Cigna policy
Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations and Re-evaluations
Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations and Re-evaluations is a public Cigna policy (policy CPG111, effective Jul 15, 2026). It lists 35 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
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- Payer
- Cigna
- Policy number
- CPG111
- Effective
- Jul 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 |
|---|---|
| 92521 | Policies naming 92521 |
| 92522 | Policies naming 92522 |
| 92523 | Policies naming 92523 |
| 92524 | Policies naming 92524 |
| 92610 | Policies naming 92610 |
| 95851 | Policies naming 95851 |
| 95852 | Policies naming 95852 |
| 97039 | Policies naming 97039 |
| 97139 | Policies naming 97139 |
| 97161 | Policies naming 97161 |
| 97162 | Policies naming 97162 |
| 97163 | Policies naming 97163 |
| 97164 | Policies naming 97164 |
| 97165 | Policies naming 97165 |
| 97166 | Policies naming 97166 |
| 97167 | Policies naming 97167 |
| 97168 | Policies naming 97168 |
| 97169 | Policies naming 97169 |
| 97170 | Policies naming 97170 |
| 97171 | Policies naming 97171 |
| 97172 | Policies naming 97172 |
| 97750 | Policies naming 97750 |
| 97755 | Policies naming 97755 |
| 97799 | Policies naming 97799 |
| 99202 | Policies naming 99202 |
| 99203 | Policies naming 99203 |
| 99204 | Policies naming 99204 |
| 99205 | Policies naming 99205 |
| 99211 | Policies naming 99211 |
| 99212 | Policies naming 99212 |
| 99213 | Policies naming 99213 |
| 99214 | Policies naming 99214 |
| 99215 | Policies naming 99215 |
| 99417 | Policies naming 99417 |
| S9152 | Policies naming S9152 |