Cigna prior authorization, page 37

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
J7316	Injection, ocriplasmin, 0.125 mg	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7318	Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7320	Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7321	Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7322	Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7323	Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7324	Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7325	Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7326	Hyaluronan or derivative, gel-one, for intra-articular injection, per dose	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7327	Hyaluronan or derivative, monovisc, for intra-articular injection, per dose	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7328	Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7329	Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7330*	Autologous cultured chondrocytes, implant	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7331	Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg	Master Precertification List For Health Care Providers, Pg 83 Original policy
J7332	Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J7340	Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml	Master Precertification List For Health Care Providers, Pg 84 Original policy
J7351	Injection, bimatoprost, intracameral implant, 1 microgram	Master Precertification List For Health Care Providers, Pg 84 Original policy
J7352	Afamelanotide implant, 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J7355	Injection, travoprost, intracameral implant, 1 microgram	Master Precertification List For Health Care Providers, Pg 84 Original policy
J7356	Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J7402	Mometasone furoate sinus implant, (sinuva), 10 micrograms	Master Precertification List For Health Care Providers, Pg 84 Original policy
J7686	Treprostinil, inhalation solution, fda-approved final product, non- compounded, administered through dme, unit dose form, 1.74 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J7999	Compounded drug, not otherwise classified	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9000*	Injection, doxorubicin hydrochloride, 10 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9003*	Leuprolide injectable (camcevi etm), 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9011*	Injection, datopotamab deruxtecandlnk, 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9015*	Injection, aldesleukin, per single use vial	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9017*	Injection, arsenic trioxide, 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9021*	Injection, asparaginase, recombinant, (rylaze), 0.1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9022*	Injection, atezolizumab, 10 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9023*	Injection, avelumab, 10 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9024*	Injection, atezolizumab, 5 mg and hyaluronidase-tqjs	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9025*	Injection, azacitidine, 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9026*	Injection, tarlatamab-dlle, 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9027*	Injection, clofarabine, 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9028*	Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9029	Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9032*	Injection, belinostat, 10 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9033*	Injection, bendamustine hydrochloride, not otherwise specified, 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9034*	Injection, bendamustine hcl (bendeka), 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9035*	Injection, bevacizumab, 10 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9036*	Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9038	Injection, axatilimab-csfr, 0.1 mg	Master Precertification List For Health Care Providers, Pg 84 Original policy
J9039*	Injection, blinatumomab, 1 microgram	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9040*	Injection, bleomycin sulfate, 15 units	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9041*	Injection, bortezomib, 0.1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9042*	Injection, brentuximab vedotin, 1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9043*	Injection, cabazitaxel, 1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9045*	Injection, carboplatin, 50 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9046*	Injection, bortezomib (dr. reddy's), not therapeutically equivalent to J9041, 0.1 mg	Master Precertification List For Health Care Providers, Pg 85 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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