Cigna prior authorization, page 14

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
33340*	Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation	Master Precertification List For Health Care Providers, Pg 33 Original policy
33361*	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach	Master Precertification List For Health Care Providers, Pg 33 Original policy
33362*	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach	Master Precertification List For Health Care Providers, Pg 33 Original policy
33363*	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach	Master Precertification List For Health Care Providers, Pg 33 Original policy
33364*	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach	Master Precertification List For Health Care Providers, Pg 33 Original policy
33365*	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy)	Master Precertification List For Health Care Providers, Pg 33 Original policy
33366*	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy)	Master Precertification List For Health Care Providers, Pg 33 Original policy
33418*	Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis	Master Precertification List For Health Care Providers, Pg 33 Original policy
33477*	Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed	Master Precertification List For Health Care Providers, Pg 33 Original policy
33930	Donor cardiectomy-pneumonectomy (including cold preservation)	Master Precertification List For Health Care Providers, Pg 33 Original policy
33933	Backbench standard preparation of cadaver donor heart/lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, and trachea for implantation	Master Precertification List For Health Care Providers, Pg 33 Original policy
33935	Heart-lung transplant with recipient cardiectomy-pneumonectomy	Master Precertification List For Health Care Providers, Pg 33 Original policy
33940	Donor cardiectomy (including cold preservation)	Master Precertification List For Health Care Providers, Pg 33 Original policy
33944	Backbench standard preparation of cadaver donor heart allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, pulmonary artery, and left atrium for implantation	Master Precertification List For Health Care Providers, Pg 33 Original policy
33945	Heart transplant, with or without recipient cardiectomy	Master Precertification List For Health Care Providers, Pg 33 Original policy
33975	Insertion of ventricular assist device; extracorporeal, single ventricle	Master Precertification List For Health Care Providers, Pg 33 Original policy
33976	Insertion of ventricular assist device; extracorporeal, biventricular	Master Precertification List For Health Care Providers, Pg 33 Original policy
33979	Insertion of ventricular assist device, implantable intracorporeal, single ventricle	Master Precertification List For Health Care Providers, Pg 33 Original policy
33981	Replacement of extracorporeal ventricular assist device, single or biventricular, pump(s), single or each pump	Master Precertification List For Health Care Providers, Pg 33 Original policy
33982	Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary bypass	Master Precertification List For Health Care Providers, Pg 33 Original policy
33983	Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, with cardiopulmonary bypass	Master Precertification List For Health Care Providers, Pg 33 Original policy
33990*	Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, arterial access only	Master Precertification List For Health Care Providers, Pg 33 Original policy
33991*	Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal puncture	Master Precertification List For Health Care Providers, Pg 33 Original policy
33993*	Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion	Master Precertification List For Health Care Providers, Pg 34 Original policy
33999*	Unlisted procedure, cardiac surgery	Master Precertification List For Health Care Providers, Pg 34 Original policy
34718*	Endovascular repair of iliac artery, not associated with placement of an aorto-iliac artery endograft at the same session, by deployment of an iliac branched endograft, including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer), unilateral	Master Precertification List For Health Care Providers, Pg 34 Original policy
36465*	Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein)	Master Precertification List For Health Care Providers, Pg 34 Original policy
36466*	Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg	Master Precertification List For Health Care Providers, Pg 34 Original policy
36468*	Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk	Master Precertification List For Health Care Providers, Pg 34 Original policy
36471*	Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg	Master Precertification List For Health Care Providers, Pg 34 Original policy
36473*	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated	Master Precertification List For Health Care Providers, Pg 34 Original policy
36474*	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites	Master Precertification List For Health Care Providers, Pg 34 Original policy
36475*	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated	Master Precertification List For Health Care Providers, Pg 34 Original policy
36476*	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites	Master Precertification List For Health Care Providers, Pg 34 Original policy
36478*	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated	Master Precertification List For Health Care Providers, Pg 34 Original policy
36479*	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites	Master Precertification List For Health Care Providers, Pg 34 Original policy
36482*	Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated	Master Precertification List For Health Care Providers, Pg 34 Original policy
36483*	Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites	Master Precertification List For Health Care Providers, Pg 34 Original policy
36514*	Therapeutic apheresis; for plasma pheresis	Master Precertification List For Health Care Providers, Pg 34 Original policy
37215*	Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection	Master Precertification List For Health Care Providers, Pg 35 Original policy
37216*	Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection	Master Precertification List For Health Care Providers, Pg 35 Original policy
37218*	Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation	Master Precertification List For Health Care Providers, Pg 35 Original policy
37238*	Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein	Master Precertification List For Health Care Providers, Pg 35 Original policy
37239*	Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein	Master Precertification List For Health Care Providers, Pg 35 Original policy
37241*	Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)	Master Precertification List For Health Care Providers, Pg 35 Original policy
37242*	Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)	Master Precertification List For Health Care Providers, Pg 35 Original policy
37243*	Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction	Master Precertification List For Health Care Providers, Pg 35 Original policy
37244*	Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation	Master Precertification List For Health Care Providers, Pg 35 Original policy
37248*	Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein	Master Precertification List For Health Care Providers, Pg 35 Original policy
37249*	Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein	Master Precertification List For Health Care Providers, Pg 35 Original policy

Removed codes

Cigna codes removed from the master precertification list

Sources

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