Cigna prior authorization, page 40

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
J9297*	Injection, pemetrexed (sandoz), not therapeutically equivalent to J9305, 10 mg	Master Precertification List For Health Care Providers, Pg 88 Original policy
J9298*	Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg	Master Precertification List For Health Care Providers, Pg 88 Original policy
J9299*	Injection, nivolumab, 1 mg	Master Precertification List For Health Care Providers, Pg 88 Original policy
J9301*	Injection, obinutuzumab, 10 mg	Master Precertification List For Health Care Providers, Pg 88 Original policy
J9302*	Injection, ofatumumab, 10 mg	Master Precertification List For Health Care Providers, Pg 88 Original policy
J9303*	Injection, panitumumab, 10 mg	Master Precertification List For Health Care Providers, Pg 88 Original policy
J9304*	Injection, pemetrexed (pemfexy), 10 mg	Master Precertification List For Health Care Providers, Pg 88 Original policy
J9305*	Injection, pemetrexed, not otherwise specified, 10 mg	Master Precertification List For Health Care Providers, Pg 88 Original policy
J9306*	Injection, pertuzumab, 1 mg	Master Precertification List For Health Care Providers, Pg 88 Original policy
J9307*	Injection, pralatrexate, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9308*	Injection, ramucirumab, 5 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9309*	Injection, polatuzumab vedotin-piiq, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9311*	Injection, rituximab 10 mg and hyaluronidase	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9312*	Injection, rituximab, 10 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9313*	Injection, moxetumomab pasudotox-tdfk, 0.01 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9314*	Injection, pemetrexed (teva), not therapeutically equivalent to J9305, 10 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9316*	Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9317*	Injection, sacituzumab govitecan-hziy, 2.5 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9318*	Injection, romidepsin, non-lyophilized, 0.1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9319*	Injection, romidepsin, lyophilized, 0.1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9320*	Injection, streptozocin, 1 gram	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9321*	Injection, epcoritamab-bysp, 0.16 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9322*	Injection, pemetrexed (bluepoint), not therapeutically equivalent to J9305, 10 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9323*	Injection, pemetrexed ditromethamine, 10 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9324*	Injection, pemetrexed (pemrydi rtu), 10 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9325*	Injection, talimogene laherparepvec, per 1 million plaque forming units - Brand name: Imlygic	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9326*	Injection, telisotuzumab vedotin-tllv, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9328*	Injection, temozolomide, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9329*	Injection, tislelizumab-jsgr, 1mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9330*	Injection, temsirolimus, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9331*	Injection, sirolimus protein-bound particles, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9332	Injection, efgartigimod alfa-fcab, 2mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9333	Injection, rozanolixizumab-noli, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9334	Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9341*	Injection, thiotepa (tepylute), 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9342*	Injection, thiotepa, not otherwise specified, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9345*	Injection, retifanlimab-dlwr, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9347*	Injection, tremelimumab-actl, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9348*	Injection, naxitamab-gqgk, 1 mg	Master Precertification List For Health Care Providers, Pg 89 Original policy
J9349*	Injection, tafasitamab-cxix, 2 mg	Master Precertification List For Health Care Providers, Pg 90 Original policy
J9350*	Injection, mosunetuzumab-axgb, 1 mg	Master Precertification List For Health Care Providers, Pg 90 Original policy
J9351*	Injection, topotecan, 0.1 mg	Master Precertification List For Health Care Providers, Pg 90 Original policy
J9353*	Injection, margetuximab-cmkb, 5 mg	Master Precertification List For Health Care Providers, Pg 90 Original policy
J9354*	Injection, ado-trastuzumab emtansine, 1 mg	Master Precertification List For Health Care Providers, Pg 90 Original policy
J9355*	Injection, trastuzumab, excludes biosimilar, 10 mg	Master Precertification List For Health Care Providers, Pg 90 Original policy
J9356*	Injection, trastuzumab, 10 mg and Hyaluronidase-oysk	Master Precertification List For Health Care Providers, Pg 90 Original policy
J9358*	Injection, fam-trastuzumab deruxtecan-nxki, 1 mg	Master Precertification List For Health Care Providers, Pg 90 Original policy
J9359*	Injection, loncastuximab tesirine-lpyl, 0.075 mg	Master Precertification List For Health Care Providers, Pg 90 Original policy
J9360*	Injection, vinblastine sulfate, 1 mg	Master Precertification List For Health Care Providers, Pg 90 Original policy
J9361*	Injection, efbemalenograstim alfa-vuxw, 0.5 mg	Master Precertification List For Health Care Providers, Pg 90 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.