Cigna prior authorization, page 23

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
72148*	Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material	Master Precertification List For Health Care Providers, Pg 55 Original policy
72149*	Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 55 Original policy
72156*	Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical	Master Precertification List For Health Care Providers, Pg 55 Original policy
72157*	Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic	Master Precertification List For Health Care Providers, Pg 55 Original policy
72158*	Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar	Master Precertification List For Health Care Providers, Pg 55 Original policy
72159*	Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s)	Master Precertification List For Health Care Providers, Pg 55 Original policy
72191*	Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing	Master Precertification List For Health Care Providers, Pg 56 Original policy
72192*	Computed tomography, pelvis; without contrast material	Master Precertification List For Health Care Providers, Pg 56 Original policy
72193*	Computed tomography, pelvis; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
72194*	Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections	Master Precertification List For Health Care Providers, Pg 56 Original policy
72195*	Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
72196*	Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
72197*	Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences	Master Precertification List For Health Care Providers, Pg 56 Original policy
72198*	Magnetic resonance angiography, pelvis, with or without contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73200*	Computed tomography, upper extremity; without contrast material	Master Precertification List For Health Care Providers, Pg 56 Original policy
73201*	Computed tomography, upper extremity; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73202*	Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections	Master Precertification List For Health Care Providers, Pg 56 Original policy
73206*	Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing	Master Precertification List For Health Care Providers, Pg 56 Original policy
73218*	Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73219*	Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73220*	Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences	Master Precertification List For Health Care Providers, Pg 56 Original policy
73221*	Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73222*	Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73223*	Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences	Master Precertification List For Health Care Providers, Pg 56 Original policy
73225*	Magnetic resonance angiography, upper extremity, with or without contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73700*	Computed tomography, lower extremity; without contrast material	Master Precertification List For Health Care Providers, Pg 56 Original policy
73701*	Computed tomography, lower extremity; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73702*	Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections	Master Precertification List For Health Care Providers, Pg 56 Original policy
73706*	Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing	Master Precertification List For Health Care Providers, Pg 56 Original policy
73718*	Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73719*	Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73720*	Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences	Master Precertification List For Health Care Providers, Pg 56 Original policy
73721*	Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material	Master Precertification List For Health Care Providers, Pg 56 Original policy
73722*	Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 56 Original policy
73723*	Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences	Master Precertification List For Health Care Providers, Pg 56 Original policy
73725*	Magnetic resonance angiography, lower extremity, with or without contrast material(s)	Master Precertification List For Health Care Providers, Pg 57 Original policy
74150*	Computed tomography, abdomen; without contrast material	Master Precertification List For Health Care Providers, Pg 57 Original policy
74160*	Computed tomography, abdomen; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 57 Original policy
74170*	Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections	Master Precertification List For Health Care Providers, Pg 57 Original policy
74174*	Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing	Master Precertification List For Health Care Providers, Pg 57 Original policy
74175*	Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing	Master Precertification List For Health Care Providers, Pg 57 Original policy
74176*	Computed tomography, abdomen and pelvis; without contrast material	Master Precertification List For Health Care Providers, Pg 57 Original policy
74177*	Computed tomography, abdomen and pelvis; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 57 Original policy
74178*	Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions	Master Precertification List For Health Care Providers, Pg 57 Original policy
74181*	Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)	Master Precertification List For Health Care Providers, Pg 57 Original policy
74182*	Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s)	Master Precertification List For Health Care Providers, Pg 57 Original policy
74183*	Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences	Master Precertification List For Health Care Providers, Pg 57 Original policy
74185*	Magnetic resonance angiography, abdomen, with or without contrast material(s)	Master Precertification List For Health Care Providers, Pg 57 Original policy
75577*	Quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, derived from augmentative software analysis of the data set from a coronary computed tomographic angiography, with interpretation and report by a physician or other qualified health care professional	Master Precertification List For Health Care Providers, Pg 57 Original policy
75635*	Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing	Master Precertification List For Health Care Providers, Pg 57 Original policy

Removed codes

Cigna codes removed from the master precertification list

Sources

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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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