21073 commercial payer coverage policies

17 commercial payer policies list 21073. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.

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Commercial payer policies listing 21073

17 policies from 11 payers

Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.

Cigna

Cigna policies listing 21073, with the code’s status in each
Policy	Effective	Status of 21073
Cigna Commercial Other Services Code ListPayerPolicy · EVICORE-HPLAN-CIGNA-906C8C902629	Mar 7, 2026	Prior auth required
Cigna Comprehensive Code ListPayerPolicy · EVICORE-HPLAN-CIGNA-1766449955E6	Mar 7, 2026	Prior auth required
Manipulation Under AnesthesiaPayerPolicy · CIGNA-0276	Sep 15, 2026	Not covered

BCBS Illinois

BCBS Illinois policies listing 21073, with the code’s status in each
Policy	Effective	Status of 21073
Manipulation Under AnesthesiaPayerPolicy · BCBSIL-THE803.016	Sep 15, 2026	Covered
Temporomandibular Joint Disorders

21073 commercial payer coverage policies

Commercial payer policies listing 21073

Cigna

BCBS Illinois

21073 commercial payer coverage policies

Commercial payer policies listing 21073

Cigna

BCBS Illinois

BCBS Montana

BCBS New Mexico

BCBS Oklahoma

Aetna

Anthem

Regence BCBS

Surest (UnitedHealthcare)

UMR (UnitedHealthcare)

UnitedHealthcare