Orthognathic Surgery | Cigna | Backwork

Orthognathic Surgery

Cigna · PayerPolicy · CIGNA-0209

Status: Active
Effective: October 15, 2025
Last checked by Backwork: September 30, 2026

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

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Codes in this policy

Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
11954	CPT	Not covered
15769	CPT	Not covered
15773	CPT	Not covered
15774	CPT	Not covered
15824	CPT	Not covered
15825	CPT	Not covered
15826	CPT	Not covered
15828	CPT	Not covered
15829	CPT	Not covered
21120	CPT	Not covered
21121	CPT	Not covered
21122	CPT	Not covered
21123	CPT	Not covered
21497	CPT	Not covered
30400	CPT	Not covered
30410	CPT	Not covered
30420	CPT	Not covered
30430	CPT	Not covered
30435	CPT	Not covered
30450	CPT	Not covered
30460	CPT	Not covered
30462	CPT	Not covered