Cigna prior authorization for C9808*: Nerve cryoablation probe (e.g., cryoice, cryosphere, cryosphere max, cryoice cryosphere, cryoice cryo2), including probe and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)
Code
C9808*
Description
Nerve cryoablation probe (e.g., cryoice, cryosphere, cryosphere max,
cryoice cryosphere, cryoice cryo2), including probe and all disposable
system components, non-opioid medical device (must be a qualifying
medicare non-opioid medical device for post-surgical pain relief in
accordance with section 4135 of the caa, 2023)
Source
Master Precertification List
For Health Care Providers, Pg 72 Original policy
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