Cigna policy

Preventive Care Services

Preventive Care Services is a public Cigna policy (policy A004, effective Oct 1, 2026). It lists 516 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

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Payer
Cigna
Policy number
A004
Effective
Oct 1, 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.

CodeOther Cigna policies
0064UPolicies naming 0064U
00812Policies naming 00812
00813Policies naming 00813
00840Policies naming 00840
00851Policies naming 00851
0403TPolicies naming 0403T
0455UPolicies naming 0455U
0464UPolicies naming 0464U
0488TPolicies naming 0488T
0792TPolicies naming 0792T
11976Policies naming 11976
11981Policies naming 11981
11982Policies naming 11982
11983Policies naming 11983
19000Policies naming 19000
19001Policies naming 19001
19081Policies naming 19081
19082Policies naming 19082
19083Policies naming 19083
19084Policies naming 19084
19085Policies naming 19085
19086Policies naming 19086
19100Policies naming 19100
19101Policies naming 19101
19120Policies naming 19120
19125Policies naming 19125
19126Policies naming 19126
19281Policies naming 19281
19282Policies naming 19282
19283Policies naming 19283
19284Policies naming 19284
19285Policies naming 19285
19286Policies naming 19286
19287Policies naming 19287
19288Policies naming 19288
19300Policies naming 19300
36415Policies naming 36415
36416Policies naming 36416
45330Policies naming 45330
45331Policies naming 45331
45333Policies naming 45333
45338Policies naming 45338
45346Policies naming 45346
45378Policies naming 45378
45380Policies naming 45380
45381Policies naming 45381
45384Policies naming 45384
45385Policies naming 45385
45388Policies naming 45388
45390Policies naming 45390
57170Policies naming 57170
58300Policies naming 58300
58301Policies naming 58301
58600Policies naming 58600
58605Policies naming 58605
58611Policies naming 58611
58615Policies naming 58615
58661Policies naming 58661
58670Policies naming 58670
58671Policies naming 58671
71271Policies naming 71271
74263Policies naming 74263
74270Policies naming 74270
74280Policies naming 74280
76098Policies naming 76098
76641Policies naming 76641
76642Policies naming 76642
76706Policies naming 76706
76977Policies naming 76977
77046Policies naming 77046
77047Policies naming 77047
77048Policies naming 77048
77049Policies naming 77049
77061Policies naming 77061
77062Policies naming 77062
77063Policies naming 77063
77065Policies naming 77065
77066Policies naming 77066
77067Policies naming 77067
77078Policies naming 77078
77080Policies naming 77080
77081Policies naming 77081
77085Policies naming 77085
77086Policies naming 77086
80061Policies naming 80061
80081Policies naming 80081
81025Policies naming 81025
81162Policies naming 81162
81163Policies naming 81163
81164Policies naming 81164
81165Policies naming 81165
81166Policies naming 81166
81167Policies naming 81167
81212Policies naming 81212
81215Policies naming 81215
81216Policies naming 81216
81217Policies naming 81217
81528Policies naming 81528
82247Policies naming 82247
82270Policies naming 82270
82274Policies naming 82274
82465Policies naming 82465
82565Policies naming 82565
82575Policies naming 82575
82610Policies naming 82610
82947Policies naming 82947
82948Policies naming 82948
82950Policies naming 82950
82951Policies naming 82951
82952Policies naming 82952
83036Policies naming 83036
83655Policies naming 83655
83718Policies naming 83718
83719Policies naming 83719
83721Policies naming 83721
84030Policies naming 84030
84152Policies naming 84152
84153Policies naming 84153
84154Policies naming 84154
84436Policies naming 84436
84437Policies naming 84437
84443Policies naming 84443
84478Policies naming 84478
84703Policies naming 84703
85004Policies naming 85004
85007Policies naming 85007
85009Policies naming 85009
85013Policies naming 85013
85014Policies naming 85014
85018Policies naming 85018
85025Policies naming 85025
85027Policies naming 85027
85041Policies naming 85041
85660Policies naming 85660
86480Policies naming 86480
86481Policies naming 86481
86580Policies naming 86580
86592Policies naming 86592
86593Policies naming 86593
86631Policies naming 86631
86632Policies naming 86632
86701Policies naming 86701
86702Policies naming 86702
86703Policies naming 86703
86704Policies naming 86704
86705Policies naming 86705
86706Policies naming 86706
86762Policies naming 86762
86780Policies naming 86780
86803Policies naming 86803
86850Policies naming 86850
86900Policies naming 86900
86901Policies naming 86901
87086Policies naming 87086
87088Policies naming 87088
87110Policies naming 87110
87270Policies naming 87270
87320Policies naming 87320
87340Policies naming 87340
87341Policies naming 87341
87389Policies naming 87389
87390Policies naming 87390
87391Policies naming 87391
87490Policies naming 87490
87491Policies naming 87491
87492Policies naming 87492
87494Policies naming 87494
87516Policies naming 87516
87520Policies naming 87520
87521Policies naming 87521
87522Policies naming 87522
87534Policies naming 87534
87535Policies naming 87535
87536Policies naming 87536
87537Policies naming 87537
87538Policies naming 87538
87539Policies naming 87539
87590Policies naming 87590
87591Policies naming 87591
87624Policies naming 87624
87625Policies naming 87625
87626Policies naming 87626
87800Policies naming 87800
87801Policies naming 87801
87806Policies naming 87806
87810Policies naming 87810
87850Policies naming 87850
88141Policies naming 88141
88142Policies naming 88142
88143Policies naming 88143
88147Policies naming 88147
88148Policies naming 88148
88150Policies naming 88150
88152Policies naming 88152
88153Policies naming 88153
88164Policies naming 88164
88165Policies naming 88165
88166Policies naming 88166
88167Policies naming 88167
88174Policies naming 88174
88175Policies naming 88175
88302Policies naming 88302
88305Policies naming 88305
88307Policies naming 88307
88720Policies naming 88720
90380Policies naming 90380
90381Policies naming 90381
90382Policies naming 90382
90460Policies naming 90460
90461Policies naming 90461
90471Policies naming 90471
90472Policies naming 90472
90473Policies naming 90473
90474Policies naming 90474
90480Policies naming 90480
90482Policies naming 90482
90483Policies naming 90483
90484Policies naming 90484
90587Policies naming 90587
90611Policies naming 90611
90619Policies naming 90619
90620Policies naming 90620
90621Policies naming 90621
90622Policies naming 90622
90623Policies naming 90623
90624Policies naming 90624
90632Policies naming 90632
90633Policies naming 90633
90634Policies naming 90634
90636Policies naming 90636
90638Policies naming 90638
90644Policies naming 90644
90647Policies naming 90647
90648Policies naming 90648
90649Policies naming 90649
90650Policies naming 90650
90651Policies naming 90651
90653Policies naming 90653
90655Policies naming 90655
90656Policies naming 90656
90657Policies naming 90657
90658Policies naming 90658
90660Policies naming 90660
90661Policies naming 90661
90662Policies naming 90662
90670Policies naming 90670
90671Policies naming 90671
90672Policies naming 90672
90673Policies naming 90673
90674Policies naming 90674
90677Policies naming 90677
90678Policies naming 90678
90679Policies naming 90679
90680Policies naming 90680
90681Policies naming 90681
90682Policies naming 90682
90683Policies naming 90683
90684Policies naming 90684
90685Policies naming 90685
90686Policies naming 90686
90687Policies naming 90687
90688Policies naming 90688
90689Policies naming 90689
90694Policies naming 90694
90696Policies naming 90696
90697Policies naming 90697
90698Policies naming 90698
90700Policies naming 90700
90702Policies naming 90702
90707Policies naming 90707
90710Policies naming 90710
90713Policies naming 90713
90714Policies naming 90714
90715Policies naming 90715
90716Policies naming 90716
90723Policies naming 90723
90732Policies naming 90732
90733Policies naming 90733
90734Policies naming 90734
90736Policies naming 90736
90739Policies naming 90739
90740Policies naming 90740
90743Policies naming 90743
90744Policies naming 90744
90746Policies naming 90746
90747Policies naming 90747
90748Policies naming 90748
90750Policies naming 90750
90756Policies naming 90756
90759Policies naming 90759
91304Policies naming 91304
91318Policies naming 91318
91319Policies naming 91319
91320Policies naming 91320
91321Policies naming 91321
91322Policies naming 91322
91323Policies naming 91323
92550Policies naming 92550
92551Policies naming 92551
92552Policies naming 92552

And 216 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.