | spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis] | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63055 | Transpedicular Approach, 1 Segment; Thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63056 | Transpedicular Approach, 1 Segment; Lumbar (Transfacet/Lateral Extraforaminal) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63057 | Transpedicular Approach, Add'l Segment; Thoracic/Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63075 | Diskectomy, Anterior; Cervical, 1 Interspace | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63076 | Diskectomy, Anterior; Cervical, Add'l Interspace | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63081 | Vertebral Corpectomy, Anterior; Cervical, 1 Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63082 | Vertebral Corpectomy, Anterior; Cervical, Add'l Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63085 | Vertebral Corpectomy, Transthoracic; Thoracic, 1 Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63086 | Vertebral Corpectomy, Transthoracic; Thoracic, Add'l Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63087 | Vertebral Corpectomy, Thoracolumbar, Lower Thoracic/Lumbar; 1 Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63088 | Vertebral Corpectomy, Thoracolumbar, Lower Thoracic/Lumbar; Add'l Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63090 | Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63091 | Vertebral Corpectomy, Trans/Retroperitoneal, Lower Thoracic/Lumbar/Sacral; Add'l Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63101 | Roots; Thoracic, Sgl Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63102 | Roots; Lumbar, Sgl Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63103 | Rts; Thoracic/Lumbar, ea addl Seg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63180 | segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63182 | 2 segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63185 | Laminectomy with rhizotomy; 1 or 2 segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63190 | Laminectomy with rhizotomy; more than 2 segments | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63191 | Laminectomy W/Section, Spinal Accessory Nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63194 | Laminectomy with cordotomy, with section of 1 spinothalamic tract, 1 stage; cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63196 | Laminectomy with cordotomy, with section of both spinothalamic tracts, 1 stage; cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63198 | days; cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63200 | Laminectomy, W/Release, Tethered Spinal Cord, Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63250 | Laminectomy, Excision/Occlusion, Avm, Spinal Cord; Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63252 | Laminectomy, Excision/Occlusion, Avm, Spinal Cord; Thoracolumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63265 | Laminectomy, Excision, Non-Neoplastic Lesion, Extradural; Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63267 | Laminectomy, Excision, Non-Neoplastic Lesion, Extradural; Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63270 | Laminectomy, Excision, Intraspinal Lesion Other Than Neoplasm, Intradural; Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63272 | Laminectomy, Excision, Intraspinal Lesion Other Than Neoplasm, Intradural; Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63275 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Extradural, Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63277 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Extradural, Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63280 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Intradural, Extramedullary, Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63282 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Intradural, Extramedullary, Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63285 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Intradural, Intramedullary, Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63287 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Intradural, Intramedullary, Thoracolumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63290 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Extradural-Intradural Lesion, Any Level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63300 | Vertebral Corpectomy, 1 Segment; Extradural, Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63301 | Vertebral Corpectomy, 1 Segment; Extradural, Thoracic, Transthoracic Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63302 | Vertebral Corpectomy, 1 Segment; Extradural, Thoracic, Thoracolumbar Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63303 | Transperitoneal/Retroperitoneal Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63304 | Vertebral Corpectomy, 1 Segment; Intradural, Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63305 | Vertebral Corpectomy, 1 Segment; Intradural, Thoracic, Transthoracic Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63306 | Vertebral Corpectomy, 1 Segment; Intradural, Thoracic, Thoracolumbar Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63307 | Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63308 | Vertebral Corpectomy, Add'l Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63620 | Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 spinal lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63650 | Percutaneous Implantation, Neurostimulator Electrode Array, Epidural | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63655 | Laminectomy, Implantation, Neurostimulator Electrodes, Plate/Paddle, Epidural | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63663 | percutaneous array(s), including fluoroscopy, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63664 | performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63685 | pocket creation and connection between electrode array and pulse generator or receiver | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 63688 | detachable connection to electrode array | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64405 | Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64415 | when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64417 | when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64447 | when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64450 | Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64454 | guidance, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64479 | guidance (fluoroscopy or CT), cervical or thoracic, single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64480 | addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64483 | guidance (fluoroscopy or CT), lumbar or sacral, single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64484 | addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64490 | single level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64491 | second level (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64492 | third and any additional level(s) (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64493 | level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64494 | second level (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64495 | and any additional level(s) (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64505 | Injection, Anesthetic Agent; Sphenopalatine Ganglion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64510 | Injection, Anesthetic Agent; Stellate Ganglion (Cervical Sympathetic) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64520 | Injection, Anesthetic Agent; Lumbar/Thoracic (Paravertebral Sympathetic) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64553 | Percutaneous implantation of neurostimulator electrode array; cranial nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64555 | sacral nerve) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64561 | placement) including image guidance, if performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64566 | programming | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64568 | pulse generator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64569 | including connection to existing pulse generator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64575 | nerve) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64581 | placement) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64582 | respiratory sensor electrode or electrode array | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64585 | Revision or removal of peripheral neurostimulator electrode array | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64590 | generator or receiver | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64596 | neurostimulator, including imaging guidance, when performed; initial electrode array | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64597 | (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64600 | Destruction, Neurolytic, Trigeminal Nerve; Supraorbital/Infraorbital/Mental/Inferior Alveolar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64605 | Destruction, Neurolytic, Trigeminal Nerve; 2nd & 3rd Division | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64610 | Destruction, Neurolytic, Trigeminal Nerve; 2nd & 3rd Division W/Radiologic Monitoring | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64624 | performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64625 | fluoroscopy or computed tomography) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64628 | vertebral bodies, lumbar or sacral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64629 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64633 | (fluoroscopy or CT); cervical or thoracic, single facet joint | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64634 | to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64635 | (fluoroscopy or CT); lumbar or sacral, single facet joint | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64636 | code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64640 | Destruction, Neurolytic; Other Peripheral Nerve/Branch | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64642 | Chemodenervation of one extremity; 1-4 muscle(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64644 | Chemodenervation of one extremity; 5 or more muscle(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64646 | Chemodenervation of trunk muscle(s); 1-5 muscle(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64647 | Chemodenervation of trunk muscle(s); 6 or more muscle(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64650 | Chemodenervation of eccrine glands; both axillae | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64653 | Chemodenervation of eccrine glands; other area(s) (eg, scalp, face, neck), per day | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64716 | Neuroplasty &/Or Transposition; Cranial Nerve (Specify) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64722 | Decompression; Unspecified Nerve(S) (Specify) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64732 | Transection/Avulsion; Supraorbital Nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64734 | Transection/Avulsion; Infraorbital Nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64736 | Transection/Avulsion; Mental Nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64738 | Transection/Avulsion; Inferior Alveolar Nerve, Osteotomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64740 | Transection/Avulsion; Lingual Nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64742 | Transection/Avulsion; Facial Nerve, Differential/Complete | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64744 | Transection/Avulsion; Greater Occipital Nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64771 | Transection/Avulsion, Other Cranial Nerve, Extradural | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64772 | Transection/Avulsion, Other Spinal Nerve, Extradural | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64864 | Suture, Facial Nerve; Extracranial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64865 | Suture, Facial Nerve; Infratemporal, W/Wo Grafting | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64866 | Anastomosis; Facial-Spinal Accessory | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 64868 | Anastomosis; Facial-Hypoglossal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 65756 | Keratoplasty (corneal transplant); endothelial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 65778 | Placement of amniotic membrane on the ocular surface; without sutures | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 65779 | Placement of amniotic membrane on the ocular surface; single layer, sutured | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 65780 | Ocular surface reconstruction; amniotic membrane transplantation, multiple layers | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 66174 | or stent | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 66175 | stent | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 66183 | approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 66989 | more | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 66991 | internal approach, one or more | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 67027 | Implant, Intravitreal Drug Delivery System W/Removal, Vitreous | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 67218 | radiation by implantation of source (includes removal of source) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 67220 | (eg, laser), 1 or more sessions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 67900 | Repair, Brow Ptosis, (Supraciliary/Mid-Forehead/Coronal Approach) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 67901 | fascia) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 67902 | obtaining fascia) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 67903 | Repair, Blepharoptosis; (Tarso) Levator Resection/Advancement, Int Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 67904 | Repair, Blepharoptosis; (Tarso) Levator Resection/Advancement, Ext Approach | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 67906 | Repair, Blepharoptosis; Superior Rectus W/Fascial Sling | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 67908 | Repair, Blepharoptosis; Conjunctivo-Tarso-Muller's Muscle-Levator Resection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69090 | Ear Piercing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69300 | Otoplasty, Protruding Ear, W/Wo Size Reduction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69710 | Bone | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69714 | speech processor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69715 | Implantation, Osseointegrated Implant, Temporal Bone; W/Mastoidectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69716 | mm surface area of bone deep to the outer cranial cortex | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69717 | percutaneous attachment to external speech processor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69718 | Replacement, Osseointegrated Implant, Temporal Bone; W/Mastoidectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69719 | cortex | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69729 | equal to 100 sq mm surface area of bone deep to the outer cranial cortex | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69730 | outer cranial cortex | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69930 | Cochlear Device Implantation, W/Wo Mastoidectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 69955 | Total Facial Nerve Decompression &/Or Repair, (May Include Graft) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70336 | Mri, Temporomandibular Joints | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70450 | Ct Scan, Head/Brain; W/O Contrast Matl | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70460 | Ct Scan, Head/Brain; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70470 | Ct Scan, Head/Brain; W/O Contrast, Then W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70480 | Ct Scan, Orbit/Sella/Posterior Fossa/Outer, Middle, Inner Ear; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70481 | Ct Scan, Orbit/Sella/Posterior Fossa/ Outer, Middle, Inner Ear; W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70482 | Ct Scan, Orbit/Sella/Posterior Fossa/ Outer, Middle, Inner Ear; W/O Contrast, Then W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70486 | Ct Scan, Maxillofacial Area; W/O Contrast Matl | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70487 | Ct Scan, Maxillofacial Area; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70488 | Ct Scan, Maxillofacial Area; W/O Contrast, Then W/Contrast & Further Sections | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70490 | Ct Scan, Soft Tissue Neck; W/O Contrast Matl | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70491 | Ct Scan, Soft Tissue Neck; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70492 | Ct Scan, Neck Tissue; W/O Contrast, Then W/Contrast & Further Sections | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70496 | images, if performed, and image postprocessing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70498 | images, if performed, and image postprocessing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70540 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70542 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70543 | material(s), followed by contrast material(s) and further sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70544 | Mra, Head; W/O Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70545 | Mra, Head; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70546 | Mra, Head; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70547 | Mra, Neck; W/O Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70548 | Mra, Neck; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70549 | Mra, Neck; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70551 | Mri, Brain; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70552 | Mri, Brain; W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70553 | Mri, Brain; W/O Contrast, Then W/Contrast & Further Sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70554 | psychologist administration | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 70555 | administration of entire neurofunctional testing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 71250 | Computed tomography, thorax, diagnostic; without contrast material | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 71260 | Computed tomography, thorax, diagnostic; with contrast material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 71270 | material(s) and further sections | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 71271 | material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 71275 | noncontrast images, if performed, and image postprocessing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 71550 | Mri, Chest; W/O Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 71551 | Mri, Chest; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 71552 | Mri, Chest; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 71555 | Mra, Chest (Exclude Myocardium), W/Wo Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72125 | Ct Scan, Cervical Spine; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72126 | Ct Scan, Cervical Spine; W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72127 | Ct Scan, Cervical Spine; W/O Contrast, Then W/Contrast & Further Sections | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72128 | Computed tomography, thoracic spine; without contrast material | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72129 | Cat,Thoracic Spine;w/Contrst Materl,18-2 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72130 | Ct Scan, Thoracic Spine; W/O Contrast, Then W/Contrast & Further Sections | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72131 | Ct Scan, Lumbar Spine; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72132 | Ct Scan, Lumbar Spine; W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72133 | Ct Scan, Lumbar Spine; W/O Contrast, Then W/Contrast & Further Sections | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72141 | Mri, Cervical Spine; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72142 | Mri, Cervical Spine; W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72146 | Mri, Thoracic Spine; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72147 | Mri, Thoracic Spine; W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72148 | Mri, Lumbar Spine; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72149 | Mri, Lumbar Spine; W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72156 | Mri, Spine W/O Contrast, Then W/Contrast; Cervical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72157 | Mri, Spine W/O Contrast, Then W/Contrast; Thoracic | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72158 | Mri, Spine W/O Contrast, Then W/Contrast; Lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72159 | Mra, Spine W/Wo Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72191 | images, if performed, and image postprocessing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72192 | Ct Scan, Pelvis; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72193 | Ct Scan, Pelvis; W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72194 | Ct Scan, Pelvis; W/O Contrast, Then W/Contrast & Further Sections | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72195 | Mri, Pelvis; W/O Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72196 | Mri, Pelvis; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72197 | Mri, Pelvis; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72198 | Mra, Pelvis, W/Wo Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72285 | Discography, cervical or thoracic, radiological supervision and interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 72295 | Discography, lumbar, radiological supervision and interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73200 | Ct Scan, Upper Extremity; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73201 | Ct Scan, Upper Extremity; W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73202 | Ct Scan, Upper Extremity; W/O Contrast, Then W/Contrast & Further Sections | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73206 | noncontrast images, if performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73218 | Mri, Upper Extremity, Other Than Joint; W/O Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73219 | Mri, Upper Extremity, Other Than Joint; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73220 | material(s), followed by contrast material(s) and further sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73221 | Mri, Any Joint, Upper Extremity; W/O Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73222 | Mri, Any Joint, Upper Extremity; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73223 | material(s), followed by contrast material(s) and further sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73225 | Mra, Upper Extremity, W/Wo Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73700 | Ct Scan, Lower Extremity; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73701 | Ct Scan, Lower Extremity; W/Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73702 | Ct Scan, Lower Extremity; W/O Contrast, Then W/Contrast & Further Sections | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73706 | noncontrast images, if performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73718 | Mri, Lower Extremity Other Than Joint; W/O Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73719 | Mri, Lower Extremity Other Than Joint; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73720 | material(s), followed by contrast material(s) and further sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73721 | Mri, Any Joint, Lower Extremity; W/O Contrast Matl | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73722 | Mri, Any Joint, Lower Extremity; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73723 | material(s), followed by contrast material(s) and further sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 73725 | Mra, Lower Extremity, W/Wo Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74150 | Ct Scan, Abdomen; W/O Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74160 | Computed tomography, abdomen; with contrast material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74170 | Ct Scan, Abdomen; W/O Contrast, Then W/Contrast & Further Sections | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74174 | Including Noncontrast Images, If Performed, And Image Postprocessing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74175 | noncontrast images, if performed, and image postprocessing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74176 | Computed tomography, abdomen and pelvis; without contrast material | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74177 | Computed tomography, abdomen and pelvis; with contrast material(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74178 | regions, followed by contrast material(s) and further sections in one or both body regions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74181 | Mri, Abdomen; W/O Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74182 | Mri, Abdomen; W/Contrast Matl(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74183 | Mri, Abdomen; W/O Contrast Matl(S) Followed By Contrast Matl(S) & Further Sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74185 | Mra, Abdomen, W/Wo Contrast | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74261 | without contrast material | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74262 | contrast material(s) including non-contrast images, if performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74263 | Computed tomographic (CT) colonography, screening, including image postprocessing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 74712 | imaging when performed; single of first gestation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 75557 | Cardiac magnetic resonance imaging for morphology and function without contrast material | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 75559 | with stress imaging | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 75561 | material(s), followed by contrast material(s) and further sequences | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 75563 | material(s), followed by contrast material(s) and further sequences; with stress imaging | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 75571 | coronary calcium | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 75572 | evaluation of venous structures, if performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 75573 | function and evaluation of vascular structures, if performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 75574 | structures, if performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 75580 | interpretation and report by a physician or other qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 75635 | postprocessing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 76120 | Cineradiography/Videoradiology, Except Where Specifically Included | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 76376 | concurrent supervision; not requiring image postprocessing on an independent workstation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 76377 | concurrent supervision; requiring image postprocessing on an independent workstation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 76390 | Mr Spectroscopy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 76391 | Magnetic resonance (eg, vibration) elastography | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 76873 | Echography, Transrectal; Prostate Volume Study, Brachytherapy Planning | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 76965 | Us Guided, Interstitial Radioelement Application | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77014 | Computed tomography guidance for placement of radiation therapy fields | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77046 | Magnetic resonance imaging, breast, without contrast material; unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77047 | Magnetic resonance imaging, breast, without contrast material; bilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77048 | pharmacokinetic analysis), when performed; unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77049 | pharmacokinetic analysis), when performed; bilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77078 | pelvis, spine) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77084 | Magnetic resonance (eg, proton) imaging, bone marrow blood supply | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77295 | 3-dimensional radiotherapy plan, including dose-volume histograms | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77301 | Intensity Modulated Radiotherapy Plan W/Dose Volume Histograms | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77316 | afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77317 | remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77318 | afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77338 | and construction per IMRT | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77370 | Special Medical Radiation Physics Consultation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77371 | cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77372 | cranial lesion(s) consisting of 1 session; linear accelerator based | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77373 | including image guidance, entire course not to exceed 5 fractions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77385 | performed; simple | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77386 | performed; complex | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77387 | intrafraction tracking, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77402 | Radiation treatment delivery, => 1 MeV; simple | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77407 | Radiation treatment delivery, => 1 MeV; intermediate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77412 | Radiation treatment delivery, => 1 MeV; complex | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77423 | coplanar geometry with blocking and/or wedge, and/or compensator(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77424 | Intraoperative Radiation Treatment Delivery, X-Ray, Single Treatment Session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77425 | Intraoperative Radiation Treatment Delivery, Electrons, Single Treatment Session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77432 | treatment consisting of 1 session) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77435 | more lesions, including image guidance, entire course not to exceed 5 fractions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77469 | Intraoperative Radiation Treatment Management | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77470 | endocavitary irradiation) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77520 | Proton Treatment Delivery; Simple W/O Compensation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77522 | Proton Treatment Delivery; Simple W/Compensation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77523 | Proton Treatment Delivery; Intermediate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77525 | Proton Treatment Delivery; Complex | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77761 | Intracavitary Radiation Source Application; Simple | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77762 | Intracavitary Radiation Source Application; Intermediate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77763 | Intracavitary Radiation Source Application; Complex | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77770 | includes basic dosimetry, when performed; 1 channel | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77771 | includes basic dosimetry, when performed; 2-12 channels | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77772 | includes basic dosimetry, when performed; over 12 channels | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77778 | Interstitial Radioelement Application; Complex | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 77790 | Supervision, Handling, Loading, Radiation Source | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78429 | with concurrently acquired computed tomography transmission scan | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78430 | transmission scan | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78431 | transmission scan | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78432 | performed), dual radiotracer (eg, myocardial viability) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78433 | tomography transmission scan | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78451 | pharmacologic) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78452 | pharmacologic) and/or redistribution and/or rest reinjection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78453 | single study, at rest or stress (exercise or pharmacologic) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78454 | rest reinjection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78459 | (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78466 | Myocardial Imaging, Infarct Avid, Planar; Qualitative/Quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78468 | Myocardial Imaging, Infarct Avid, Planar; W/Ejection Fraction, 1st Pass Technique | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78469 | Myocardial Imaging, Infarct Avid, Planar; Tomographic Spect W/Wo Quantification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78472 | Cardiac Blood Pool Imaging, Gated Equilibrium; Planar, Single Study, Rest/Stress | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78473 | Cardiac Blood Pool Imaging, Gated Equilibrium; Planar, Multiple Studies, Rest/Stress | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78481 | Quantification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78483 | without quantification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78491 | stress (exercise or pharmacologic) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78492 | and stress (exercise or pharmacologic) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78494 | Quantification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78608 | Brain Imaging, Positron Emission Tomography (Pet); Metabolic Evaluation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78609 | Brain Imaging, Positron Emission Tomography (Pet); Perfusion Evaluation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78803 | performed) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78811 | Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78812 | Positron emission tomography (PET) imaging; skull base to mid-thigh | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78813 | Positron emission tomography (PET) imaging; whole body | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78814 | head/neck) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78815 | for attenuation correction and anatomical localization imaging; skull base to mid-thigh | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 78816 | for attenuation correction and anatomical localization imaging; whole body | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 79101 | Radiopharmaceutical Therapy, By Intravenous Administration | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 79403 | Radiopharmaceutical Therapy, Radiolabeled Monoclonal Antibody By Intravenous Infusion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81120 | R132H, R132C) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81121 | R140W, R172M) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81161 | duplication analysis, if performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81162 | duplication/deletion analysis (ie, detection of large gene rearrangements) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81163 | hereditary breast and ovarian cancer) gene analysis; full sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81164 | detection of large gene rearrangements) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81165 | analysis; full sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81166 | analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81167 | analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81170 | kinase inhibitor resistance), gene analysis, variants in the kinase domain | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81171 | [FRAXE]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81172 | [FRAXE]) gene analysis; characterization of alleles (eg, expanded size and methylation status) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81173 | chromosome inactivation) gene analysis; full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81174 | chromosome inactivation) gene analysis; known familial variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81175 | sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81176 | sequence analysis (eg, exon 12) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81177 | detect abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81178 | expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81179 | expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81180 | evaluation to detect abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81181 | expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81182 | analysis, evaluation to detect abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81183 | (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81184 | analysis; evaluation to detect abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81185 | analysis; full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81186 | analysis; known familial variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81187 | gene analysis, evaluation to detect abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81188 | abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81189 | CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81190 | CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; known familial variant(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81191 | NTRK1 (neurotrophic receptor tyrosine kinase 1) (eg, solid tumors) translocation analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81192 | NTRK2 (neurotrophic receptor tyrosine kinase 2) (eg, solid tumors) translocation analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81193 | NTRK3 (neurotrophic receptor tyrosine kinase 3) (eg, solid tumors) translocation analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81194 | translocation analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81200 | Y231X) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81201 | FAP) gene analysis; full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81202 | FAP) gene analysis; known familial variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81203 | FAP) gene analysis; duplication/deletion variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81204 | methylation status) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81205 | Urine Disease) Gene Analysis, Common Variants (Eg, R183P, G278S, E422X) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81206 | Breakpoint, Qualitative Or Quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81207 | Breakpoint, Qualitative Or Quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81208 | Breakpoint, Qualitative Or Quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81209 | 2281Del6Ins7 Variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81210 | V600E Variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81212 | hereditary breast and ovarian cancer) gene analysis; 185delAG, 5385insC, 6174delT variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81215 | analysis; known familial variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81216 | analysis; full sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81217 | analysis; known familial variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81218 | analysis, full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81219 | 9 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81220 | Analysis; Common Variants (Eg, Acmg/Acog Guidelines) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81221 | Analysis; Known Familial Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81222 | Analysis; Duplication/Deletion Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81223 | Analysis; Full Gene Sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81224 | Analysis; Intron 8 Poly-T Analysis (Eg, Male Infertility) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81225 | Gene Analysis, Common Variants (Eg, *2, *3, *4, *8, *17) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81226 | *2XN, *4XN) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81227 | Gene Analysis, Common Variants (Eg, *2, *3, *5, *6) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81228 | [CGH] microarray analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81229 | variants, comparative genomic hybridization (CGH) microarray analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81230 | analysis, common variant(s) (eg, *2, *22) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81231 | analysis, common variants (eg, *2, *3, *4, *5, *6, *7) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81232 | metabolism), gene analysis, common variant(s) (eg, *2A, *4, *5, *6) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81233 | variants (eg, C481S, C481R, C481F) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81234 | abnormal (expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81235 | common variants (eg, exon 19 LREA deletion, L858R, T790M, G719A, G719S, L861Q) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81236 | syndrome, myeloproliferative neoplasms) gene analysis, full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81237 | lymphoma) gene analysis, common variant(s) (eg, codon 646) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81239 | alleles (eg, expanded size) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81240 | 20210G>A Variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81241 | F5 (Coagulation Factor V) (Eg, Hereditary Hypercoagulability) Gene Analysis, Leiden Variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81242 | Analysis, Common Variant (Eg, Ivs4+4A>T) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81243 | disability [XLID]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81244 | disability [XLID]) gene analysis; characterization of alleles (eg, expanded size | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81245 | Tandem Duplication (Itd) Variants (Ie, Exons 14, 15) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81246 | kinase domain (TKD) variants (eg, D835, I836) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81247 | common variant(s) (eg, A, A-) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81248 | known familial variant(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81249 | full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81250 | Von Gierke Disease) Gene Analysis, Common Variants (Eg, R83C, Q347X) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81251 | N370S, 84Gg, L444P, Ivs2+1G>A) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81252 | analysis; full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81253 | analysis; known familial variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81254 | D13S1854)]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81255 | Common Variants (Eg, 1278Instatc, 1421+1G>C, G269S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81256 | (Eg, C282Y, H63D) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81257 | Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant Spring) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81258 | syndrome, HbH disease), gene analysis; known familial variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81259 | syndrome, HbH disease), gene analysis; full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81260 | 2507+6T>C, R696P) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81261 | polymerase chain reaction) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81262 | (eg, Southern blot) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81263 | Region Somatic Mutation Analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81264 | Rearrangement Analysis, Evaluation To Detect Abnormal Clonal Population(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81265 | testing, twin zygosity testing, or maternal cell contamination of fetal cells) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81266 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81269 | syndrome, HbH disease), gene analysis; duplication/deletion variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81270 | Variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81271 | expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81272 | analysis (eg, exons 8, 11, 13, 17, 18) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81273 | analysis, D816 variant(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81274 | expanded size) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81275 | In Codons 12 And 13 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81276 | variant(s) (eg, codon 61, codon 146) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81277 | for copy number and loss-of-heterozygosity variants for chromosomal abnormalities | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81278 | region (MBR) and minor cluster region (mcr) breakpoints, qualitative or quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81279 | 12 and 13) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81283 | IFNL3 (interferon, lambda 3) (eg, drug response), gene analysis, rs12979860 variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81284 | alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81285 | size) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81286 | FXN (frataxin) (eg, Friedreich ataxia) gene analysis; full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81287 | methylation analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81288 | colorectal cancer, Lynch syndrome) gene analysis; promoter methylation analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81289 | FXN (frataxin) (eg, Friedreich ataxia) gene analysis; known familial variant(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81290 | 2A>G, Del6.4Kb) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81291 | Analysis, Common Variants (Eg, 677T, ) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81292 | Colorectal Cancer, Lynch Syndrome) Gene Analysis; Full Sequence Analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81293 | Colorectal Cancer, Lynch Syndrome) Gene Analysis; Known Familial Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81294 | Colorectal Cancer, Lynch Syndrome) Gene Analysis; Duplication/Deletion Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81295 | Colorectal Cancer, Lynch Syndrome) Gene Analysis; Full Sequence Analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81296 | Colorectal Cancer, Lynch Syndrome) Gene Analysis; Known Familial Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81297 | Colorectal Cancer, Lynch Syndrome) Gene Analysis; Duplication/Deletion Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81298 | Syndrome) Gene Analysis; Full Sequence Analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81299 | Syndrome) Gene Analysis; Known Familial Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81300 | Syndrome) Gene Analysis; Duplication/Deletion Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81301 | comparison of neoplastic and normal tissue, if performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81302 | Analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81303 | Variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81304 | Duplication/Deletion Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81305 | lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81306 | *3, *4, *5, *6) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81307 | gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81308 | known familial variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81309 | colorectal and breast cancer) gene analysis, targeted sequence analysis (eg, exons 7, 9, 20) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81310 | Npm1 (Nucleophosmin) (Eg, Acute Myeloid Leukemia) Gene Analysis, Exon 12 Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81311 | analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81312 | analysis, evaluation to detect abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81313 | [prostate specific antigen]) ratio (eg, prostate cancer) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81314 | stromal tumor [GIST]), gene analysis, targeted sequence analysis (eg, exons 12, 18) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81315 | 6), qualitative or quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81316 | exon 6), qualitative or quantitative | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81317 | Colorectal Cancer, Lynch Syndrome) Gene Analysis; Full Sequence Analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81318 | Colorectal Cancer, Lynch Syndrome) Gene Analysis; Known Familial Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81319 | Colorectal Cancer, Lynch Syndrome) Gene Analysis; Duplication/Deletion Variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81320 | common variants (eg, R665W, S707F, L845F) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81321 | syndrome) gene analysis; full sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81322 | syndrome) gene analysis; known familial variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81323 | syndrome) gene analysis; duplication/deletion variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81324 | liability to pressure palsies) gene analysis; duplication/deletion analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81325 | liability to pressure palsies) gene analysis; full sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81326 | liability to pressure palsies) gene analysis; known familial variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81327 | SEPT9 (Septin9) (eg, colorectal cancer) promoter methylation analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81328 | reaction), gene analysis, common variant(s) (eg, *5) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81329 | centromeric) analysis, if performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81330 | Type A) Gene Analysis, Common Variants (Eg, R496L, L302P, Fsp330) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81331 | E3A) (Eg, Prader-Willi Syndrome And/Or Angelman Syndrome), Methylation Analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81332 | (eg, alpha-1-antitrypsin deficiency), gene analysis, common variants (eg, *S and *Z) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81333 | common variants (eg, R124H, R124C, R124L, R555W, R555Q) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81334 | exons 3-8) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81335 | (eg, *2, *3) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81336 | gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81337 | known familial sequence variant(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81338 | analysis; common variants (eg, W515A, W515K, W515L, W515R) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81339 | analysis; sequence analysis, exon 10 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81340 | polymerase chain reaction) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81341 | Southern blot) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81342 | Analysis, Evaluation To Detect Abnormal Clonal Population(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81343 | analysis, evaluation to detect abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81344 | abnormal (eg, expanded) alleles | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81345 | gene analysis, targeted sequence analysis (eg, promoter region) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81346 | common variant(s) (eg, tandem repeat variant) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81347 | leukemia) gene analysis, common variants (eg, A672T, E622D, L833F, R625C, R625L) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81348 | myeloid leukemia) gene analysis, common variants (eg, P95H, P95L) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81349 | pass sequencing analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81350 | variants (eg, *28, *36, *37) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81351 | TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81352 | (eg, 4 oncology) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81353 | TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; known familial variant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81355 | Analysis, Common Variants (Eg, -1639/3673) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81357 | leukemia) gene analysis, common variants (eg, S34F, S34Y, Q157R, Q157P) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81360 | E65fs, E122fs, R448fs) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81361 | hemoglobinopathy); common variant(s) (eg, HbS, HbC, HbE) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81362 | hemoglobinopathy); known familial variant(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81363 | hemoglobinopathy); duplication/deletion variant(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81364 | hemoglobinopathy); full gene sequence | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81378 | Hla Class I And Ii Typing, High Resolution (Ie, Alleles Or Allele Groups), Hla-A, -B, -C, And -Drb1 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81379 | C) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81380 | C), Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81381 | (Eg, B*57:01P), Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81400 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 1 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81401 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81402 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 3 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81403 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 4 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81404 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 5 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81405 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 6 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81406 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 7 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81407 | MOLECULAR PATHOLOGY PROCEDURE LEVEL 8 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81408 | sequence analysis) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81410 | ACTA2, SLC2A10, SMAD3, and MYLK | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81411 | include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81412 | ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, and SMPD1 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81413 | KCNH2, KCNJ2, KCNQ1, RYR2, and SCN5A | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81414 | panel, must include analysis of at least 2 genes, including KCNH2 and KCNQ1 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81415 | Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81416 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81417 | condition/syndrome) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81418 | analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81419 | SCN2A, SCN8A, SLC2A1, SLC9A6, STXBP1, SYNGAP1, TCF4, TPP1, TSC1, TSC2, and ZEB2 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81425 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81426 | for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81427 | condition/syndrome) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81430 | TMPRSS3, USH1C, USH1G, USH2A, and WFS1 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81431 | deletions in GJB2 and GJB6 genes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81432 | variants and copy number variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81433 | analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81434 | RP2, RPE65, RPGR, and USH2A | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81435 | more genes, interrogation for sequence variants and copy number variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81436 | include analysis of at least 5 genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81437 | analysis panel, 5 or more genes, interrogation for sequence variants and copy number variants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81438 | panel, must include analyses for SDHB, SDHC, SDHD, and VHL | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81439 | PKP2, TTN) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81440 | SLC25A4, SUCLA2, SUCLG1, TAZ, TK2, and TYMP | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81441 | TERT, and TINF2 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81442 | MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81443 | FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81445 | combined DNA and RNA analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81448 | genes (eg, BSCL2, GJB1, MFN2, MPZ, REEP1, SPAST, SPG11, SPTLC1) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81449 | sequence variants and copy number variants or rearrangements, if performed; RNA analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81450 | analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81451 | expression or mRNA expression levels, if performed; RNA analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81455 | or combined DNA and RNA analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81456 | rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81457 | DNA analysis, microsatellite instability | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81458 | DNA analysis, copy number variants and microsatellite instability | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81459 | DNA analysis or combined DNA and RNA analysis, copy number variants, microsatellite | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81460 | mitochondrial genome with heteroplasmy detection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81462 | number variants and rearrangements | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81463 | instability | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81464 | number variants, microsatellite instability, tumor mutation burden, and rearrangements | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81465 | performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81470 | RPS6KA3, and SLC16A2 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81471 | RPS6KA3, and SLC16A2 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81479 | Unlisted molecular pathology procedure | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81490 | serum, prognostic algorithm reported as a disease activity score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81493 | utilizing whole peripheral blood, algorithm reported as a risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81504 | formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81506 | Reporting A Risk Score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81517 | related clinical events within 5 years | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81518 | endocrine therapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81519 | formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81520 | a recurrence risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81521 | algorithm reported as index related to risk of distant metastasis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81522 | recurrence risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81523 | algorithm reported as index related to risk to distant metastasis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81525 | a recurrence score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81529 | algorithm reported as recurrence risk, including likelihood of sentinel lymph node metastasis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81535 | drug combination | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81538 | prognostic and predictive algorithm reported as good versus poor overall survival | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81540 | of a predicted main cancer type and subtype | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81541 | reported as a disease-specific mortality risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81542 | formalin-fixed paraffin-embedded tissue, algorithm reported as metastasis risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81545 | algorithm reported as a categorical result (eg, benign or suspicious) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81546 | aspirate, algorithm reported as a categorical result (eg, benign or suspicious) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81551 | of prostate cancer detection on repeat biopsy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81552 | embedded tissue, algorithm reported as risk of metastasis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81554 | result (eg, positive or negative for high probability of usual interstitial pneumonia [UIP]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81560 | blood, algorithm reported as a rejection risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81595 | algorithm reported as a rejection risk score | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81596 | prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 81599 | Unlisted Multianalyte Assay With Algorithmic Analysis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 82787 | Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 83516 | qualitative or semiquantitative, multiple step method | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 83520 | quantitative, not otherwise specified | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 86001 | Allergen Specific Igg Quantitative/Semiquantitative, Ea Allergen | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 86343 | Leukocyte Histamine Release Test (Lhr) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 86352 | biomarker (eg, ATP) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 86357 | Natural killer (NK) cells, total count | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 88356 | Morphometric Analysis; Nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89250 | Culture, Oocyte(S) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89251 | Culture & Fertilization, Oocyte(S); W/Co-Culture | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89253 | Assisted Embryo Hatching, Microtechniques (Any Method) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89254 | Oocyte Identification, Follicular Fluid | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89255 | Preparation, Embryo, Transfer (Any Method) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89268 | Insemination of Oocytes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89272 | Extended Culture of Oocyte(s)/Embryo(s), 4-7 Days | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89329 | Sperm Evaluation; Hamster Penetration Test | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89330 | Sperm Evaluation; Cervical Mucus Penetration Test, W/Wo Spinnbarkeit Test | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89344 | Storage, (Per Year); Reproductive Tissue, Testicular/Ovarian | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89346 | Storage, (Per Year); Oocyte | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89354 | Thawing of Cryopreserved; Reproductive Tissue, Testicular/Ovarian | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 89356 | Thawing of Cryopreserved; Oocytes, Each Aliquot | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90281 | Immune Globulin (Ig), Human, Im Use | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90283 | Immune Globulin (Igiv), Human, Iv Use | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90284 | Immune globulin (SCIg), human, for use in subcutaneous infusions, 100mg, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90378 | each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90380 | intramuscular use | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90381 | intramuscular use | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90867 | cortical mapping, motor threshold determination, delivery and management | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90868 | and management, per session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90869 | Threshold Re-Determination With Delivery And Management | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90875 | supportive psychotherapy); 30 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90876 | supportive psychotherapy); 45 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90901 | Biofeedback Training, Any Modality | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90912 | health care professional contact with the patient | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 90913 | for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 91112 | with interpretation and report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92507 | individual | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92508 | group, 2 or more individuals | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92521 | Evaluation of speech fluency (eg, stuttering, cluttering) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92522 | dysarthria) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92523 | expressive language) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92524 | Behavioral and qualitative analysis of voice and resonance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92526 | Treatment, Swallowing Dysfunction &/Or Oral Function, Feeding | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92605 | communication device, face-to-face with the patient; first hour | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92606 | Therapeutic Service(S), Use Non-Speech Generatiing Device, W/Programming & Modification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92607 | Hr | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92608 | Add'l 30 Min | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92609 | Therapeutic Services, Non-Speech Generative Device Use, W/Programming & Modification | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92610 | Eval, Oral & Pharyngeal Swallow Function | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92611 | Motion Fluoroscopic Eval, Swallow Function, Cine/Video Record | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92618 | separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92626 | status of a surgically implanted device(s); first hour | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92627 | addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92630 | Auditory rehabilitation; pre-lingual hearing loss | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92633 | Auditory rehabilitation; post-lingual hearing loss | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92920 | Percutaneous transluminal coronary angioplasty; single major coronary artery or branch | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92924 | single major coronary artery or branch | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92928 | when performed; single major coronary artery or branch | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92933 | angioplasty when performed; single major coronary artery or branch | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92937 | atherectomy and angioplasty, including distal protection when performed; single vessel | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92943 | stent, atherectomy and angioplasty; single vessel | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 92972 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93150 | and programming | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93151 | stimulator system | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93152 | polysomnography | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93153 | Interrogation without programming of implanted phrenic nerve stimulator system | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93228 | computerized real time data analysis and greater than 24 hours of accessible ECG data | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93229 | computerized real time data analysis and greater than 24 hours of accessible ECG data | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93264 | at least weekly downloads of pulmonary artery pressure recordings, interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93303 | Transthoracic Echocardiography, Congenital Cardiac Anomalies; Complete | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93304 | Transthoracic Echocardiography, Congenital Cardiac Anomalies; Follow-Up/Limited Study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93306 | flow Doppler echocardiography | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93307 | recording, when performed, complete, without spectral or color Doppler echocardiography | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93308 | recording, when performed, follow-up or limited study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93312 | M-mode recording); including probe placement, image acquisition, interpretation and report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93313 | M-mode recording); placement of transesophageal probe only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93314 | M-mode recording); image acquisition, interpretation and report only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93315 | Report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93316 | Placement Only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93317 | Echocardiography, Transesophageal, Congenital Anomalies; Image, Interpretation & Report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93350 | exercise and/or pharmacologically induced stress, with interpretation and report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93351 | other qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93454 | injection(s) for coronary angiography, imaging supervision and interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93455 | intraprocedural injection(s) for bypass graft angiography | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93456 | catheterization | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93457 | intraprocedural injection(s) for bypass graft angiography and right heart catheterization | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93458 | performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93459 | grafts) with bypass graft angiography | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93460 | performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93461 | left heart catheterization including intraprocedural injection(s) for left ventriculography, when | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93580 | Perc Transcatheter Closure, Congenital Interatrial Communication W/Implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93600 | Bundle Of His Recording | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93602 | Intra-Atrial Recording | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93603 | Right Ventricular Recording | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93609 | Intraventricular &/Or Intra-Atrial Mapping, Tachycardia Site(S) W/Catheter Manipulation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93613 | Intracardiac Electrophysiologic 3-Dimensional Mapping | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93619 | Induction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93620 | Electrophys Eval, Insert Cath, W/Arrhyth Induction; W/Right Atrial/Ventricular Pace/Record | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93621 | Electrophys Eval, Insert Cath, W/Arrhyth Induction; W/Lt Atrial Pace/Record | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93622 | Electrophys Eval, Insert Cath, W/Arrythmia Induction; W/Lt Vent Pace/Record | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93624 | Electrophys, Follow-Up Study W/Pacing & Recording W/Arrhyth Induction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93640 | Electrophys Eval, Single/Dual Pacing Cardio/Defib Leads, Initial Implant/Replace | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93641 | Generator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93650 | Intracardiac Catheter Ablation, Atrioventricular Node Function/Conduction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93653 | other single atrial focus or source of atrial re-entry | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93654 | left ventricular pacing and recording, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93655 | induced arrhythmia (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93656 | interpretation, right ventricular pacing/recording, and His bundle recording, when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93657 | addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93702 | Bioimpedance spectroscopy (BIS), extracellular fluid analysis for lymphedema assessment(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93745 | system and patient reporting of problems or events | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93880 | Duplex Scan, Extracranial Arteries; Complete Bilat Study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93882 | Duplex Scan, Extracranial Arteries; Unilat/Limited Study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93922 | lower extremity: ankle/brachial indices at distal posterior tibial and anterior | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93923 | more levels (eg, for lower extremity: ankle/brachial indices at distal posterior | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93924 | complete bilateral study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93925 | Duplex Scan, Lower Extremity Arteries/Arterial Bypass Grafts; Complete Bilat Study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93926 | Duplex Scan, Lower Extremity Arteries/Arterial Bypass Grafts; Unilat/Limited Study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93930 | Duplex Scan, Upper Extremity Arteries/Arterial Bypass Grafts; Complete Bilat Study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93931 | Duplex Scan, Upper Extremity Arteries/Arterial Bypass Grafts; Unilat/Limited Study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93978 | Duplex Scan, Aorta, Inferior Vena Cava, Iliac Vasculature/Bypass Grafts; Complete Study | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 93979 | Duplex Scan, Aorta, Inferior Vena Cava, Iliac Vasculature/Bypass Grafts; Unilat/Limited | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 94667 | Chest Wall Manipulation, Facilitate Lung Function; Initial Demo &/Or Eval | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 94668 | Chest Wall Manipulation, Facilitate Lung Function; Subsequent | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95782 | sleep, attended by a technologist | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95783 | sleep, with initiation of continuous positive airway pressure therapy or bi-level | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95800 | analysis (eg, by airflow or peripheral arterial tone), and sleep time | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95801 | and respiratory analysis (eg, by airflow or peripheral arterial tone) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95803 | consecutive days of recording) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95805 | Multiple Sleep Latency Test, Multiple Trails | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95806 | airflow, and respiratory | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95807 | Sleep Study, Attended | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95808 | a technologist | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95810 | sleep, attended by a technologist | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95811 | attended by a technologist | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95905 | and report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95965 | Magnetoencephalography (Meg), Record & Analysis; For Spontaneous Brain Magnetic Activity | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95966 | Modality | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95967 | Modality | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95976 | generator/transmitter programming by physician or other qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 95977 | generator/transmitter programming by physician or other qualified health care professional | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 96001 | dynamic plantar pressure measurements during walking | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 96365 | up to 1 hour | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 96372 | or intramuscular | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 96904 | melanoma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 96931 | acquisition and interpretation and report, first lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 96932 | acquisition only, first lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 96933 | interpretation and report only, first lesion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97010 | Application of a modality to 1 or more areas; hot or cold packs | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97012 | Application of a modality to 1 or more areas; traction, mechanical | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97014 | Application of a modality to 1 or more areas; electrical stimulation (unattended) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97016 | Application of a modality to 1 or more areas; vasopneumatic devices | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97018 | Application of a modality to 1 or more areas; paraffin bath | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97022 | Application of a modality to 1 or more areas; whirlpool | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97024 | Application of a modality to 1 or more areas; diathermy (eg, microwave) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97026 | Application of a modality to 1 or more areas; infrared | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97028 | Application of a modality to 1 or more areas; ultraviolet | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97032 | Application, Modality 1+ Areas; Electrical Stimulation (Manual), Each 15 Min | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97033 | Application of a modality to 1 or more areas; iontophoresis, each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97034 | Application, Modality To 1+ Areas; Contrast Baths, Each 15 Min | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97035 | Application, Modality To 1+ Areas; Ultrasound, Each 15 Min | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97036 | Application, Modality To 1+ Areas; Hubbard Tank, Each 15 Min | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97110 | Therapeutic Proc, 1+ Areas, Each 15 Min; Therapeutic Exercises | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97112 | Therapeutic Proc, 1+ Areas, Each 15 Min; Neuromuscular Reeducation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97113 | Therapeutic Proc, 1+ Areas, Each 15 Min; Aquatic Therapy W/Exercises | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97116 | Therapeutic Proc, 1+ Areas, Each 15 Min; Gait Training (W/Stair Climbing) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97124 | Therapeutic Proc, 1+ Areas, Each 15 Min; Massage | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97129 | minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97130 | additional 15 minutes (List separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97140 | Manual Therapy Techniques, 1+ Regions, Each 15 Min | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97150 | Therapeutic Proc(S), Group, (2+ Individuals) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97151 | scoring/interpreting the assessment, and preparing the report/treatment plan | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97152 | patient, each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97153 | minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97154 | more patients, each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97155 | face-to-face with one patient, each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97156 | guardian(s)/caregiver(s), each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97157 | multiple sets of guardians/caregivers, each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97158 | other qualified health care professional, face-to-face with multiple patients, each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97161 | Physical therapy evaluation; low complexity, requiring components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97162 | Physical therapy evaluation; moderate complexity requiring components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97163 | Physical therapy evaluation; high complexity requiring components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97164 | Reevaluation of physical therapy established plan of care requiring components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97165 | Occupational therapy evaluation; low complexity requiring components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97166 | Occupational therapy evaluation; moderate complexity requiring components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97167 | Occupational therapy evaluation; high complexity requiring components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97168 | Reevaluation of occupational therapy care/established plan of care requiring components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97530 | improve functional performance), each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97533 | responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97535 | devices/adaptive equipment) direct one-on-one contact, each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97537 | minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97542 | Wheelchair management (eg, assessment, fitting, training), each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97545 | Work Hardening/Conditioning; Initial 2 Hours | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97546 | Work Hardening/Conditioning; Add'l Hr | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97610 | performed, wound assessment, and instruction(s) for ongoing care, per day | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97750 | Physical Performance Test, W/Written Report, Each 15 Min | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97755 | contact, with written report, each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97760 | each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97761 | 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 97763 | extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99183 | oxygen therapy, per session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99500 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99501 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99502 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99503 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99504 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99505 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99506 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99507 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99508 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99509 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99510 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99511 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99512 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99513 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99514 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99515 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99516 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99517 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99518 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99519 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99520 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99521 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99522 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99523 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99524 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99525 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99526 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99527 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99528 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99529 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99530 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99531 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99532 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99533 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99534 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99535 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99536 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99537 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99538 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99539 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99540 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99541 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99542 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99543 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99544 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99545 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99546 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99547 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99548 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99549 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99550 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99551 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99552 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99553 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99554 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99555 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99556 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99557 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99558 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99559 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99560 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99561 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99562 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99563 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99564 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99565 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99566 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99567 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99568 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99569 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99570 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99571 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99572 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99573 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99574 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99575 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99576 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99577 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99578 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99579 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99580 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99581 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99582 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99583 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99584 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99585 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99586 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99587 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99588 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99589 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99590 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99591 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99592 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99593 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99594 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99595 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99596 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99597 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99598 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99599 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99600 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99601 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| 99602 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A0430 | Fixed Wing Air Transport | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A0431 | Rotary Wing Air Transport | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A0435 | Fixed Wing Air Mileage | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A0436 | Rotary Wing Air Mileage | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2001 | InnovaMatrix AC, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2002 | Mirragen Advanced Wound Matrix, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2004 | XCelliStem, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2005 | Microlyte Matrix, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2006 | Novosorb synpath dermal matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2007 | Restrata, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2008 | Theragenesis, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2009 | Symphony, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2010 | Apis, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2011 | Supra SDRM, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2012 | SUPRATHEL, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2013 | Innovamatrix FS, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2014 | Omeza collagen matrix, per 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2015 | Phoenix Wound Matrix, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2016 | Permeaderm b, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2017 | PermeaDerm Glove, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2018 | Permeaderm c, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2019 | Kerecis omega3 marigen shield, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2020 | Ac5 advanced wound system (ac5) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2021 | Neomatrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2022 | InnovaBurn or InnovaMatrix XL, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2023 | InnovaMatrix PD, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2024 | Resolve matrix or xenopatch, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2025 | Miro3D, per cu cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A2026 | Restrata MiniMatrix, 5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4341 | Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4342 | replacement only, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4438 | Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4468 | Exsufflation belt, includes all supplies and accessories | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4540 | arm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4542 | the wrist | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4555 | replacement only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4575 | Topical hyperbaric oxygen chamber, disposable | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4596 | Cranial electrotherapy stimulation (ces) system supplies and accessories, per month | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4600 | SLEEVE FOR INTERMITTENT LIMB COMPRESSION DEVICE, REPLACEMENT ONLY, EACH | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A4604 | Tubing with integrated heating element for use with positive airway pressure device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7027 | Combination oral/nasal mask, used with continuous positive airway pressure | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7028 | Oral cushion for combination oral/nasal mask, replacement only, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7029 | Nasal pillows for combination oral/nasal mask, replacement only, pair | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7030 | Full Face Mask Used With Positive Airway Pressure Device, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7031 | Face Mask Interface, Replacement For Full Face Mask, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7032 | Cushion for use on nasal mask interface, replacement only, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7033 | Pillow for use on nasal cannula type interface, replacement only, pair | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7034 | Nasal Interface (Mask Or Cannula Type) Used With Positive Airway Press | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7035 | Headgear Used With Positive Airway Pressure Device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7036 | Chinstrap Used With Positive Airway Pressure Device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7037 | Tubing Used With Positive Airway Pressure Device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7038 | Filter, Disposable, Used With Positive Airway Pressure Device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7039 | Filter, Non Disposable, Used With Positive Airway Pressure Device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7044 | Oral Interface Used With Positive Airway Pressure Device, Each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7045 | Repl exhalation port for PAP | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A7046 | Water chamber for humidifier, used with positive airway pressure device, replacement, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A9268 | Programmer for transient, orally ingested capsule | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A9269 | month | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A9292 | Prescription digital visual therapy, software-only, FDA cleared, per course of treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A9513 | Lutetium Lu 177, dotatate, therapeutic, 1 mCi | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A9543 | Yttrium Y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A9582 | Iodine I-123 Iobenguane, Diagnostic, Per Study Dose, Up To 15 Millicuries | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A9590 | Iodine I-131, iobenguane, 1 mCi | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A9606 | Radium RA-223 dichloride, therapeutic, per UCI | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| A9607 | Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4164 | mix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4168 | Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4172 | Parenteral nutrition solution; amino acid, 5.5% through 7%, (500 ml = 1 unit) - home mix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4176 | Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - home mix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4178 | Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4180 | home mix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4185 | Parenteral nutrition solution, not otherwise specified, 10 grams lipids | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4187 | Omegaven, 10 g lipids | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4189 | trace elements, and vitamins, including preparation, any strength, 10 to 51 g of protein, premix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4193 | trace elements, and vitamins, including preparation, any strength, 52 to 73 g of protein, premix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4197 | premix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4199 | trace elements and vitamins, including preparation, any strength, over 100 g of protein - premix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4216 | day | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4220 | Parenteral nutrition supply kit; premix, per day | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4222 | Parenteral nutrition supply kit; home mix, per day | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B4224 | Parenteral nutrition administration kit, per day | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B5000 | NephrAmine, RenAmine - premix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B5100 | premix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B5200 | acids-FreAmine-HBC-premix | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B9004 | Parenteral nutrition infusion pump, portable | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| B9006 | Parenteral nutrition infusion pump, stationary | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1605 | components), rate-responsive, including all necessary components for implantation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1721 | Cardioverter-defibrillator, dual chamber (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1722 | Cardioverter-defibrillator, single chamber (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1734 | Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1764 | Event recorder, cardiac (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1767 | Generator, neurostimulator (implantable), nonrechargeable | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1777 | Lead, cardioverter-defibrillator, endocardial single coil (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1778 | Lead, neurostimulator (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1785 | Pacemaker, dual chamber, rate-responsive (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1786 | Pacemaker, single chamber, rate-responsive (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1787 | Patient programmer, neurostimulator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1789 | Prosthesis, breast (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1813 | Prosthesis, penile, inflatable | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1815 | Prosthesis, urinary sphincter (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1816 | Receiver and/or transmitter, neurostimulator (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1820 | Generator, neurostimulator (implantable), with rechargeable battery and charging system | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1821 | Interspinous process distraction device (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1822 | charging system | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1823 | stimulation leads | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1824 | Generator, cardiac contractility modulation (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1825 | stimulation lead(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1832 | Autograft suspension, including cell processing and application, and all system components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1833 | Monitor, cardiac, including intracardiac lead and all system components (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1839 | Iris prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1878 | Material for vocal cord medialization, synthetic (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1882 | Cardioverter-defibrillator, other than single or dual chamber (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1883 | Adaptor/extension, pacing lead or neurostimulator lead (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1895 | Lead, cardioverter-defibrillator, endocardial dual coil (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C1896 | Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C2614 | Probe, percutaneous lumbar discectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C2619 | Pacemaker, dual chamber, nonrate-responsive (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C2620 | Pacemaker, single chamber, nonrate-responsive (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C2621 | Pacemaker, other than single or dual chamber (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C2622 | Prosthesis, penile, noninflatable | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C2624 | system components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C5271 | 100 sq cm; first 25 sq cm or less wound surface area | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C5273 | infants and children | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C5275 | sq cm or less wound surface area | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C5277 | 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C7531 | supervision and interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C7534 | therapeutic intervention, including radiological supervision and interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C7535 | interpretation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C7538 | upgrade to dual chamber system) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C7539 | generator (e.g., for upgrade to dual chamber system) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C7540 | generator (e.g., for upgrade to dual chamber system) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C8903 | Magnetic resonance imaging with contrast, breast; unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C8905 | Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C8906 | Magnetic resonance imaging with contrast, breast; bilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C8908 | Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9047 | Injection, caplacizumab-yhdp, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9076 | including leukapheresis and dose preparation procedures, per therapeutic dose | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9077 | Injection, cabotegravir and rilpivirine, 2 mg/3 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9079 | Injection, evinacumab-dgnb, 5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9081 | including leukapheresis and dose preparation procedures, per therapeutic dose | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9084 | Injection, loncastuximab tesirine-lpyl, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9085 | Injection, avalglucosidase alfa-ngpt, 4 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9086 | Injection, anifrolumab-fnia, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9090 | Injection, plasminogen, human-tvmh, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9091 | Injection, sirolimus protein-bound particles, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9094 | Injection, sutimlimab-jome, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9095 | Injection, tebentafusp-tebn, 1 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9096 | Injection, filgrastim-ayow, biosimilar, (Releuko), 1 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9097 | Injection, faricimab-svoa, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9098 | directed CAR-positive T cells, including leukapheresis and dose preparation procedures | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9142 | Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9146 | Injection, mirvetuximab soravtansine-gynx, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9147 | Injection, tremelimumab-actl, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9148 | Injection, teclistamab-cqyv, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9149 | Injection, teplizumab-mzwv, 5 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9151 | Injection, pegcetacoplan, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9157 | Injection, tofersen, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9160 | Injection, daxibotulinumtoxina-lanm, 1 unit | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9161 | Injection, aflibercept hd, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9162 | Injection, avacincaptad pegol, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9166 | Injection, secukinumab, IV, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9167 | Injection, apadamtase alfa, 10 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9168 | Injection, mirikizumab-mrkz, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9169 | Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9170 | Injection, tarlatamab-dlle, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9257 | Injection, bevacizumab, 0.25 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9352 | Microporous collagen implantable tube (NeuraGen Nerve Guide), per cm length | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9353 | Microporous collagen implantable slit tube (NeuraWrap Nerve Protector), per cm length | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9354 | Acellular pericardial tissue matrix of nonhuman origin (Veritas), per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9355 | Collagen nerve cuff (NeuroMatrix), per 0.5 cm length | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9356 | Tendon Protector Sheet), per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9358 | Matrix), per 0.5 sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9359 | Putty, Integra OS Osteoconductive Scaffold Putty), per 0.5 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9360 | Matrix), per 0.5 sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9361 | Collagen matrix nerve wrap (NeuroMend Collagen Nerve Wrap), per 0.5 cm length | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9362 | Strip), per 0.5 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9363 | Skin substitute (Integra Meshed Bilayer Wound Matrix), per square cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9364 | Porcine implant, Permacol, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9600 | angioplasty when performed; single major coronary artery or branch | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9601 | in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9602 | coronary angioplasty when performed; single major coronary artery or branch | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9603 | separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9604 | atherectomy and angioplasty, including distal protection when performed; single vessel | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9605 | procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9607 | intracoronary stent, atherectomy and angioplasty; single vessel | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9608 | artery branch, or bypass graft (list separately in addition to code for primary procedure) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9727 | Insertion of implants into the soft palate; minimum of 3 implants | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9734 | magnetic resonance (mr) guidance | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9751 | (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9752 | guidance (e.g., fluoroscopy), lumbar/sacrum | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9762 | segmental dysfunction; with strain imaging | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9763 | segmental dysfunction; with stress imaging | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9764 | when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9765 | angioplasty within the same vessel(s), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9766 | same vessel(s), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9767 | atherectomy, includes angioplasty within the same vessel(s), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9770 | pharmacologic/biologic agent | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9771 | Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9772 | intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9773 | intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9774 | when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9775 | angioplasty within the same vessel(s), when performed | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9784 | system and tissue anchoring components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9785 | insertion, if performed, including all system and tissue anchoring components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9796 | plug (e.g., porcine small intestine submucosa [SIS]) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| C9797 | intervention; for tumors, organ ischemia, or infarction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7810 | Open Reduction Of Dislocation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7820 | Closed Reduction Of Dislocation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7830 | Manipulation Under Anesthesia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7840 | condylectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7850 | Surgical Discectomy, With/Without Implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7852 | Disc Repair | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7854 | Synovectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7856 | Myotomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7858 | Joint Reconstruction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7860 | Arthrotomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7865 | Arthroplasty | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7870 | Arthrocentesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7871 | Non-Arthroscopic Lysis And Lavage | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7873 | arthroscopy: lavage and lysis of adhesions | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7874 | arthroscopy: disc repositioning and stabilization | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7875 | arthroscopy: synovectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7876 | arthroscopy: discectomy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7877 | arthroscopy: debridement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7880 | Occlusal Orthotic Device, By Report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7899 | Unspecified Tmd Therapy, By Report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7940 | Osteoplasty - For Orthognathic Deformities | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7941 | Osteotomy - Mandibular Rami | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7943 | Osteotomy - Mandibular Rami With Bone Graft; Includes Obtaining The Graft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7944 | OSTEOTOMY-SEGMENTED OR SUBAPICAL | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7945 | osteotomy - body of mandible | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7946 | LeFort I (maxilla - total) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7947 | Lefort I (Maxilla - Segmented) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7948 | bone graft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7949 | Lefort Ii Or Lefort Iii - With Bone Graft | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7950 | nonautogenous, by report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7995 | Synthetic Graft - Mandible Or Facial Bones, By Report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D7996 | Implant-Mandible For Augmentation Purposes (Excluding Alveolar Ridge), By Report | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D9950 | Occlusion Analysis - Mounted Case | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D9951 | Occlusal Adjustment - Limited | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| D9952 | Occlusal Adjustment - Complete | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0217 | Water Circ Heat Pad W Pump | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0218 | Fluid circulating cold pad with pump, any type | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0236 | Pump for water circulating pad | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0470 | Respiratory assist device, bi-level pressure capability, without backup rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0471 | Respiratory assist device, bi-level pressure capability, with back-up rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0481 | Intrapulmonary percussive ventilation system and related accessories | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0485 | prefabricated, includes fitting and adjustment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0486 | custom fabricated, includes fitting and adjustment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0490 | electrical stimulation of the tongue muscle, controlled by hardware remote | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0491 | conjunction with the power source and control electronics unit, controlled by hard | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0492 | electrical stimulation of the tongue muscle, controlled by phone application | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0493 | application, 90-day supply | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0530 | and accessories, any type | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0561 | Humidifier, non-heated, used with positive airway pressure device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0562 | Humidifier, heated, used with positive airway pressure device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0601 | Continuous positive airway pressure (cpap) device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0616 | Cardiac Event Recorder | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0617 | Automatic Ext Defibrillator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0650 | Pneuma Compresor Non-Segment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0651 | Pneum Compressor Segmental | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0652 | Pneum Compres W/Cal Pressure | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0655 | Pneumatic Appliance Half Arm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0656 | Segmental pneumatic appliance for use with pneumatic compressor, trunk | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0657 | Segmental pneumatic appliance for use with pneumatic compressor, chest | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0660 | Pneumatic Appliance Full Leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0665 | Pneumatic Appliance Full Arm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0666 | Pneumatic Appliance Half Leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0667 | Seg Pneumatic Appl Full Leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0668 | Seg Pneumatic Appl Full Arm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0669 | Seg Pneumatic Appli Half Leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0670 | and trunk | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0671 | Pressure Pneum Appl Full Leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0672 | Pressure Pneum Appl Full Arm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0673 | Pressure Pneum Appl Half Leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0676 | OTHERWISE | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0677 | Non-pneumatic sequential compression garment, trunk | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0678 | Non-pneumatic sequential compression garment, full leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0679 | Non-pneumatic sequential compression garment, half leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0680 | Non-pneumatic compression controller with sequential calibrated gradient pressure | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0681 | Non-pneumatic compression controller without calibrated gradient pressure | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0682 | Non-pneumatic sequential compression garment, full arm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0691 | area 2 sq ft or less | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0692 | panel | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0693 | panel | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0694 | and eye protection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0732 | Cranial electrotherapy stimulation (ces) system, any type | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0734 | External upper limb tremor stimulator of the peripheral nerves of the wrist | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0735 | Non-invasive vagus nerve stimulator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0745 | Neuromuscular Stim For Shock | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0746 | Electromyograph Biofeedback | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0748 | Elec Osteogen Stim Spinal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0760 | Osteogen Ultrasound Stimltor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0761 | Non-Thermal Pulsed High Frequency Radiowaves, High Peak Power Electrom | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0762 | Transcutaneous electrical joint stimulation device system, includes all accessories | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0764 | groups of ambulation with computer | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0766 | Electrical stimulation device used for cancer treatment, includes all accessories, any type | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0769 | Electrical stimulation or electromagnetic wound treatment device, not otherwise classified | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0770 | any type, complete system, not otherwise specified | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E0986 | Manual wheelchair accessory, push-rim activated power assist, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1002 | Wheelchair accessory, power seating system, tilt only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1003 | Wheelchair accessory, power seating system, recline only, without shear | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1004 | Wheelchair accessory, power seating system, recline only, with mechanical shear | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1005 | Wheelchair accessory, power seatng system, recline only, with power shear | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1006 | reduction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1007 | reduction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1008 | reduction | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1230 | Power Operated Vehicle | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1390 | concentration at the prescribed flow rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1700 | Jaw Motion Rehab System | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1701 | Repl Cushions For Jaw Motion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1702 | Repl Measr Scales Jaw Motion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1801 | motion adjustment, includes all components and accessories | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1806 | motion adjustment, includes all components and accessories | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1811 | motion adjustment, includes all components and accessories | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1816 | motion adjustment, includes all components and accessories | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1818 | motion adjustment, includes all components and accessories | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1821 | Replacement soft interface material/cuffs for bi-directional static progressive stretch device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1831 | adjustment, includes all components and accessories | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1841 | includes all components and acce | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E1905 | software | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| E2298 | Complex rehabilitative power wheelchair accessory, power seat elevation system, any type | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0173 | Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0176 | more) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0251 | course of treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0255 | Current perception threshold/sensory nerve conduction test, (SNCT) per limb, any nerve | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0260 | therapeutic agent, with or without arthrography | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0277 | Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0281 | care | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0282 | described in | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0283 | care, as part of a therapy plan of care | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0289 | compartment of the same knee | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0295 | or for other uses | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0329 | Electromagnetic therapy, to one or more areas, for wound care other than described in | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0339 | therapy in one session or first session of fractionated treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0340 | second through fifth sessions, maximum five sessions per course of treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0341 | Percutaneous islet cell transplant, includes portal vein catheterization and infusion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0342 | Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0343 | Laparotomy for islet cell transplant, includes portal vein catheterization and infusion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0398 | channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0399 | respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0400 | Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0428 | Menaflex) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0429 | result of highly active | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0448 | system, for left ventricular pacing | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0458 | Low dose rate (ldr) prostate brachytherapy services, composite rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0460 | or mixing, and all other preparatory procedures, per treatment) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G0465 | procedures, per treatment) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G2082 | administration observation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G2083 | administration observation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6001 | Ultrasonic guidance for placement of radiation therapy fields | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6002 | therapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6003 | simple blocks or no blocks: up to 5mev | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6004 | simple blocks or no blocks: 6-10mev | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6005 | simple blocks or no blocks: 11-19mev | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6006 | simple blocks or no blocks: 20mev or greater | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6007 | area, use of multiple blocks: up to 5mev | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6008 | area, use of multiple blocks: 6-10mev | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6009 | area, use of multiple blocks: 11-19mev | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6010 | area, use of multiple blocks: 20 mev or greater | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6011 | ports, wedges, rotational beam, compensators, electron beam; up to 5mev | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6012 | ports, wedges, rotational beam, compensators, electron beam; 6-10mev | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6013 | ports, wedges, rotational beam, compensators, electron beam; 11-19mev | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6014 | ports, wedges, rotational beam, compensators, electron beam; 20mev or greater | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6015 | temporally modulated beams, binary, dynamic mlc, per treatment session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6016 | 3 or more high resolution (milled or cast) compensator, convergent beam modulated field | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G6017 | therapy (eg,3d positional tracking, gating, 3d surface tracking), each fracti | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G9143 | specimen(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G9840 | RAS (KRAS and NRAS) gene mutation testing performed before initiation of anti-EGFR MoAb | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| G9841 | RAS (KRAS and NRAS) gene mutation testing not performed before initiation of anti-EGFR MoAb | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H0006 | Alcohol and/or drug services; case management | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H0015 | including assessment, counseling; crisis intervention, and activity therapies or education | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H0017 | board, per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H0019 | program where stay is typically longer than 30 days), without room and board, per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H0023 | Behavioral health outreach service (planned approach to reach a targeted population) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H0035 | Mental health partial hospitalization, treatment, less than 24 hours | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H0038 | Self-help/peer services, per 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H0039 | Assertive community treatment, face-to-face, per 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H0040 | Assertive community treatment program, per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H2014 | Skills training and development, per 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| H2021 | Community-based wrap-around services, per 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0129 | the direct supervision of a physician, not for use when drug is self-administered) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0135 | Adalimumab injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0172 | Injection, aducanumab-avwa, 2 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0174 | Injection, lecanemab-irmb, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0177 | Injection, aflibercept HD, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0178 | Injection, aflibercept, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0180 | Agalsidase beta injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0202 | Injection, alemtuzumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0207 | Amifostine | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0208 | Injection, sodium thiosulfate (Pedmark), 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0217 | Injection, velmanase alfa-tycv, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0218 | Injection, olipudase alfa-rpcp, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0219 | Injection, avalglucosidase alfa-ngpt, 4 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0221 | Injection, alglucosidase alfa, (Lumizyme), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0222 | Injection, Patisiran, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0223 | Injection, givosiran, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0224 | Injection, lumasiran, 0.5 m | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0225 | Injection, vutrisiran, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0256 | Injection, alpha 1-proteinase inhibitor (human), not otherwise specified, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0257 | Injection, alpha 1 proteinase inhibitor (human), (GLASSIA), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0456 | Azithromycin | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0485 | Injection, belatacept, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0490 | Injection, belimumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0491 | Injection, anifrolumab-fnia, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0517 | Injection, benralizumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0558 | Injection, penicillin g benzathine and penicillin g procaine, 100,000 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0561 | Injection, penicillin g benzathine, 100,000 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0565 | Injection, bezlotoxumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0567 | Injection, cerliponase alfa, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0584 | Injection, burosumab-twza 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0585 | Injection, Onabotulinumtoxina, 1 Unit | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0586 | Injection, Abobotulinumtoxina, 5 Units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0587 | Injection, Rimabotulinumtoxinb, 100 Units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0588 | Injection, incobotulinumtoxinA, 1 unit | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0589 | Injection, daxibotulinumtoxina-lanm, 1 unit | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0593 | under direct supervision of a physician, not for use when drug is self-administered) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0596 | Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0597 | Injection, c-1 esterase inhibitor (human), berinert, 10 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0598 | Injection, c-1 esterase inhibitor (human), cinryze, 10 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0599 | Injection, C-1 esterase inhibitor (human), (Haegarda), 10 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0638 | Injection, canakinumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0641 | Injection, levoleucovorin, not otherwise specified, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0642 | Injection, levoleucovorin (khapzory), 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0690 | Cefazolin Sodium Injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0696 | Ceftriaxone Sodium Injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0698 | Cefotaxime Sodium Injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0717 | under the direct supervision of a physician, not for use when drug is self-administered) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0741 | Injection, cabotegravir and rilpivirine, 2 mg/3 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0743 | Cilastatin Sodium Injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0775 | Injection, collagenase, clostridium histolyticum, 0.01 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0791 | Injection, crizanlizumab-tmca, 5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0800 | Injection, corticotropin, up to 40 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0801 | Injection, corticotropin (Acthar Gel), up to 40 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0802 | Injection, corticotropin (ANI), up to 40 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0881 | Injection, darbepoetin alfa, 1 mcg (non-ESRD use) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0882 | Injection, darbepoetin alfa, 1 mcg (for ESRD on dialysis) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0885 | Injection, epoetin alfa, (for non-ESRD use), 1000 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0887 | Injection, epoetin beta, 1 microgram, (for esrd on dialysis) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0888 | Injectin, epoetin beta, 1 microgram, (for non esrd use) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0896 | Injection, luspatercept-aamt, 0.25 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J0897 | Injection, denosumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1203 | Injection, cipaglucosidase alfa-atga, 5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1267 | Injection, doripenem, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1290 | Injection, ecallantide, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1300 | Injection, eculizumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1301 | Injection, edaravone, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1302 | Injection, sutimlimab-jome, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1303 | Injection, ravulizumab-cwvz, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1304 | Injection, tofersen, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1305 | Injection, evinacumab-dgnb, 5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1306 | Injection, inclisiran, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1322 | Injection, elosulfase alfa, 1mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1323 | Injection, elranatamab-bcmm, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1325 | Epoprostenol Injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1335 | Injection, ertapenem sodium, 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1411 | Injection, etranacogene dezaparvovec-drlb, per therapeutic dose | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1412 | genomes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1413 | Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1426 | Injection, casimersen, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1427 | Injection, viltolarsen, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1428 | Injection, eteplirsen, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1429 | Injection, golodirsen, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1437 | Injection, ferric derisomaltose, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1438 | Etanercept Injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1439 | Injection, ferric carboxymaltose, 1mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1440 | Fecal microbiota, live - jslm, 1 ml | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1442 | 5G-CSFexcludes biosimilars, 1 microgram | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1447 | Injection, tbo-filgrastim, 1 microgram | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1448 | Injection, trilaciclib, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1449 | Injection, eflapegrastim-xnst, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1450 | Fluconazole | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1454 | Injection, fosnetupitant 235 mg and palonosetron 0.25 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1458 | INJECTION, GALSULFASE, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1459 | Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1460 | Gamma Globulin 1 Cc Inj | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1551 | Injection, immune globulin (cutaquig), 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1554 | Injection, immune globulin (asceniv), 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1555 | Injection, immune globulin (Cuvitru), 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1556 | Injection, immune globulin (bivigam), 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1557 | Injection, immune globulin, (Gammaplex), intravenous, nonlyophilized (e.g., liquid), 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1558 | Injection, immune globulin (xembify), 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1559 | Injection, immune globulin (hizentra), 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1560 | Gamma Globulin > 10 Cc Inj | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1561 | 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1566 | 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1569 | Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1572 | liquid), 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1575 | Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1576 | Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1595 | Injection, glatiramer acetate, 20 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1599 | 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1628 | Injection, guselkumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1632 | Injection, brexanolone, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1675 | Injection, histrelin acetate, 10 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1729 | Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1743 | Injection, idursulfase, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1744 | Injection, icatibant, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1746 | Injection, ibalizumab-uiyk, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1747 | Injection, spesolimab-sbzo, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1748 | Injection, infliximab-dyyb (Zymfentra), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1750 | Injection, Iron Dextran, 50mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1756 | Injection, Iron Sucrose, 1 Mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1786 | Injection, imiglucerase, 10 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1815 | Injection, Insulin, Per 5 Units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1817 | Insulin For Administration Through Dme (I.E., Insulin Pump) Per 50 U | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1823 | Injection, inebilizumab-cdon, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1826 | Injection, interferon beta-1a, 30 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1830 | Interferon Beta-1b / .25 Mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1930 | Injection, lanreotide, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1931 | Laronidase injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1932 | Injection, lanreotide, (cipla), 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1951 | Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 m | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1954 | Injection, leuprolide acetate for depot suspension (cipla), 7.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1956 | Levofloxacin Injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J1961 | Injection, lenacapavir, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2170 | INJECTION, MECASERMIN, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2182 | Injection, mepolizumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2185 | Injection, meropenem, 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2267 | Injection, mirikizumab-mrkz, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2277 | Injection, motixafortide, 0.25 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2278 | Injection, ziconotide, 1 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2280 | Injection, moxifloxacin, 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2323 | Imjection, natalizumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2326 | Injection, nusinersen, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2327 | Injection, risankizumab-rzaa, intravenous, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2329 | Injection, ublituximab-xiiy, 1mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2350 | Injection, ocrelizumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2353 | Injection, octreotide, depot form for intramuscular injection, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2354 | Injection, octreotide, non-depot form for subcutaneous or intravenous | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2356 | Injection, tezepelumab-ekko, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2357 | Omalizumab injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2502 | Injection, pasireotide long acting, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2503 | Injection, pegaptanib sodium, 0.3 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2505 | Injection, pegfilgrastim, 6 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2507 | Injection, pegloticase, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2508 | Injection, pegunigalsidase alfa-iwxj, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2510 | Penicillin G Procaine Inj | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2540 | Penicillin G Potassium Inj | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2562 | Injection, Plerixafor, 1 Mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2778 | Injection, ranibizumab, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2779 | Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2782 | Injection, avacincaptad pegol, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2786 | Injection, reslizumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2793 | Injection, Rilonacept, 1 Mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2796 | Injection, Romiplostim, 10 Micrograms | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2820 | Sargramostim Injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2840 | Injection, sebelipase alfa, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2860 | Injection, siltuximab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2916 | Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2940 | Injection, somatrem, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2941 | Injection, somatropin, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J2998 | Injection, plasminogen, human-tvmh, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3032 | Injection, eptinezumab-jjmr, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3055 | Injection, talquetamab-tgvs, 0.25 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3060 | Injection, taliglucerace alfa, 10 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3241 | Injection, teprotumumab-trbw, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3245 | Injection, tildrakizumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3247 | Injection, secukinumab, IV, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3262 | Injection, tocilizumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3263 | Injection, toripalimab-tpzi, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3285 | Injection, treprostinil, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3299 | Injection, triamcinolone acetonide (xipere), 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3304 | formulation, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3315 | Injection, Triptorelin Pamoate, 3.75 Mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3316 | Injection, triptorelin, extended-release, 3.75 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3357 | Ustekinumab, for subcutaneous injection, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3358 | Ustekinumab, for intravenous injection, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3380 | Injection, vedolizumab, IV, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3385 | Injection, velaglucerase alfa, 100 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3393 | Injection, betibeglogene autotemcel, per treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3394 | Injection, lovotibeglogene autotemcel, per treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3397 | Injection, vestronidase alfa-vjbk, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3398 | Injection, voretigene neparvovec-rzyl, 1 billion vector genomes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3399 | Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3401 | vector genomes, per 0.1 ml | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3489 | Injection, zoledronic acid, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J3590 | UNCLASSIFIED BIOLOGICS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7171 | Injection, ADAMTS13, recombinant-krhn, 10 IU | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7175 | Injection, factor x, (human), 1 i.u | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7177 | Injection, human fibrinogen concentrate (Fibryga), 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7178 | Injection, human fibrinogen concentrate, not otherwise specified, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7179 | Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7180 | Injection, factor XIII (antihemophilic factor, human), 1 IU | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7181 | Injection, factor xiii a-subunit, (recombinant), per iu | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7182 | Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7183 | Injection, von Willebrand factor complex (human), Wilate, 1 IU vWF:RCo | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7185 | Injection, Factor Viii (Antihemophilic Factor, Recombinant) (Xyntha), Per I.U | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7186 | Injection, antihemophilic factor VIII/von Willebrand factor complex (human), per factor VIII i.u | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7187 | Injection, von Willebrand factor complex (Humate-P), per IU vWF-RC0 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7188 | Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7189 | Factor VIIa (antihemophilic Factor, recombinant), per 1 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7190 | Factor Viii | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7191 | Factor Viii (Porcine) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7192 | Factor Viii (Antihemophilic Factor, Recombinant) Per I.U., Not Otherwise Specified | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7193 | Factor IX (antihemophilic factor, purified, non-recombinant) per IU | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7194 | Factor Ix Complex | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7195 | Factor IX (antihemophilic factor, recombinant) per IU | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7198 | Anti-Inhibitor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7200 | Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7201 | Injection, factor IX, Fc fusion protein, (recombinant), Alprolix, 1 IU | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7202 | Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7203 | Injection Factor IX, (antihemophilic factor, recombinant), glycopegylated, (Rebinyn), 1 IU | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7204 | per IU | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7205 | Injection, factor viii fc fusion (recombinant), per iu | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7207 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7208 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7209 | Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7210 | Injection, Factor VIII, (antihemophilic factor, recombinant), (Afstyla), 1 IU | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7211 | Injection, Factor VIII, (antihemophilic factor, recombinant), (Kovaltry), 1 IU | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7212 | Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7213 | Injection, coagulation factor ix (recombinant), ixinity, 1 i.u | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7214 | Injection, Factor VIII/von Willebrand factor complex, recombinant (Altuviiio), per Factor VIII IU | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7311 | Injection, fluocinolone acetonide, intravitreal implant (Retisert), 0.01 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7313 | Injection, fluocinolone acetonide, intravitreal implant (Iluvien), 0.01 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7314 | Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7330 | Cultured Chondrocytes Implnt | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7340 | Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7351 | Injection, bimatoprost, intracameral implant, 1 microgram | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7352 | Afamelanotide implant, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7353 | Anacaulase-bcdb, 8.8% gel, 1 gm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7354 | Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7355 | Injection, travoprost, intracameral implant, 1 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7402 | Mometasone furoate sinus implant, (sinuva), 10 micrograms | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J7686 | through dme, unit dose form, 1.74 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9015 | Injection, aldesleukin, per single use vial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9019 | Injection, asparaginase (erwinaze), 1,000 iu | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9021 | Injection, asparaginase, recombinant, (rylaze), 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9022 | Injection, atezolizumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9023 | Injection, avelumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9029 | Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9032 | Injection, belinostat, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9033 | Injection, bendamustine hydrochloride, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9034 | Injection, bendamustine hcl (bendeka), 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9035 | Bevacizumab injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9036 | Injection, bendamustine hydrochloride, (Belrapzo), 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9039 | Injection, blinatumomab, 1 microgram | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9042 | Injection, brentuximab vedotin, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9043 | Injection, cabazitaxel, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9047 | Injection, carfilzomib, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9055 | Cetuximab injection | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9056 | Injection, bendamustine hydrochloride (vivimusta), 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9057 | Injection, copanlisib, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9058 | Injection, bendamustine hydrochloride (apotex), 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9059 | Injection, bendamustine hydrochloride (baxter), 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9061 | Injection, amivantamab-vmjw, 2 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9063 | Injection, mirvetuximab soravtansine-gynx, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9064 | Injection, cabazitaxel (Sandoz), not therapeutically equivalent to , 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9118 | Injection, calaspargase pegol-mknl, 10 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9119 | Injection, cemiplimab-rwlc, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9145 | Injection, daratumumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9173 | Injection, durvalumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9176 | Injection, elotuzumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9177 | Injection, enfortumab vedotin-ejfv, 0.25 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9179 | Injection, eribulin mesylate, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9202 | Goserelin Acetate Implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9203 | Injection, gemtuzumab ozogamicin, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9207 | Injection, ixabepilone, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9210 | Injection, emapalumab-lzsg, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9216 | Injection, interferon, gamma-1B, 3 million units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9217 | Leuprolide Acetate Suspnsion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9223 | Injection, lurbinectedin, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9225 | Histrelin implant (Vantas), 50 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9226 | Histrelin implant (supprelin LA), 50 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9227 | Injection, isatuximab-irfc, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9228 | Injection, ipilimumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9229 | Injection, inotuzumab ozogamicin, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9247 | Injection, melphalan flufenamide, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9258 | mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9259 | to , 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9262 | Injection, omacetaxine mepesuccinate, 0.01 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9264 | to , 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9266 | Injection, pegaspargase, per single dose vial | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9269 | Injection, tagraxofusp-erzs, 10 micrograms | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9271 | Injection, pembrolizumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9272 | Injection, dostarlimab-gxly, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9273 | Injection, tisotumab vedotin-tftv, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9274 | Injection, tebentafusp-tebn, 1 microgram | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9281 | Mitomycin pyelocalyceal instillation, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9286 | Injection, glofitamab-gxbm, 2.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9294 | Injection, pemetrexed (Hospira), not therapeutically equivalent to , 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9296 | Injection, pemetrexed (Accord), not therapeutically equivalent to , 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9297 | Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9298 | Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9299 | Injection, nivolumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9301 | Injection, obinutuzumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9302 | Injection, ofatumumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9303 | Injection, panitumumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9304 | Injection, pemetrexed (pemfexy), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9305 | Injection, pemetrexed (Hospira), not therapeutically equivalent to , 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9306 | Injection, pertuzumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9308 | Injection, ramucirumab, 5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9309 | Injection, polatuzumab vedotin-piiq, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9312 | Injection, rituximab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9313 | Injection, moxetumomab pasudotox-tdfk, 0.01 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9314 | Injection, pemetrexed (Teva), not therapeutically equivalent to , 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9316 | Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9317 | Injection, sacituzumab govitecan-hziy, 2.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9318 | Injection, romidepsin, nonlyophilized, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9319 | Injection, romidepsin, lyophilized, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9321 | Injection, epcoritamab-bysp, 0.16 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9322 | Injection, pemetrexed (BluePoint), not therapeutically equivalent to , 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9323 | Injection, pemetrexed (hospira) not therapeutically equivalent to j9305, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9324 | Injection, pemetrexed (pemrydi rtu), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9325 | Injection, talimogene laherparepvec, per 1 million plaque forming units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9329 | Injection, tislelizumab-jsgr, 1mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9331 | Injection, sirolimus protein-bound particles, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9332 | Injection, efgartigimod alfa-fcab, 2mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9333 | Injection, rozanolixizumab-noli, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9334 | Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9345 | Injection, retifanlimab-dlwr, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9347 | Injection, tremelimumab-actl, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9348 | Injection, naxitamab-gqgk, 1 m | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9349 | Injection, tafasitamab-cxix, 2 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9350 | Injection, mosunetuzumab-axgb, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9353 | Injection, margetuximab-cmkb, 5 m | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9354 | Injection, ado-trastuzumab emtansine, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9358 | Injection, fam-trastuzumab deruxtecan-nxki, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9359 | Injection, loncastuximab tesirine-lpyl, 0.075 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9361 | Injection, efbemalenograstim alfa-vuxw, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9376 | Injection, pozelimab-bbfg, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9380 | Injection, teclistamab-cqyv, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9381 | Injection, teplizumab-mzwv, 5 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9393 | Injection, fulvestrant (Teva), not therapeutically equivalent to , 25 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9394 | Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9395 | Injection, fulvestrant (Teva), not therapeutically equivalent to , 25 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| J9400 | Injection, ziv-aflibercept, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0010 | Standard-weight frame motorized/power wheelchair | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0011 | for speed adjustment, tremor dampening, acceleration control and braking | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0012 | Lightweight portable motorized/power wheelchair | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0013 | Custom motorized/power wheelchair base | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0014 | Other motorized/power wheelchair base | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0455 | Pump Uninterrupted Infusion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0606 | Automatic external defibrillator, with integrated electrocardiogram analysis, garment type | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0800 | INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0801 | POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0802 | TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0806 | INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0807 | POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0808 | TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0812 | POWER OPERATED VEHICLE, NOT OTHERWISE CLASSIFIED | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0813 | PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0814 | CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0815 | CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0816 | UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0820 | WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0821 | CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0822 | CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0823 | UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0824 | CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0825 | 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0826 | WEIGHT CAPACITY 451 TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0827 | CAPACITY 451 TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0828 | WEIGHT CAPACITY 601 POUNDS OR MORE | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0829 | CAPACITY 601 POUNDS OR MORE | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0830 | PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0831 | WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0835 | SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0836 | PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0837 | SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0838 | PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0839 | SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0840 | SEAT/BACK, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0841 | SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0842 | PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0843 | SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0848 | CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0849 | UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0850 | CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0851 | 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0852 | WEIGHT CAPACITY 451 TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0853 | CAPACITY, 451 TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0854 | WEIGHT CAPACITY 601 POUNDS OR MORE | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0855 | CAPACITY 601 POUNDS OR MORE | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0856 | SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0857 | PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0858 | SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0859 | PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0860 | SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0861 | SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0862 | SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0863 | SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0864 | SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0868 | CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0869 | UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0870 | CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0871 | WEIGHT CAPACITY 451 TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0877 | SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0878 | PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0879 | SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0880 | SEAT/BACK, PATIENT WEIGHT 451 TO 600 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0884 | SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0885 | WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0886 | SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0890 | SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 125 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K0891 | SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 125 POUNDS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1001 | and accessories, any type | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1004 | and accessories | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1007 | components and accessories, motors, microprocessors, sensors | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1018 | External upper limb tremor stimulator of the peripheral nerves of the wrist | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1019 | the wrist | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1020 | Non-invasive vagus nerve stimulator | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1024 | Nonpneumatic compression controller with sequential calibrated gradient pressure | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1025 | Nonpneumatic sequential compression garment, full arm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1030 | modulation generator, replacement only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1031 | Nonpneumatic compression controller without calibrated gradient pressure | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1032 | Nonpneumatic sequential compression garment, full leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1033 | Nonpneumatic sequential compression garment, half leg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| K1036 | device, per month | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L5991 | Addition to lower extremity prostheses, osseointegrated external prosthetic connector | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6025 | charger, myoelectric control of terminal device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6026 | batteries, charger, myoelectric control of terminal device, excludes terminal device(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6611 | ADDITION TO UPPER EXTREMITY PROSTHESIS, EXTERNAL POWERED, ADDITIONAL SWITCH | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6677 | and elbow | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6715 | Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6880 | pattern or combination of grasp patterns, includes motor(s) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6881 | AUTOMATIC GRASP FEATURE, ADDITION TO UPPER LIMB ELECTRIC PROSTHETIC TERMINAL | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6882 | Microprocessor control feature, addition to upper limb prosthesis terminal device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6925 | terminal device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6935 | terminal device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6945 | myoelectronic control of terminal device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6955 | myoelectronic control of terminal device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6965 | electrodes, cables, two batteries and one charger, myoelectronic control of terminal device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L6975 | electrodes, cables, two batteries and one charger, myoelectronic control of terminal device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L7190 | Electronic elbow, adolescent, Variety Village or equal, myoelectronically controlled | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L7191 | Electronic elbow, child, Variety Village or equal, myoelectronically controlled | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L7510 | Repair of prosthetic device, repair or replace minor parts | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L7520 | Repair prosthetic device, labor component, per 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8045 | Auricular prosthesis, provided by a nonphysician | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8600 | Implantable breast prosthesis, silicone or equal | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8607 | supplies | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8614 | COCHLEAR DEVICE, INCLUDES ALL INTERNAL AND EXTERNAL COMPONENTS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8619 | Cochlear Implant, External Speech Processor And Controller, Integrated System, Replacement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8627 | Cochlear Implant, External Speech Processor, Component, Replacement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8628 | Cochlear Implant, External Controller Component, Replacement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8678 | Electrical stimulator supplies (external) for use with implantable neurostimulator, per month | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8679 | Implantable neurostimulator, pulse generator, any type | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8680 | Implantable neurostimulator electrode, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8681 | generator, replacement only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8682 | Implantable neurostimulator radiofrequency receiver | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8683 | radiofrequency receiver | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8684 | receiver for bowel and bladder management, replacement | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8685 | Implantable neurostimulator pulse generator, single array, rechargeable, includes extension | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8686 | extension | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8687 | Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8688 | extension | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8690 | COMPONENTS | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8691 | replacement only, each | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8692 | body worn, includes headband or other means of external attachment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8693 | Auditory osseointegrated device abutment, any length, replacement only | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8701 | custom fabricated | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| L8702 | custom fabricated | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| M0075 | Cellular Therapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q0138 | Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (Non-Esrd Use) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2026 | Injection, Radiesse, 0.1ml | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2028 | Injection, sculptra, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2041 | including leukapheresis and dose preparation procedures, per therapeutic dose | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2042 | dose preparation procedures, per therapeutic dose | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2043 | including leukapheresis and all other preparatory procedures, per infusion | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2049 | Injection, doxorubicin hydrochloride, liposomal, imported Lipodox, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2050 | Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2053 | including leukapheresis and dose preparation procedures, per therapeutic dose | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2054 | including leukapheresis and dose preparation procedures, per therapeutic dose | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2055 | therapeutic dose | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q2056 | directed car-positive t cells, including leukapheresis and dose preparation procedures | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q3001 | Brachytherapy Radioelements | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q3027 | Injection, interferon beta-1a, 1 mcg for intramuscular use | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q3028 | Injection, interferon beta-1a, 1 mcg for subcutaneous use | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4074 | through DME, unit dose form, up to 20 mcg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4081 | INJECTION, EPOETIN ALFA, 100 UNITS (FOR ESRD ON DIALYSIS) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4100 | Skin substitute, not otherwise specified | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4101 | Apligraf, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4102 | Oasis wound matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4103 | Oasis burn matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4104 | Integra bilayer matrix wound dressing (bmwd), per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4105 | per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4106 | Dermagraft, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4107 | Graftjacket, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4108 | Integra matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4110 | Primatrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4111 | Gammagraft, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4112 | Cymetra, injectable, 1cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4113 | GRAFTJACKET XPRESS, injectable, 1cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4114 | Integra flowable wound matrix, injectable, 1 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4115 | Alloskin, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4116 | Alloderm, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4117 | Hyalomatrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4118 | Matristem micromatrix, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4121 | Theraskin, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4122 | Dermacell, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4123 | AlloSkin RT, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4124 | OASIS ultra tri-layer wound matrix, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4125 | Arthroflex, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4126 | MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4127 | Talymed, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4128 | FlexHD, or AllopatchHD, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4130 | Strattice TM, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4132 | Grafix Core and GrafixPL Core, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4133 | Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4134 | Hmatrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4135 | Mediskin, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4136 | Ez-derm, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4137 | AmnioExcel, AmnioExcel Plus or BioDExcel, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4138 | Biodfence dryflex, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4139 | Amniomatrix or biodmatrix, injectable, 1 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4140 | Biodfence, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4141 | Alloskin ac, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4142 | Xcm biologic tissue matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4143 | Repriza, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4145 | Epifix, injectable, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4146 | Tensix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4147 | Architect extracellular matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4148 | Neox Cord 1K, Neox Cord RT, or Clarix Cord 1K, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4149 | Excellagen, 0.1 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4150 | Allowrap ds or dry, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4151 | Amnioband or guardian, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4152 | Dermapure, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4153 | Dermavest, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4154 | Biovance, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4155 | Neoxflo or clarixflo, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4156 | Neox 100 or Clarix 100, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4157 | Revitalon, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4158 | Kerecis Omega3, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4159 | Affinity, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4160 | Nushield, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4161 | Bio-connekt wound matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4162 | WoundEx Flow, BioSkin Flow, 0.5 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4163 | WoundEx, BioSkin, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4164 | Helicoll, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4165 | Keramatrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4166 | Cytal, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4167 | Truskin, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4168 | Amnioband, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4169 | Artacent wound, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4170 | Cygnus, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4171 | Interfyl, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4173 | Palingen or palingen xplus, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4174 | Palingen or promatrx, 0.36 mg per 0.25 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4175 | Miroderm, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4176 | Neopatch or Therion, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4177 | FlowerAmnioFlo, 0.1 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4178 | FlowerAmnioPatch, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4179 | FlowerDerm, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4180 | Revita, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4181 | Amnio Wound, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4183 | Surgigraft, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4184 | Cellesta, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4185 | Cellesta Flowable Amnion (25 mg per cc); per 0.5 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4186 | Epifix, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4187 | Epicord, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4188 | AmnioArmor, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4189 | Artacent AC, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4190 | Artacent AC, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4191 | Restorigin, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4192 | Restorigin, 1 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4193 | Coll-e-Derm, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4194 | Novachor, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4195 | PuraPly, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4196 | PuraPly AM, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4197 | PuraPly XT, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4198 | Genesis Amniotic Membrane, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4199 | Cygnus matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4200 | SkinTE, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4201 | Matrion, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4202 | Keroxx (2.5g/cc), 1cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4203 | Derma-Gide, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4204 | XWRAP, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4205 | Membrane graft or membrane wrap, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4206 | Fluid flow or fluid GF, 1 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4208 | Novafix, per square cenitmeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4209 | Surgraft, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4210 | Axolotl graft or axolotl dualgraft, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4211 | Amnion bio or Axobiomembrane, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4212 | Allogen, per cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4213 | Ascent, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4214 | Cellesta cord, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4215 | Axolotl ambient or axolotl cryo, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4216 | Artacent cord, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4217 | square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4218 | Surgicord, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4219 | Surgigraft-dual, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4220 | BellaCell HD or Surederm, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4221 | Amniowrap2, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4222 | Progenamatrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4224 | Human Health Factor 10 Amniotic Patch (HHF10-P), per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4225 | Amniobind or dermabind tl, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4226 | MyOwn skin, includes harvesting and preparation procedures, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4227 | AmnioCoreTM, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4229 | Cogenex Amniotic Membrane, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4230 | Cogenex Flowable Amnion, per 0.5 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4231 | Corplex P, per cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4232 | Corplex, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4233 | SurFactor or NuDyn, per 0.5 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4234 | XCellerate, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4235 | AMNIOREPAIR or AltiPly, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4236 | carePATCH, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4237 | Cryo-Cord, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4238 | Derm-Maxx, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4239 | Amnio-Maxx or Amnio-Maxx Lite, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4240 | CoreCyte, for topical use only, per 0.5 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4241 | PolyCyte, for topical use only, per 0.5 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4242 | AmnioCyte Plus, per 0.5 cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4244 | Procenta, per 200 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4245 | AmnioText, per cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4246 | CoreText or ProText, per cc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4247 | Amniotext patch, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4248 | Dermacyte Amniotic Membrane Allograft, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4249 | Amniply, for topical use only, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4250 | Amnioamp-mp, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4251 | Vim, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4252 | Vendaje, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4253 | Zenith Amniotic Membrane, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4254 | Novafix DL, per sq c | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4255 | Reguard, for topical use only, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4256 | MLG-Complete, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4257 | Relese, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4258 | Enverse, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4259 | Celera dual layer or celera dual membrane, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4260 | Signature apatch, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4261 | Tag, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4262 | Dual layer impax membrane, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4263 | Surgraft tl, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4264 | Cocoon membrane, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4265 | Neostim tl, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4266 | Neostim membrane, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4267 | Neostim dl, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4268 | Surgraft ft, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4269 | Surgraft xt, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4270 | Complete sl, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4271 | Complete ft, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4272 | Esano a, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4273 | Esano aaa, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4274 | Esano ac, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4275 | Esano aca, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4276 | Orion, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4277 | Woundplus membrane or e-graft, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4278 | Epieffect, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4279 | Vendaje ac, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4280 | Xcell amnio matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4281 | Barrera sl or barrera dl, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4282 | Cygnus dual, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4283 | Biovance tri-layer or biovance 3l, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4284 | Dermabind sl, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4285 | NuDYN DL or NuDYN DL MESH, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4286 | NuDYN SL or NuDYN SLW, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4287 | Dermabind dl, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4288 | Dermabind ch, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4289 | Revoshield + amniotic barrier, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4290 | Membrane Wrap-Hydro, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4291 | Lamellas xt, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4292 | Lamellas, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4293 | Acesso dl, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4294 | Amnio quad-core, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4295 | Amnio tri-core amniotic, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4296 | Rebound matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4297 | Emerge matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4298 | Amnicore pro, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4299 | Amnicore pro+, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4300 | Acesso tl, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4301 | Activate matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4302 | Complete aca, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4303 | Complete aa, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4304 | Grafix plus, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4305 | American Amnion AC Tri-Layer, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4306 | American Amnion AC, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4307 | American Amnion, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4308 | Sanopellis, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4309 | VIA Matrix, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q4310 | Procenta, per 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5101 | Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5105 | Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for ESRD on dialysis), 100 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for non-ESRD use), 1000 units | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (Mvasi), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5108 | Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5109 | Injection, infliximab-qbtx, biosimilar, (Ixifi), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5111 | Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5112 | Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5113 | Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5114 | Injection, trastuzumab-dkst, biosimilar, (Ogivri), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5115 | Injection, rituximab-abbs, biosimilar, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5116 | Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5118 | Injection, bevacizumab-bvzr, biosimilar, (Zirabev), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (RUXIENCE), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5120 | Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5121 | Injection, infliximab-axxq, biosimilar, (AVSOLA), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5122 | Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 m | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (Byooviz), 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5125 | Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5126 | Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5127 | Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5129 | Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5130 | Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5131 | Injection, adalimumab-aacf (idacio), biosimilar, 20 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5132 | Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5133 | Injection, tocilizumab-bavi (Tofidence), biosimilar, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5134 | Injection, natalizumab-sztn (Tyruko), biosimilar, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5135 | Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5137 | Injection, ustekinumab-auub (Wezlana), biosimilar, SC, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| Q5138 | Injection, ustekinumab-auub (Wezlana), biosimilar, IV, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S0013 | Esketamine, nasal spray, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S0353 | Treatment planning and care coordination management for cancer initial treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S0354 | change of regimen | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S1091 | Stent, non-coronary, temporary, with delivery system (propel) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2053 | Transplantation Of Small Int | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2054 | Transplantation Of Multivisc | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2055 | Harvesting Of Donor Multivis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2060 | Lobar Lung Transplantation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2061 | Donor Lobectomy (Lung) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2065 | Simultaneous pancreas kidney transplantation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2066 | Breast reconstruction with gluteal artery perforator (GAP) flap, including | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2067 | Breast reconstruction of a single breast with "stacked" deep inferior | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2068 | donor site and shaping the flap into a breast, unilateral | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2080 | Laser-assisted uvulopalatoplasty (LAUP) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2102 | Islet Cell Tissue Transplant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2103 | Adrenal Tissue Transplant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2107 | infiltrating lymphocyte therapy) per course of treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2112 | Arthroscopy, knee, surgical for harvesting of cartilage (chondrocyte cells) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2117 | Arthroereisis, subtalar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2118 | Metal-on-metal total hip resurfacing including acetabular and femoral components | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2120 | Low Density Lipoprotein(Ldl) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2140 | Cord Blood Harvesting | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2142 | Cord Blood-Derived Stem-Cell | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2150 | number of days of pre- and posttransplant care in the global definition | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2202 | Echosclerotherapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2230 | ear | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2235 | Implantation of auditory brain stem implant | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2300 | Arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2340 | Chemodenervation Of Abductor | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2341 | Chemodenervation of adductor muscle(s) of vocal cord | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2348 | Decompress disc RF lumbar | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2400 | Repair, congenital hernia in the fetus, procedure performed in utero | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2401 | Repair, urinary tract obstruction in the fetus, procedure performed in utero | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2402 | utero | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2403 | Repair, extralobar pulmonary sequestration in the fetus, procedure performed in utero | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2404 | Repair, myelomeningocele in the fetus, procedure performed in utero | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2405 | Repair of sacrococcygeal teratoma in the fetus, procedure performed in utero | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S2409 | classified | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3800 | Genetic testing for amyotrophic lateral sclerosis (ALS) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3840 | DNA analysis for germline mutations of the ret proto-oncogene | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3841 | Genetic testing for retinoblastoma | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3842 | Genetic testing for von hippel-lindau disease | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3844 | DNA analysis of the connexin 26 gene (gjb2) for susceptibility to congenital, profound deafness | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3845 | Genetic testing for alpha-thalassemia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3846 | Genetic testing for hemoglobin e beta-thalassemia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3849 | Genetic testing for niemann-pick disease | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3850 | Genetic testing for sickle cell anemia | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3852 | DNA analysis for apoe epilson 4 allele for susceptibility to Alzheimer's disease | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3853 | Genetic testing for myotonic muscular dystrophy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3854 | Gene expression profiling panel for use in the management of breast cancer treatment | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3861 | suspected Brugada Syndrome | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3865 | Comprehensive gene sequence analysis for hypertrophic cardiomyopathy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3866 | individual with a known HCM mutation in the family | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3870 | spectrum disorder and/or intellectual disability | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S3900 | Surface electromyography (EMG) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4011 | determination of development | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4013 | Complete Cycle, Gamete Intrafallopian Transfer (Gift), Case Rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4014 | Complete Cycle, Zygote Intrafallopian Transfer (Zift), Case Rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4015 | Complete in vitro fertilization cycle, case rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4016 | Frozen in vitro fertilization cycle, case rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4017 | Incomplete Cycle, Treatment Cancelled Prior To Stimulation, Case Rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4018 | Frozen embryo transfer procedure cancelled before transfer, case rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4020 | In vitro fertilization procedure cancelled before aspiration, case rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4021 | In vitro fertilization procedure cancellation after aspiration, case rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4022 | Assisted oocyte fertilization, case rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4023 | Donor Egg Cycle, Incomplete, Case Rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4025 | Donor services for in vitro fertilization (sperm or embryo), case rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4026 | Procurement of donor sperm from sperm bank | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4027 | Storage of previously frozen embryos | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4028 | Microsurgical epididymal sperm aspiration (mesa) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4030 | Sperm procurement and cryopreservation services; initial visit | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4031 | Sperm procurement and cryopreservation services; subsequent visit | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4035 | Stimulated Intrauterine Insemination (Iui), Case Rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4037 | Cryopreserved Embryo Transfer, Case Rate | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S4040 | Monitoring And Storage Of Cryopreserved Embryos, Per 30 Days | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8030 | Scleral application of tantalum ring(s) for localization of lesions for proton beam therapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8035 | Magnetic Source Imaging | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8037 | Magnetic resonance cholangiopancreatography (MRCP) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8040 | Topographic Brain Mapping | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8092 | Electron Beam Computed Tomog | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8130 | Interferential current stimulator, 2 channel | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8131 | Interferential current stimulator, 4 channel | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8930 | one contact with patient | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8940 | EQUESTRIAN/HIPPOTHERAPY PER SESSION | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8948 | Application of a modality (requiring constant provider attendance) to one or | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8950 | Complex Lymphedema Therapy | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S8990 | Physical or manipulative therapy performed for maintenance rather than restoration | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9002 | device | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9056 | Coma Stimulation Per Diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9090 | Vertebral Axial Decompressio | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9123 | to be used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9124 | Nursing care, in the home; by licensed practical nurse, per hour | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9152 | Speech therapy, re-evaluation | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9347 | (e.g., Epoprostenol) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9359 | Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e.g., Infliximab) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9364 | using daily volume scales) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9365 | using daily volume scales) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9366 | separately), per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9368 | using daily volume scales) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9480 | Intensive outpatient psychiatric services, per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9494 | codes for hourly dosing schedules - ) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9497 | codes for hourly dosing schedules - ) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9500 | supplies and equipment (drugs and nursing visits coded separately), per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9501 | supplies and equipment (drugs and nursing visits coded separately), per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9502 | supplies and equipment (drugs and nursing visits coded separately), per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9503 | equipment (drugs and nursing visits coded separately), per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9504 | codes for hourly dosing schedules - ) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9558 | nursing visits coded separately), per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9559 | visits coded separately), per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9562 | supplies and equipment (drugs and nursing visits coded separately), per diem | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9960 | Ambulance service, conventional air services, nonemergency transport, one way (fixed wing) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| S9961 | Ambulance service, conventional air service, nonemergency transport, one way (rotary wing) | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| T2036 | Therapeutic camping, overnight, waiver; each session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| T2037 | Therapeutic camping, day, waiver; each session | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| V2787 | Astigmatism correcting function of intraocular lens | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| V2788 | Presbyopia correcting function of intraocular lens | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| V2790 | Amniotic Membrane | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| V5095 | Semi-Implantable Middle Ear Hearing Prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| V5362 | Speech Screening | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| V5363 | Language Screening | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |
| V5364 | Dysphagia Screening | 2026-07-06 | Not listed | 97% | [PDF] Section III. Prior Authorizations and Concurrent Review - Cigna PA-CPT |