Cigna prior authorization, page 18

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
44137	Removal of transplanted intestinal allograft, complete	Master Precertification List For Health Care Providers, Pg 45 Original policy
44238*	Unlisted laparoscopy procedure, intestine (except rectum)	Master Precertification List For Health Care Providers, Pg 45 Original policy
44715	Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation, including mobilization and fashioning of the superior mesenteric artery and vein	Master Precertification List For Health Care Providers, Pg 45 Original policy
44720	Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; venous anastomosis, each	Master Precertification List For Health Care Providers, Pg 45 Original policy
44721	Backbench reconstruction of cadaver or living donor intestine allograft prior to transplantation; arterial anastomosis, each	Master Precertification List For Health Care Providers, Pg 45 Original policy
44799*	Unlisted procedure, small intestine	Master Precertification List For Health Care Providers, Pg 45 Original policy
44979*	Unlisted laparoscopy procedure, appendix	Master Precertification List For Health Care Providers, Pg 45 Original policy
45399*	Unlisted procedure, colon	Master Precertification List For Health Care Providers, Pg 45 Original policy
45999*	Unlisted procedure, rectum	Master Precertification List For Health Care Providers, Pg 45 Original policy
46707*	Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [SIS])	Master Precertification List For Health Care Providers, Pg 45 Original policy
46999*	Unlisted procedure, anus	Master Precertification List For Health Care Providers, Pg 45 Original policy
47133	Donor hepatectomy (including cold preservation), from cadaver donor	Master Precertification List For Health Care Providers, Pg 45 Original policy
47135	Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age	Master Precertification List For Health Care Providers, Pg 45 Original policy
47140	Donor hepatectomy (including cold preservation), from living donor; left lateral segment only (segments II and III)	Master Precertification List For Health Care Providers, Pg 45 Original policy
47141	Donor hepatectomy (including cold preservation), from living donor; total left lobectomy (segments II, III and IV)	Master Precertification List For Health Care Providers, Pg 45 Original policy
47142	Donor hepatectomy (including cold preservation), from living donor; total right lobectomy (segments V, VI, VII and VIII)	Master Precertification List For Health Care Providers, Pg 45 Original policy
47143	Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; without trisegment or lobe split	Master Precertification List For Health Care Providers, Pg 45 Original policy
47144	Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with trisegment split of whole liver graft into 2 partial liver grafts (ie, left lateral segment [segments II and III] and right trisegment [segments I and IV through VIII])	Master Precertification List For Health Care Providers, Pg 46 Original policy
47145	Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with lobe split of whole liver graft into 2 partial liver grafts (ie, left lobe [segments II, III, and IV] and right lobe [segments I and V through VIII])	Master Precertification List For Health Care Providers, Pg 46 Original policy
47146	Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; venous anastomosis, each	Master Precertification List For Health Care Providers, Pg 46 Original policy
47147	Backbench reconstruction of cadaver or living donor liver graft prior to allotransplantation; arterial anastomosis, each	Master Precertification List For Health Care Providers, Pg 46 Original policy
47379*	Unlisted laparoscopic procedure, liver	Master Precertification List For Health Care Providers, Pg 46 Original policy
47399*	Unlisted procedure, liver	Master Precertification List For Health Care Providers, Pg 46 Original policy
47579*	Unlisted laparoscopy procedure, biliary tract	Master Precertification List For Health Care Providers, Pg 46 Original policy
47999*	Unlisted procedure, biliary tract	Master Precertification List For Health Care Providers, Pg 46 Original policy
48160	Pancreatectomy, total or subtotal, with autologous transplantation of pancreas or pancreatic islet cells	Master Precertification List For Health Care Providers, Pg 46 Original policy
48550	Donor pancreatectomy (including cold preservation), with or without duodenal segment for transplantation	Master Precertification List For Health Care Providers, Pg 46 Original policy
48551	Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, including dissection of allograft from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and Y-graft arterial anastomoses from iliac artery to superior mesenteric artery and to splenic artery	Master Precertification List For Health Care Providers, Pg 46 Original policy
48552	Backbench reconstruction of cadaver donor pancreas allograft prior to transplantation, venous anastomosis, each	Master Precertification List For Health Care Providers, Pg 46 Original policy
48554	Transplantation of pancreatic allograft	Master Precertification List For Health Care Providers, Pg 46 Original policy
48556	Removal of transplanted pancreatic allograft	Master Precertification List For Health Care Providers, Pg 46 Original policy
48999*	Unlisted procedure, pancreas	Master Precertification List For Health Care Providers, Pg 46 Original policy
49329*	Unlisted laparoscopy procedure, abdomen, peritoneum and omentum	Master Precertification List For Health Care Providers, Pg 46 Original policy
49411*	Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-abdominal, intra- pelvic (except prostate), and/or retroperitoneum, single or multiple	Master Precertification List For Health Care Providers, Pg 46 Original policy
49412*	Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple	Master Precertification List For Health Care Providers, Pg 46 Original policy
49659*	Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy	Master Precertification List For Health Care Providers, Pg 46 Original policy
49999*	Unlisted procedure, abdomen, peritoneum and omentum	Master Precertification List For Health Care Providers, Pg 46 Original policy
50300	Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral	Master Precertification List For Health Care Providers, Pg 46 Original policy
50320	Donor nephrectomy (including cold preservation); open, from living donor	Master Precertification List For Health Care Providers, Pg 46 Original policy
50323	Backbench standard preparation of cadaver donor renal allograft prior to transplantation, including dissection and removal of perinephric fat, diaphragmatic and retroperitoneal attachments, excision of adrenal gland, and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary	Master Precertification List For Health Care Providers, Pg 46 Original policy
50325	Backbench standard preparation of living donor renal allograft (open or laparoscopic) prior to transplantation, including dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary	Master Precertification List For Health Care Providers, Pg 47 Original policy
50327	Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis, each	Master Precertification List For Health Care Providers, Pg 47 Original policy
50328	Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; arterial anastomosis, each	Master Precertification List For Health Care Providers, Pg 47 Original policy
50329	Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; ureteral anastomosis, each	Master Precertification List For Health Care Providers, Pg 47 Original policy
50340	Recipient nephrectomy	Master Precertification List For Health Care Providers, Pg 47 Original policy
50360	Renal allotransplantation, implantation of graft; without recipient nephrectomy	Master Precertification List For Health Care Providers, Pg 47 Original policy
50365	Renal allotransplantation, implantation of graft; with recipient nephrectomy	Master Precertification List For Health Care Providers, Pg 47 Original policy
50370	Removal of transplanted renal allograft	Master Precertification List For Health Care Providers, Pg 47 Original policy
50547	Laparoscopy, surgical; donor nephrectomy (including cold preservation), from living donor	Master Precertification List For Health Care Providers, Pg 47 Original policy
50949*	Unlisted laparoscopy procedure, ureter	Master Precertification List For Health Care Providers, Pg 47 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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