Cigna prior authorization, page 35

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
J2507	Injection, pegloticase, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2508	Injection, pegunigalsidase alfa-iwxj, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2562	Injection, plerixafor, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2724	Injection, protein c concentrate, intravenous, human, 10 iu	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2777	Injection, faricimab-svoa, 0.1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2778	Injection, ranibizumab, 0.1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2779	Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2782	Injection, avacincaptad pegol, 0.1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2786	Injection, reslizumab, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2793	Injection, rilonacept, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2797*	Injection, rolapitant, 0.5 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2802*	Injection, romiplostim, 1 microgram	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2840	Injection, sebelipase alfa, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2860*	Injection, siltuximab, 10 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2941	Injection, somatropin, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J2998	Injection, plasminogen, human-tvmh, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J3031	Injection, fremanezumab-vfrm, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J3032	Injection, eptinezumab-jjmr, 1 mg	Master Precertification List For Health Care Providers, Pg 80 Original policy
J3055*	Injection, talquetamab-tgvs, 0.25 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3060	Injection, taliglucerase alfa, 10 units	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3111	Injection, romosozumab-aqqg, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3145	Injection, testosterone undecanoate, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3241	Injection, teprotumumab-trbw, 10 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3245	Injection, tildrakizumab, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3247	Injection, secukinumab, intravenous, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3262*	Injection, tocilizumab, 1 mg - Brand name: Actemra	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3263*	Injection, toripalimab-tpzi, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3285	Injection, treprostinil, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3299	Injection, triamcinolone acetonide (xipere), 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3304	Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3315*	Injection, triptorelin pamoate, 3.75 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3316	Injection, triptorelin, extended-release, 3.75 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3357	Ustekinumab, for subcutaneous injection, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3358	Ustekinumab, for intravenous injection, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3380	Injection, vedolizumab, intravenous, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3385	Injection, velaglucerase alfa, 100 units	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3386	Injection, etuvetidigene autotemcel, per treatment	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3387	Injection, elivaldogene autotemcel, per treatment	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3389	Topical administration, prademagene zamikeracel, per treatment	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3391	Injection, atidarsagene autotemcel, per treatment	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3392	Injection, exagamglogene autotemcel, per treatment	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3393	Injection, betibeglogene autotemcel, per treatment	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3394	Injection, lovotibeglogene autotemcel, per treatment	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3397	Injection, vestronidase alfa-vjbk, 1 mg	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3398	Injection, voretigene neparvovec-rzyl, 1 billion vector genomes	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3399	Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3401	Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3402	Injection, remestemcel-l-rknd, per therapeutic dose	Master Precertification List For Health Care Providers, Pg 81 Original policy
J3403	Revakinagene taroretcel-lwey, per implant	Master Precertification List For Health Care Providers, Pg 81 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.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.