Cigna prior authorization, page 22

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
67902*	Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia)	Master Precertification List For Health Care Providers, Pg 54 Original policy
67903*	Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach	Master Precertification List For Health Care Providers, Pg 54 Original policy
67904*	Repair of blepharoptosis; (tarso) levator resection or advancement, external approach	Master Precertification List For Health Care Providers, Pg 54 Original policy
67906*	Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia)	Master Precertification List For Health Care Providers, Pg 54 Original policy
67908*	Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type)	Master Precertification List For Health Care Providers, Pg 54 Original policy
67911*	Correction of lid retraction	Master Precertification List For Health Care Providers, Pg 54 Original policy
67999*	Unlisted procedure, eyelids	Master Precertification List For Health Care Providers, Pg 54 Original policy
68899*	Unlisted procedure, lacrimal system	Master Precertification List For Health Care Providers, Pg 54 Original policy
69300*	Otoplasty, protruding ear, with or without size reduction	Master Precertification List For Health Care Providers, Pg 54 Original policy
69399*	Unlisted procedure, external ear	Master Precertification List For Health Care Providers, Pg 54 Original policy
69705*	Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral	Master Precertification List For Health Care Providers, Pg 54 Original policy
69706*	Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); bilateral	Master Precertification List For Health Care Providers, Pg 54 Original policy
69714*	Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor	Master Precertification List For Health Care Providers, Pg 54 Original policy
69716*	Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or resulting in removal of less than 100 sq mm surface area of bone deep to the outer cranial cortex	Master Precertification List For Health Care Providers, Pg 54 Original policy
69799*	Unlisted procedure, middle ear	Master Precertification List For Health Care Providers, Pg 54 Original policy
69930*	Cochlear device implantation, with or without mastoidectomy	Master Precertification List For Health Care Providers, Pg 54 Original policy
69949*	Unlisted procedure, inner ear	Master Precertification List For Health Care Providers, Pg 54 Original policy
70336*	Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)	Master Precertification List For Health Care Providers, Pg 54 Original policy
70471*	Computed tomographic angiography (CTA), head and neck, with contrast material(s), including noncontrast images, when performed, and image postprocessing	Master Precertification List For Health Care Providers, Pg 54 Original policy
70490*	Computed tomography, soft tissue neck; without contrast material	Master Precertification List For Health Care Providers, Pg 54 Original policy
70491*	Computed tomography, soft tissue neck; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 54 Original policy
70492*	Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections	Master Precertification List For Health Care Providers, Pg 54 Original policy
70498*	Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing	Master Precertification List For Health Care Providers, Pg 54 Original policy
70540*	Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s)	Master Precertification List For Health Care Providers, Pg 54 Original policy
70542*	Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 54 Original policy
70543*	Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences	Master Precertification List For Health Care Providers, Pg 54 Original policy
70547*	Magnetic resonance angiography, neck; without contrast material(s)	Master Precertification List For Health Care Providers, Pg 54 Original policy
70548*	Magnetic resonance angiography, neck; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 54 Original policy
70549*	Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences	Master Precertification List For Health Care Providers, Pg 55 Original policy
71250*	Computed tomography, thorax, diagnostic; without contrast material	Master Precertification List For Health Care Providers, Pg 55 Original policy
71260*	Computed tomography, thorax, diagnostic; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 55 Original policy
71270*	Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections	Master Precertification List For Health Care Providers, Pg 55 Original policy
71275*	Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing	Master Precertification List For Health Care Providers, Pg 55 Original policy
71550*	Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s)	Master Precertification List For Health Care Providers, Pg 55 Original policy
71551*	Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast material(s)	Master Precertification List For Health Care Providers, Pg 55 Original policy
71552*	Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences	Master Precertification List For Health Care Providers, Pg 55 Original policy
71555*	Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s)	Master Precertification List For Health Care Providers, Pg 55 Original policy
72125*	Computed tomography, cervical spine; without contrast material	Master Precertification List For Health Care Providers, Pg 55 Original policy
72126*	Computed tomography, cervical spine; with contrast material	Master Precertification List For Health Care Providers, Pg 55 Original policy
72127*	Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections	Master Precertification List For Health Care Providers, Pg 55 Original policy
72128*	Computed tomography, thoracic spine; without contrast material	Master Precertification List For Health Care Providers, Pg 55 Original policy
72129*	Computed tomography, thoracic spine; with contrast material	Master Precertification List For Health Care Providers, Pg 55 Original policy
72130*	Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections	Master Precertification List For Health Care Providers, Pg 55 Original policy
72131*	Computed tomography, lumbar spine; without contrast material	Master Precertification List For Health Care Providers, Pg 55 Original policy
72132*	Computed tomography, lumbar spine; with contrast material	Master Precertification List For Health Care Providers, Pg 55 Original policy
72133*	Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections	Master Precertification List For Health Care Providers, Pg 55 Original policy
72141*	Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material	Master Precertification List For Health Care Providers, Pg 55 Original policy
72142*	Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 55 Original policy
72146*	Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material	Master Precertification List For Health Care Providers, Pg 55 Original policy
72147*	Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 55 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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