Cigna policy

Infant Nutritional Formula

Infant Nutritional Formula is a public Cigna policy (policy 0136, effective Sep 15, 2026). It lists 5 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

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Payer: Cigna
Policy number: 0136
Effective: Sep 15, 2026
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
B4154	Policies naming B4154
B4155	Policies naming B4155
B4157	Policies naming B4157
B4162	Policies naming B4162
S9435	Policies naming S9435

All Cigna policies · Cigna prior authorization CPT list

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.