Cigna prior authorization, page 12

Requirements

Read the care-management columns separately. Complete, PHS+, Preferred, and Basic Standard do not collapse into one Cigna answer. The long descriptor is blank because no AMA-licensed CPT file was available to copy.

Cigna precertification list

Cigna master precertification list

Cigna precertification

CPT code lookup

Prior authorization codes

Prior authorization codes
Code	Description	Source
27599*	Unlisted procedure, femur or knee	Master Precertification List For Health Care Providers, Pg 29 Original policy
27702*	Arthroplasty, ankle; with implant (total ankle)	Master Precertification List For Health Care Providers, Pg 29 Original policy
27703*	Arthroplasty, ankle; revision, total ankle	Master Precertification List For Health Care Providers, Pg 29 Original policy
27860*	Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus)	Master Precertification List For Health Care Providers, Pg 29 Original policy
27899*	Unlisted procedure, leg or ankle	Master Precertification List For Health Care Providers, Pg 29 Original policy
28291*	Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant	Master Precertification List For Health Care Providers, Pg 29 Original policy
28890*	Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia	Master Precertification List For Health Care Providers, Pg 29 Original policy
28899*	Unlisted procedure, foot or toes	Master Precertification List For Health Care Providers, Pg 29 Original policy
29804*	Arthroscopy, temporomandibular joint, surgical	Master Precertification List For Health Care Providers, Pg 29 Original policy
29805*	Arthroscopy, shoulder, diagnostic, with or without synovial biopsy	Master Precertification List For Health Care Providers, Pg 29 Original policy
29806*	Arthroscopy, shoulder, surgical; capsulorrhaphy	Master Precertification List For Health Care Providers, Pg 29 Original policy
29807*	Arthroscopy, shoulder, surgical; repair of SLAP lesion	Master Precertification List For Health Care Providers, Pg 29 Original policy
29819*	Arthroscopy, shoulder, surgical; with removal of loose body or foreign body	Master Precertification List For Health Care Providers, Pg 29 Original policy
29820*	Arthroscopy, shoulder, surgical; synovectomy, partial	Master Precertification List For Health Care Providers, Pg 29 Original policy
29821*	Arthroscopy, shoulder, surgical; synovectomy, complete	Master Precertification List For Health Care Providers, Pg 29 Original policy
29822*	Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])	Master Precertification List For Health Care Providers, Pg 29 Original policy
29823*	Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])	Master Precertification List For Health Care Providers, Pg 29 Original policy
29824*	Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)	Master Precertification List For Health Care Providers, Pg 30 Original policy
29825*	Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation	Master Precertification List For Health Care Providers, Pg 30 Original policy
29826*	Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed	Master Precertification List For Health Care Providers, Pg 30 Original policy
29827*	Arthroscopy, shoulder, surgical; with rotator cuff repair	Master Precertification List For Health Care Providers, Pg 30 Original policy
29828*	Arthroscopy, shoulder, surgical; biceps tenodesis	Master Precertification List For Health Care Providers, Pg 30 Original policy
29850*	Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy)	Master Precertification List For Health Care Providers, Pg 30 Original policy
29851*	Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; with internal or external fixation (includes arthroscopy)	Master Precertification List For Health Care Providers, Pg 30 Original policy
29855*	Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy)	Master Precertification List For Health Care Providers, Pg 30 Original policy
29856*	Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar, includes internal fixation, when performed (includes arthroscopy)	Master Precertification List For Health Care Providers, Pg 30 Original policy
29860*	Arthroscopy, hip, diagnostic with or without synovial biopsy	Master Precertification List For Health Care Providers, Pg 30 Original policy
29861*	Arthroscopy, hip, surgical; with removal of loose body or foreign body	Master Precertification List For Health Care Providers, Pg 30 Original policy
29862*	Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum	Master Precertification List For Health Care Providers, Pg 30 Original policy
29863*	Arthroscopy, hip, surgical; with synovectomy	Master Precertification List For Health Care Providers, Pg 30 Original policy
29866*	Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s])	Master Precertification List For Health Care Providers, Pg 30 Original policy
29867*	Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty)	Master Precertification List For Health Care Providers, Pg 30 Original policy
29868*	Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral	Master Precertification List For Health Care Providers, Pg 30 Original policy
29870*	Arthroscopy, knee, diagnostic, with or without synovial biopsy	Master Precertification List For Health Care Providers, Pg 30 Original policy
29871*	Arthroscopy, knee, surgical; for infection, lavage and drainage	Master Precertification List For Health Care Providers, Pg 30 Original policy
29873*	Arthroscopy, knee, surgical; with lateral release	Master Precertification List For Health Care Providers, Pg 30 Original policy
29874*	Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation)	Master Precertification List For Health Care Providers, Pg 30 Original policy
29875*	Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection)	Master Precertification List For Health Care Providers, Pg 30 Original policy
29876*	Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (eg, medial or lateral)	Master Precertification List For Health Care Providers, Pg 30 Original policy
29877*	Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)	Master Precertification List For Health Care Providers, Pg 30 Original policy
29879*	Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture	Master Precertification List For Health Care Providers, Pg 30 Original policy
29880*	Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed	Master Precertification List For Health Care Providers, Pg 30 Original policy
29881*	Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed	Master Precertification List For Health Care Providers, Pg 30 Original policy
29882*	Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)	Master Precertification List For Health Care Providers, Pg 31 Original policy
29883*	Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)	Master Precertification List For Health Care Providers, Pg 31 Original policy
29884*	Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation	Master Precertification List For Health Care Providers, Pg 31 Original policy
29885*	Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion)	Master Precertification List For Health Care Providers, Pg 31 Original policy
29886*	Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion	Master Precertification List For Health Care Providers, Pg 31 Original policy
29887*	Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation	Master Precertification List For Health Care Providers, Pg 31 Original policy
29888*	Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction	Master Precertification List For Health Care Providers, Pg 31 Original policy

Removed codes

Cigna codes removed from the master precertification list

Sources

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.