4 commercial payer policies list 41874. 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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4 policies from 2 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 41874 |
|---|---|---|
| Alveoloplasty | Aug 15, 2026 | Covered with conditions |
| Cigna Commercial Other Services Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 41874 |
|---|---|---|
| Administrative Guidelines to Determine Dental vs Medical Services | Mar 1, 2026 | Covered |