Cigna prior authorization, page 16

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
37765*	Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions	Master Precertification List For Health Care Providers, Pg 42 Original policy
37766*	Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions	Master Precertification List For Health Care Providers, Pg 42 Original policy
37780*	Ligation and division of short saphenous vein at saphenopopliteal junction	Master Precertification List For Health Care Providers, Pg 42 Original policy
37785*	Ligation, division, and/or excision of varicose vein cluster(s), 1 leg	Master Precertification List For Health Care Providers, Pg 42 Original policy
37799*	Unlisted procedure, vascular surgery	Master Precertification List For Health Care Providers, Pg 42 Original policy
38129*	Unlisted laparoscopy procedure, spleen	Master Precertification List For Health Care Providers, Pg 42 Original policy
38204	Management of recipient hematopoietic progenitor cell donor search and cell acquisition	Master Precertification List For Health Care Providers, Pg 42 Original policy
38205	Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic	Master Precertification List For Health Care Providers, Pg 42 Original policy
38206	Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous	Master Precertification List For Health Care Providers, Pg 42 Original policy
38207	Transplant preparation of hematopoietic progenitor cells; cryopreservation and storage	Master Precertification List For Health Care Providers, Pg 42 Original policy
38208	Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor	Master Precertification List For Health Care Providers, Pg 42 Original policy
38209	Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing, per donor	Master Precertification List For Health Care Providers, Pg 42 Original policy
38210	Transplant preparation of hematopoietic progenitor cells; specific cell depletion within harvest, T-cell depletion	Master Precertification List For Health Care Providers, Pg 42 Original policy
38211	Transplant preparation of hematopoietic progenitor cells; tumor cell depletion	Master Precertification List For Health Care Providers, Pg 42 Original policy
38212	Transplant preparation of hematopoietic progenitor cells; red blood cell removal	Master Precertification List For Health Care Providers, Pg 42 Original policy
38213	Transplant preparation of hematopoietic progenitor cells; platelet depletion	Master Precertification List For Health Care Providers, Pg 42 Original policy
38214	Transplant preparation of hematopoietic progenitor cells; plasma (volume) depletion	Master Precertification List For Health Care Providers, Pg 42 Original policy
38215	Transplant preparation of hematopoietic progenitor cells; cell concentration in plasma, mononuclear, or buffy coat layer	Master Precertification List For Health Care Providers, Pg 42 Original policy
38225	Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood- derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day	Master Precertification List For Health Care Providers, Pg 42 Original policy
38226	Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood- derived T lymphocytes for transportation (eg, cryopreservation, storage)	Master Precertification List For Health Care Providers, Pg 42 Original policy
38227	Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for administration	Master Precertification List For Health Care Providers, Pg 42 Original policy
38228	Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous	Master Precertification List For Health Care Providers, Pg 42 Original policy
38230	Bone marrow harvesting for transplantation; allogeneic	Master Precertification List For Health Care Providers, Pg 42 Original policy
38232	Bone marrow harvesting for transplantation; autologous	Master Precertification List For Health Care Providers, Pg 42 Original policy
38240	Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor	Master Precertification List For Health Care Providers, Pg 42 Original policy
38241	Hematopoietic progenitor cell (HPC); autologous transplantation	Master Precertification List For Health Care Providers, Pg 42 Original policy
38242	Allogeneic lymphocyte infusions	Master Precertification List For Health Care Providers, Pg 42 Original policy
38243	Hematopoietic progenitor cell (HPC); HPC boost	Master Precertification List For Health Care Providers, Pg 42 Original policy
38589*	Unlisted laparoscopy procedure, lymphatic system	Master Precertification List For Health Care Providers, Pg 42 Original policy
38999*	Unlisted procedure, hemic or lymphatic system	Master Precertification List For Health Care Providers, Pg 42 Original policy
39599*	Unlisted procedure, diaphragm	Master Precertification List For Health Care Providers, Pg 43 Original policy
40799*	Unlisted procedure, lips	Master Precertification List For Health Care Providers, Pg 43 Original policy
41019*	Placement of needles, catheters, or other device(s) into the head and/or neck region (percutaneous, transoral, or transnasal) for subsequent interstitial radioelement application	Master Precertification List For Health Care Providers, Pg 43 Original policy
41512*	Tongue base suspension, permanent suture technique	Master Precertification List For Health Care Providers, Pg 43 Original policy
41530*	Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session	Master Precertification List For Health Care Providers, Pg 43 Original policy
41599*	Unlisted procedure, tongue, floor of mouth	Master Precertification List For Health Care Providers, Pg 43 Original policy
41874*	Alveoloplasty, each quadrant (specify)	Master Precertification List For Health Care Providers, Pg 43 Original policy
41899	Unlisted procedure, dentoalveolar structures	Master Precertification List For Health Care Providers, Pg 43 Original policy
42140*	Uvulectomy, excision of uvula	Master Precertification List For Health Care Providers, Pg 43 Original policy
42145*	Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty)	Master Precertification List For Health Care Providers, Pg 43 Original policy
42160*	Destruction of lesion, palate or uvula (thermal, cryo or chemical)	Master Precertification List For Health Care Providers, Pg 43 Original policy
42299*	Unlisted procedure, palate, uvula	Master Precertification List For Health Care Providers, Pg 43 Original policy
42699*	Unlisted procedure, salivary glands or ducts	Master Precertification List For Health Care Providers, Pg 43 Original policy
42975*	Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic	Master Precertification List For Health Care Providers, Pg 43 Original policy
42999*	Unlisted procedure, pharynx, adenoids, or tonsils	Master Precertification List For Health Care Providers, Pg 43 Original policy
43210*	Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed	Master Precertification List For Health Care Providers, Pg 43 Original policy
43233*	Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)	Master Precertification List For Health Care Providers, Pg 43 Original policy
43235*	Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed	Master Precertification List For Health Care Providers, Pg 43 Original policy
43236*	Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance	Master Precertification List For Health Care Providers, Pg 43 Original policy
43239*	Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple	Master Precertification List For Health Care Providers, Pg 43 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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