Cigna prior authorization, page 38

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
J9047*	Injection, carfilzomib, 1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9048*	Injection, bortezomib (fresenius kabi), not therapeutically equivalent to J9041, 0.1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9049*	Injection, bortezomib (hospira), not therapeutically equivalent to J9041, 0.1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9051*	Injection, bortezomib (maia), not therapeutically equivalent to J9041, 0.1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9053*	Injection, belantamab mafodotin-blmf, 0.1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9054*	Injection, bortezomib (boruzu), 0.1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9055*	Injection, cetuximab, 10 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9056*	Injection, bendamustine hydrochloride (vivimusta), 1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9057*	Injection, copanlisib, 1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9060*	Injection, cisplatin, powder or solution, 10 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9061*	Injection, amivantamab-vmjw, 2 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9062*	Injection, amivantamab 5 mg and hyaluronidase-lpuj	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9063*	Injection, mirvetuximab soravtansine-gynx, 1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9064*	Injection, cabazitaxel (sandoz), not therapeutically equivalent to J9043, 1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9065*	Injection, cladribine, per 1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9066*	Injection, bendamustine hydrochloride (avyxa), 1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9100*	Injection, cytarabine, 100 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9118*	Injection, calaspargase pegol-mknl, 10 units	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9119*	Injection, cemiplimab-rwlc, 1 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9120*	Injection, dactinomycin, 0.5 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9130*	Dacarbazine, 100 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9144*	Injection, daratumumab, 10 mg and hyaluronidase-fihj	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9145*	Injection, daratumumab, 10 mg	Master Precertification List For Health Care Providers, Pg 85 Original policy
J9150*	Injection, daunorubicin, 10 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9153*	Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9155*	Injection, degarelix, 1 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9161*	Injection, denileukin diftitox-cxdl, 1 mcg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9171*	Injection, docetaxel, 1 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9172*	Injection, docetaxel (docivyx), 1 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9173*	Injection, durvalumab, 10 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9174*	Injection, docetaxel (beizray), 1 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9176*	Injection, elotuzumab, 1 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9177*	Injection, enfortumab vedotin-ejfv, 0.25 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9178*	Injection, epirubicin hcl, 2 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9179*	Injection, eribulin mesylate, 0.1 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9183*	Gemcitabine intravesical system, 225 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9184*	Injection, gemcitabine hydrochloride (avyxa), 200 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9185*	Injection, fludarabine phosphate, 50 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9186*	Injection, etoposide (avyxa), 1 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9187*	injection, etoposide, 1 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9191*	Injection, fluorouracil (avyxa), 10 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9192*	Injection, fluorouracil, 10 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9196*	Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to J9201, 200 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9198*	Injection, gemcitabine hydrochloride, (infugem), 100 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9200*	Injection, floxuridine, 500 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9201*	Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9202*	Goserelin acetate implant, per 3.6 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9203*	Injection, gemtuzumab ozogamicin, 0.1 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9204*	Injection, mogamulizumab-kpkc, 1 mg	Master Precertification List For Health Care Providers, Pg 86 Original policy
J9205*	Injection, irinotecan liposome, 1 mg	Master Precertification List For Health Care Providers, Pg 86 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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