Cigna policy
Anesthesia and Facility Services for Dental Treatment
Anesthesia and Facility Services for Dental Treatment is a public Cigna policy (policy 0415, effective Aug 15, 2025). It lists 18 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
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- Payer
- Cigna
- Policy number
- 0415
- Effective
- Aug 15, 2025
- Line of business
- Commercial
- Source
- static.cigna.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes. Open official prior authorization lists to check the member’s product.
| Code | Other Cigna policies |
|---|---|
| 00170 | Policies naming 00170 |
| 01999 | Policies naming 01999 |
| 41899 | Policies naming 41899 |
| D7140 | Policies naming D7140 |
| D7230 | Policies naming D7230 |
| D7240 | Policies naming D7240 |
| D7241 | Policies naming D7241 |
| D7250 | Policies naming D7250 |
| D7272 | Policies naming D7272 |
| D7310 | Policies naming D7310 |
| D7311 | Policies naming D7311 |
| D7320 | Policies naming D7320 |
| D7321 | Policies naming D7321 |
| D7471 | Policies naming D7471 |
| D7473 | Policies naming D7473 |
| D9222 | Policies naming D9222 |
| D9223 | Policies naming D9223 |
| G0330 | Policies naming G0330 |