Cigna prior authorization, page 13

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
29889*	Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction	Master Precertification List For Health Care Providers, Pg 31 Original policy
29914*	Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)	Master Precertification List For Health Care Providers, Pg 31 Original policy
29915*	Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)	Master Precertification List For Health Care Providers, Pg 31 Original policy
29916*	Arthroscopy, hip, surgical; with labral repair	Master Precertification List For Health Care Providers, Pg 31 Original policy
29999*	Unlisted procedure, arthroscopy	Master Precertification List For Health Care Providers, Pg 31 Original policy
30150*	Rhinectomy; partial	Master Precertification List For Health Care Providers, Pg 31 Original policy
30400*	Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip	Master Precertification List For Health Care Providers, Pg 31 Original policy
30410*	Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip	Master Precertification List For Health Care Providers, Pg 31 Original policy
30420*	Rhinoplasty, primary; including major septal repair	Master Precertification List For Health Care Providers, Pg 31 Original policy
30430*	Rhinoplasty, secondary; minor revision (small amount of nasal tip work)	Master Precertification List For Health Care Providers, Pg 31 Original policy
30435*	Rhinoplasty, secondary; intermediate revision (bony work with osteotomies)	Master Precertification List For Health Care Providers, Pg 31 Original policy
30450*	Rhinoplasty, secondary; major revision (nasal tip work and osteotomies)	Master Precertification List For Health Care Providers, Pg 31 Original policy
30460*	Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only	Master Precertification List For Health Care Providers, Pg 31 Original policy
30462*	Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies	Master Precertification List For Health Care Providers, Pg 31 Original policy
30465*	Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)	Master Precertification List For Health Care Providers, Pg 31 Original policy
30468*	Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)	Master Precertification List For Health Care Providers, Pg 31 Original policy
30469*	Repair of nasal valve collapse with low energy, temperature-controlled (ie, radiofrequency) subcutaneous/submucosal remodeling	Master Precertification List For Health Care Providers, Pg 31 Original policy
30520*	Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft	Master Precertification List For Health Care Providers, Pg 31 Original policy
30620*	Septal or other intranasal dermatoplasty (does not include obtaining graft)	Master Precertification List For Health Care Providers, Pg 31 Original policy
30999*	Unlisted procedure, nose	Master Precertification List For Health Care Providers, Pg 31 Original policy
31295*	Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa	Master Precertification List For Health Care Providers, Pg 31 Original policy
31296*	Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium	Master Precertification List For Health Care Providers, Pg 31 Original policy
31297*	Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); sphenoid sinus ostium	Master Precertification List For Health Care Providers, Pg 31 Original policy
31298*	Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal and sphenoid sinus ostia	Master Precertification List For Health Care Providers, Pg 31 Original policy
31299*	Unlisted procedure, accessory sinuses	Master Precertification List For Health Care Providers, Pg 31 Original policy
31599*	Unlisted procedure, larynx	Master Precertification List For Health Care Providers, Pg 32 Original policy
31899*	Unlisted procedure, trachea, bronchi	Master Precertification List For Health Care Providers, Pg 32 Original policy
32553*	Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple	Master Precertification List For Health Care Providers, Pg 32 Original policy
32664*	Thoracoscopy, surgical; with thoracic sympathectomy	Master Precertification List For Health Care Providers, Pg 32 Original policy
32850	Donor pneumonectomy(s) (including cold preservation), from cadaver donor	Master Precertification List For Health Care Providers, Pg 32 Original policy
32851	Lung transplant, single; without cardiopulmonary bypass	Master Precertification List For Health Care Providers, Pg 32 Original policy
32852	Lung transplant, single; with cardiopulmonary bypass	Master Precertification List For Health Care Providers, Pg 32 Original policy
32853	Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass	Master Precertification List For Health Care Providers, Pg 32 Original policy
32854	Lung transplant, double (bilateral sequential or en bloc); with cardiopulmonary bypass	Master Precertification List For Health Care Providers, Pg 32 Original policy
32855	Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; unilateral	Master Precertification List For Health Care Providers, Pg 32 Original policy
32856	Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; bilateral	Master Precertification List For Health Care Providers, Pg 32 Original policy
32999*	Unlisted procedure, lungs and pleura	Master Precertification List For Health Care Providers, Pg 32 Original policy
33224*	Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)	Master Precertification List For Health Care Providers, Pg 32 Original policy
33225*	Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)	Master Precertification List For Health Care Providers, Pg 32 Original policy
33249*	Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber	Master Precertification List For Health Care Providers, Pg 32 Original policy
33254*	Operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure)	Master Precertification List For Health Care Providers, Pg 32 Original policy
33255*	Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); without cardiopulmonary bypass	Master Precertification List For Health Care Providers, Pg 32 Original policy
33258*	Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (eg, maze procedure), without cardiopulmonary bypass	Master Precertification List For Health Care Providers, Pg 32 Original policy
33265*	Endoscopy, surgical; operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure), without cardiopulmonary bypass	Master Precertification List For Health Care Providers, Pg 32 Original policy
33266*	Endoscopy, surgical; operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure), without cardiopulmonary bypass	Master Precertification List For Health Care Providers, Pg 32 Original policy
33267*	Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip)	Master Precertification List For Health Care Providers, Pg 32 Original policy
33269*	Exclusion of left atrial appendage, thoracoscopic, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip)	Master Precertification List For Health Care Providers, Pg 32 Original policy
33270*	Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed	Master Precertification List For Health Care Providers, Pg 32 Original policy
33285*	Insertion, subcutaneous cardiac rhythm monitor, including programming	Master Precertification List For Health Care Providers, Pg 32 Original policy
33289*	Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed	Master Precertification List For Health Care Providers, Pg 33 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.

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