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Cigna policy

Master Precertification List - Removed Codes

Master Precertification List - Removed Codes is a public Cigna policy. It lists 505 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

View the original policy (PDF) ↗

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Payer
Cigna
Line of business
Commercial
Source
www.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.

CodeOther Cigna policies
0071TPolicies naming 0071T
0072TPolicies naming 0072T
0080UPolicies naming 0080U
0118UPolicies naming 0118U
0132UPolicies naming 0132U
0169UPolicies naming 0169U
0245UPolicies naming 0245U
0261UPolicies naming 0261U
0263TPolicies naming 0263T
0275TPolicies naming 0275T
0365UPolicies naming 0365U
0366UPolicies naming 0366U
0367UPolicies naming 0367U
0384UPolicies naming 0384U
0385UPolicies naming 0385U
0394TPolicies naming 0394T
0441TPolicies naming 0441T
0442TPolicies naming 0442T
0443UPolicies naming 0443U
0445UPolicies naming 0445U
0446TPolicies naming 0446T
0448TPolicies naming 0448T
0448UPolicies naming 0448U
0449UPolicies naming 0449U
0457UPolicies naming 0457U
0458UPolicies naming 0458U
0459UPolicies naming 0459U
0464UPolicies naming 0464U
0479UPolicies naming 0479U
0482UPolicies naming 0482U
0490UPolicies naming 0490U
0491UPolicies naming 0491U
0492UPolicies naming 0492U
0503UPolicies naming 0503U
0511UPolicies naming 0511U
0514UPolicies naming 0514U
0515UPolicies naming 0515U
0517UPolicies naming 0517U
0518UPolicies naming 0518U
0519UPolicies naming 0519U
0520UPolicies naming 0520U
0537TPolicies naming 0537T
0538TPolicies naming 0538T
0539TPolicies naming 0539T
0540TPolicies naming 0540T
0544UPolicies naming 0544U
0558UPolicies naming 0558U
0559UPolicies naming 0559U
0568UPolicies naming 0568U
0574UPolicies naming 0574U
0616TPolicies naming 0616T
0617TPolicies naming 0617T
0618TPolicies naming 0618T
0623TPolicies naming 0623T
0624TPolicies naming 0624T
0625TPolicies naming 0625T
0626TPolicies naming 0626T
0720TPolicies naming 0720T
0795TPolicies naming 0795T
0796TPolicies naming 0796T
0797TPolicies naming 0797T
0801TPolicies naming 0801T
0802TPolicies naming 0802T
0803TPolicies naming 0803T
0823TPolicies naming 0823T
0824TPolicies naming 0824T
0825TPolicies naming 0825T
0898TPolicies naming 0898T
0977TPolicies naming 0977T
15819Policies naming 15819
19105Policies naming 19105
21032Policies naming 21032
21181Policies naming 21181
21182Policies naming 21182
21280Policies naming 21280
21282Policies naming 21282
21325Policies naming 21325
21347Policies naming 21347
21348Policies naming 21348
21432Policies naming 21432
21433Policies naming 21433
21435Policies naming 21435
21436Policies naming 21436
22102Policies naming 22102
22325Policies naming 22325
22326Policies naming 22326
22328Policies naming 22328
23106Policies naming 23106
23802Policies naming 23802
26341Policies naming 26341
27033Policies naming 27033
27197Policies naming 27197
27331Policies naming 27331
27340Policies naming 27340
27347Policies naming 27347
27407Policies naming 27407
27409Policies naming 27409
27445Policies naming 27445
28446Policies naming 28446
31643Policies naming 31643
31647Policies naming 31647
31660Policies naming 31660
31661Policies naming 31661
33206Policies naming 33206
33207Policies naming 33207
33208Policies naming 33208
33274Policies naming 33274
34717Policies naming 34717
37220Policies naming 37220
37221Policies naming 37221
37222Policies naming 37222
37223Policies naming 37223
37224Policies naming 37224
37225Policies naming 37225
37226Policies naming 37226
37227Policies naming 37227
37228Policies naming 37228
37229Policies naming 37229
37230Policies naming 37230
37231Policies naming 37231
37232Policies naming 37232
37233Policies naming 37233
37234Policies naming 37234
37235Policies naming 37235
41820Policies naming 41820
42950Policies naming 42950
43200Policies naming 43200
43201Policies naming 43201
43202Policies naming 43202
43204Policies naming 43204
43205Policies naming 43205
43206Policies naming 43206
43211Policies naming 43211
43212Policies naming 43212
43213Policies naming 43213
43214Policies naming 43214
43215Policies naming 43215
43216Policies naming 43216
43217Policies naming 43217
43220Policies naming 43220
43226Policies naming 43226
43227Policies naming 43227
43229Policies naming 43229
43246Policies naming 43246
43648Policies naming 43648
50380Policies naming 50380
54408Policies naming 54408
54410Policies naming 54410
54416Policies naming 54416
57700Policies naming 57700
61888Policies naming 61888
61891Policies naming 61891
62326Policies naming 62326
63011Policies naming 63011
64561Policies naming 64561
64581Policies naming 64581
64620Policies naming 64620
64804Policies naming 64804
66184Policies naming 66184
70450Policies naming 70450
70460Policies naming 70460
70470Policies naming 70470
70480Policies naming 70480
70481Policies naming 70481
70482Policies naming 70482
70486Policies naming 70486
70487Policies naming 70487
70488Policies naming 70488
70496Policies naming 70496
70544Policies naming 70544
70545Policies naming 70545
70546Policies naming 70546
70551Policies naming 70551
70552Policies naming 70552
70553Policies naming 70553
70554Policies naming 70554
70555Policies naming 70555
71271Policies naming 71271
74261Policies naming 74261
74262Policies naming 74262
74263Policies naming 74263
75557Policies naming 75557
75559Policies naming 75559
75561Policies naming 75561
75563Policies naming 75563
75565Policies naming 75565
75571Policies naming 75571
75572Policies naming 75572
75573Policies naming 75573
76380Policies naming 76380
77011Policies naming 77011
77014Policies naming 77014
77078Policies naming 77078
77385Policies naming 77385
77386Policies naming 77386
77401Policies naming 77401
77600Policies naming 77600
77605Policies naming 77605
77610Policies naming 77610
77615Policies naming 77615
77620Policies naming 77620
77750Policies naming 77750
78451Policies naming 78451
78452Policies naming 78452
78453Policies naming 78453
78454Policies naming 78454
78456Policies naming 78456
78466Policies naming 78466
78468Policies naming 78468
78469Policies naming 78469
78472Policies naming 78472
78473Policies naming 78473
78481Policies naming 78481
78483Policies naming 78483
78494Policies naming 78494
78496Policies naming 78496
78499Policies naming 78499
81235Policies naming 81235
81325Policies naming 81325
81326Policies naming 81326
81328Policies naming 81328
81331Policies naming 81331
81438Policies naming 81438
81506Policies naming 81506
86950Policies naming 86950
89329Policies naming 89329
90281Policies naming 90281
90989Policies naming 90989
90993Policies naming 90993
90999Policies naming 90999
91110Policies naming 91110
91111Policies naming 91111
91112Policies naming 91112
91113Policies naming 91113
92971Policies naming 92971
93350Policies naming 93350
93351Policies naming 93351
93583Policies naming 93583
93593Policies naming 93593
93594Policies naming 93594
93595Policies naming 93595
93596Policies naming 93596
93597Policies naming 93597
99500Policies naming 99500
99501Policies naming 99501
99502Policies naming 99502
99503Policies naming 99503
99504Policies naming 99504
99505Policies naming 99505
99506Policies naming 99506
99507Policies naming 99507
99509Policies naming 99509
99510Policies naming 99510
99511Policies naming 99511
A0140Policies naming A0140
A2027Policies naming A2027
A2028Policies naming A2028
A2029Policies naming A2029
A4271Policies naming A4271
A4543Policies naming A4543
A4544Policies naming A4544
A4545Policies naming A4545
A4641Policies naming A4641
A4648Policies naming A4648
A4650Policies naming A4650
A6025Policies naming A6025
A7021Policies naming A7021
A9506Policies naming A9506
A9610Policies naming A9610
C1715Policies naming C1715
C1716Policies naming C1716
C1717Policies naming C1717
C1719Policies naming C1719
C1728Policies naming C1728
C1761Policies naming C1761
C1824Policies naming C1824
C1825Policies naming C1825
C2634Policies naming C2634
C2635Policies naming C2635
C2636Policies naming C2636
C2637Policies naming C2637
C2638Policies naming C2638
C2639Policies naming C2639
C2640Policies naming C2640
C2641Policies naming C2641
C2642Policies naming C2642
C2643Policies naming C2643
C2645Policies naming C2645
C2698Policies naming C2698
C2699Policies naming C2699
C5271Policies naming C5271
C5273Policies naming C5273
C5275Policies naming C5275
C7504Policies naming C7504
C7505Policies naming C7505
C7507Policies naming C7507
C7508Policies naming C7508
C7516Policies naming C7516
C7517Policies naming C7517
C7518Policies naming C7518

And 205 more in the original policy.

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.

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