Cigna prior authorization, page 6

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
15013*	Preparation of skin cell suspension autograft, requiring enzymatic processing, manual mechanical disaggregation of skin cells, and filtration; first 25 sq cm or less of harvested skin	Master Precertification List For Health Care Providers, Pg 18 Original policy
15014*	Preparation of skin cell suspension autograft, requiring enzymatic processing, manual mechanical disaggregation of skin cells, and filtration; each additional 25 sq cm of harvested skin or part thereof	Master Precertification List For Health Care Providers, Pg 18 Original policy
15015*	Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; first 480 sq cm or less	Master Precertification List For Health Care Providers, Pg 18 Original policy
15016*	Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; each additional 480 sq cm or part thereof	Master Precertification List For Health Care Providers, Pg 18 Original policy
15017*	Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 480 sq cm or less	Master Precertification List For Health Care Providers, Pg 18 Original policy
15018*	Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 480 sq cm or part thereof	Master Precertification List For Health Care Providers, Pg 18 Original policy
15150*	Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less	Master Precertification List For Health Care Providers, Pg 18 Original policy
15151*	Tissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm to 75 sq cm	Master Precertification List For Health Care Providers, Pg 18 Original policy
15152*	Tissue cultured skin autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof	Master Precertification List For Health Care Providers, Pg 18 Original policy
15155*	Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less	Master Precertification List For Health Care Providers, Pg 18 Original policy
15156*	Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; additional 1 sq cm to 75 sq cm	Master Precertification List For Health Care Providers, Pg 18 Original policy
15157*	Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof	Master Precertification List For Health Care Providers, Pg 18 Original policy
15271*	Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area	Master Precertification List For Health Care Providers, Pg 18 Original policy
15272*	Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof	Master Precertification List For Health Care Providers, Pg 18 Original policy
15273*	Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children	Master Precertification List For Health Care Providers, Pg 18 Original policy
15274*	Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof	Master Precertification List For Health Care Providers, Pg 18 Original policy
15275*	Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area	Master Precertification List For Health Care Providers, Pg 19 Original policy
15276*	Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof	Master Precertification List For Health Care Providers, Pg 19 Original policy
15277*	Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children	Master Precertification List For Health Care Providers, Pg 19 Original policy
15278*	Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof	Master Precertification List For Health Care Providers, Pg 19 Original policy
15769*	Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)	Master Precertification List For Health Care Providers, Pg 19 Original policy
15771*	Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate	Master Precertification List For Health Care Providers, Pg 19 Original policy
15772*	Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part thereof	Master Precertification List For Health Care Providers, Pg 19 Original policy
15773*	Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate	Master Precertification List For Health Care Providers, Pg 19 Original policy
15774*	Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part thereof	Master Precertification List For Health Care Providers, Pg 19 Original policy
15777*	Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk)	Master Precertification List For Health Care Providers, Pg 19 Original policy
15778*	Implantation of absorbable mesh or other prosthesis for delayed closure of defect(s) (ie, external genitalia, perineum, abdominal wall) due to soft tissue infection or trauma	Master Precertification List For Health Care Providers, Pg 19 Original policy
15786*	Abrasion; single lesion (eg, keratosis, scar)	Master Precertification List For Health Care Providers, Pg 19 Original policy
15787*	Abrasion; each additional 4 lesions or less	Master Precertification List For Health Care Providers, Pg 19 Original policy
15820*	Blepharoplasty, lower eyelid;	Master Precertification List For Health Care Providers, Pg 19 Original policy
15821*	Blepharoplasty, lower eyelid; with extensive herniated fat pad	Master Precertification List For Health Care Providers, Pg 19 Original policy
15822*	Blepharoplasty, upper eyelid;	Master Precertification List For Health Care Providers, Pg 19 Original policy
15823*	Blepharoplasty, upper eyelid; with excessive skin weighting down lid	Master Precertification List For Health Care Providers, Pg 19 Original policy
15824*	Rhytidectomy; forehead	Master Precertification List For Health Care Providers, Pg 19 Original policy
15825*	Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap)	Master Precertification List For Health Care Providers, Pg 19 Original policy
15828*	Rhytidectomy; cheek, chin, and neck	Master Precertification List For Health Care Providers, Pg 19 Original policy
15829*	Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap	Master Precertification List For Health Care Providers, Pg 19 Original policy
15830*	Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy	Master Precertification List For Health Care Providers, Pg 19 Original policy
15832*	Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh	Master Precertification List For Health Care Providers, Pg 19 Original policy
15833*	Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg	Master Precertification List For Health Care Providers, Pg 19 Original policy
15834*	Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip	Master Precertification List For Health Care Providers, Pg 20 Original policy
15835*	Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock	Master Precertification List For Health Care Providers, Pg 20 Original policy
15836*	Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm	Master Precertification List For Health Care Providers, Pg 20 Original policy
15837*	Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand	Master Precertification List For Health Care Providers, Pg 20 Original policy
15838*	Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad	Master Precertification List For Health Care Providers, Pg 20 Original policy
15839*	Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area	Master Precertification List For Health Care Providers, Pg 20 Original policy
15847*	Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication)	Master Precertification List For Health Care Providers, Pg 20 Original policy
15876*	Suction assisted lipectomy; head and neck	Master Precertification List For Health Care Providers, Pg 20 Original policy
15877*	Suction assisted lipectomy; trunk	Master Precertification List For Health Care Providers, Pg 20 Original policy
15878*	Suction assisted lipectomy; upper extremity	Master Precertification List For Health Care Providers, Pg 20 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.