Cigna · PayerPolicy · CIGNA-0510
Summary of the payer’s published policy. Not a coverage determination — confirm with Cigna before submitting.
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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.
| Code | Code system | Status in this policy |
|---|---|---|
| 93303 | CPT | Covered |
| 93304 | CPT | Covered |
| 93306 | CPT | Covered |
| 93307 | CPT | Covered |
| 93308 | CPT | Covered |
| 93356 | CPT | Covered |
| A18.84 | ICD10CM | Covered |
| A36.81 | ICD10CM | Covered |
| A39.50 | ICD10CM | Covered |
| A39.51 | ICD10CM | Covered |
| A39.52 | ICD10CM | Covered |
| A39.53 | ICD10CM | Covered |
| A40.0 | ICD10CM | Covered |
| A40.1 | ICD10CM | Covered |
| A40.3 | ICD10CM | Covered |
| A40.8 | ICD10CM | Covered |
| A40.9 | ICD10CM | Covered |
| A41.01-A41.9 | ICD10CM | Covered |
| A42.7 | ICD10CM | Covered |
| A52.00 | ICD10CM | Covered |
| A52.01 | ICD10CM | Covered |
| A52.02 | ICD10CM | Covered |
| A52.03 | ICD10CM | Covered |
| A52.06 | ICD10CM | Covered |
| A54.83 | ICD10CM | Covered |
| B00.7 | ICD10CM | Covered |
| B33.20-B33.24 | ICD10CM | Covered |
| B33.21 | ICD10CM | Covered with conditions |
| B33.22 | ICD10CM | Covered with conditions |
| B33.23 | ICD10CM | Covered with conditions |
| B33.24 | ICD10CM | Covered with conditions |
| B37.6 | ICD10CM | Covered |
| B37.7 | ICD10CM | Covered |
| B57.0 | ICD10CM | Covered |
| B57.2 | ICD10CM | Covered |
| B58.81 | ICD10CM | Covered |
| C33 | ICD10CM | Covered |
| C34.00-C34.92 | ICD10CM | Covered with conditions |
| C34.01-C34.92 | ICD10CM | Covered |
| C37 | ICD10CM | Covered |
| C38.0-C38.8 | ICD10CM | Covered |
| C39.0-C39.9 | ICD10CM | Covered |
| C45.2 | ICD10CM | Covered |
| C50.011-C50.912 | ICD10CM | Covered |
| C50.921-C50.922 | ICD10CM | Covered |
| C50.A0-C50.A2 | ICD10CM | Covered |
| C81.00-C81.99 | ICD10CM | Covered with conditions |
| C81.00-C81.9A | ICD10CM | Covered |
| C82.00-C82.99 | ICD10CM | Covered with conditions |
| C82.00-C82.9A | ICD10CM | Covered |
| C83.00-C83.99 | ICD10CM | Covered with conditions |
| C83.00-C83.9A | ICD10CM | Covered |
| C84.60-C84.69 | ICD10CM | Covered with conditions |
| C84.60-C84.6A | ICD10CM | Covered |
| C84.70-C84.7A | ICD10CM | Covered with conditions |
| C84.70-C84.7B | ICD10CM | Covered |
| C85.10-C85.99 | ICD10CM | Covered with conditions |
| C85.10-C85.9A | ICD10CM | Covered |
| C86.0-C86.6 | ICD10CM | Covered with conditions |
| C86.00-C86.61 | ICD10CM | Covered |
| C88.0-C88.9 | ICD10CM | Covered with conditions |
| C88.00-C88.91 | ICD10CM | Covered |
| D15.1 | ICD10CM | Covered |
| D86.85 | ICD10CM | Covered |
| E34.00-E34.09 | ICD10CM | Covered |
| E83.110 | ICD10CM | Covered |
| E83.111 | ICD10CM | Covered |
| E83.118 | ICD10CM | Covered |
| E83.119 | ICD10CM | Covered |
| G06.0 | ICD10CM | Covered |
| G06.1 | ICD10CM | Covered |
| G40.811-G40.814 | ICD10CM | Covered |
| G40.833-G40.834 | ICD10CM | Covered |
| G40.841-G40.844 | ICD10CM | Covered |
| G45.0-G45.9 | ICD10CM | Covered |
| G71.01 | ICD10CM | Covered |
| G90.A | ICD10CM | Covered |
| I01.0 | ICD10CM | Covered with conditions |
| I01.0-I01.9 | ICD10CM | Covered |
| I01.1 | ICD10CM | Covered with conditions |
| I01.2 | ICD10CM | Covered with conditions |
| I02.0 | ICD10CM | Covered |
| I05.0-I09.9 | ICD10CM | Covered |
| I06.0 | ICD10CM | Covered with conditions |
| I06.2 | ICD10CM | Covered with conditions |
| I09.0 | ICD10CM | Covered with conditions |
| I09.2 | ICD10CM | Covered with conditions |
| I10 | ICD10CM | Covered |
| I11.0-I11.9 | ICD10CM | Covered |
| I13.0-I13.2 | ICD10CM | Covered |
| I20.0-I20.9 | ICD10CM | Covered |
| I21.01-I21.A9 | ICD10CM | Covered |
| I22.0-I22.9 | ICD10CM | Covered |
| I23.0-I23.8 | ICD10CM | Covered |
| I24.0-I24.9 | ICD10CM | Covered |
| I25.10-I25.119 | ICD10CM | Covered |
| I25.2 | ICD10CM | Covered |
| I25.3 | ICD10CM | Covered |
| I25.41 | ICD10CM | Covered |
| I25.42 | ICD10CM | Covered |
| I25.5 | ICD10CM | Covered |
| I25.6 | ICD10CM | Covered |
| I25.700-I25.799 | ICD10CM | Covered |
| I25.750-I25.759 | ICD10CM | Covered with conditions |
| I25.760-I25.769 | ICD10CM | Covered with conditions |
| I25.810 | ICD10CM | Covered |
| I25.811 | ICD10CM | Covered |
| I25.812 | ICD10CM | Covered |
| I25.84 | ICD10CM | Covered |
| I25.89 | ICD10CM | Covered |
| I26.01-I26.99 | ICD10CM | Covered |
| I27.0-I27.9 | ICD10CM | Covered |
| I28.0 | ICD10CM | Covered |
| I30.0-I30.9 | ICD10CM | Covered |
| I31.0-I31.9 | ICD10CM | Covered |
| I31.31 | ICD10CM | Covered with conditions |
| I31.39 | ICD10CM | Covered with conditions |
| I32 | ICD10CM | Covered |
| I33.0-I33.9 | ICD10CM | Covered |
| I34.0-I34.9 | ICD10CM | Covered |
| I35.0-I35.9 | ICD10CM | Covered |
| I35.2 | ICD10CM | Covered with conditions |
| I36.0-I36.9 | ICD10CM | Covered |
| I37.0-I37.9 | ICD10CM | Covered |
| I38 | ICD10CM | Covered |
| I39 | ICD10CM | Covered |
| I40.0-I40.9 | ICD10CM | Covered |
| I41 | ICD10CM | Covered |
| I42.0-I42.9 | ICD10CM | Covered |
| I42.2 | ICD10CM | Covered with conditions |
| I42.5 | ICD10CM | Covered with conditions |
| I42.6 | ICD10CM | Covered with conditions |
| I42.7 | ICD10CM | Covered with conditions |
| I42.8 | ICD10CM | Covered with conditions |
| I42.9 | ICD10CM | Covered with conditions |
| I43 | ICD10CM | Covered |
| I44.2 | ICD10CM | Covered |
| I44.30 | ICD10CM | Covered |
| I44.39 | ICD10CM | Covered |
| I44.7 | ICD10CM | Covered |
| I45.0 | ICD10CM | Covered |
| I45.10 | ICD10CM | Covered |
| I45.19 | ICD10CM | Covered |
| I45.2 | ICD10CM | Covered |
| I45.3 | ICD10CM | Covered |
| I45.4 | ICD10CM | Covered |
| I45.5 | ICD10CM | Covered |
| I45.6 | ICD10CM | Covered |
| I45.81 | ICD10CM | Covered |
| I45.89 | ICD10CM | Covered |
| I46.2-I46.9 | ICD10CM | Covered |
| I47.0-I47.9 | ICD10CM | Covered |
| I48.0-I48.92 | ICD10CM | Covered |
| I49.01-I49.9 | ICD10CM | Covered |
| I50.1-I50.9 | ICD10CM | Covered |
| I51.0 | ICD10CM | Covered |
| I51.1 | ICD10CM | Covered |
| I51.2 | ICD10CM | Covered |
| I51.3 | ICD10CM | Covered |
| I51.4 | ICD10CM | Covered |
| I51.5 | ICD10CM | Covered |
| I51.7 | ICD10CM | Covered |
| I51.81 | ICD10CM | Covered |
| I51.89 | ICD10CM | Covered |
| I5A | ICD10CM | Covered |
| I63.00-I63.9 | ICD10CM | Covered |
| I66.01-I66.9 | ICD10CM | Covered |
| I71.010-I71.019 | ICD10CM | Covered |
| I71.03 | ICD10CM | Covered |
| I71.10-I71.13 | ICD10CM | Covered |
| I71.20-I71.23 | ICD10CM | Covered |
| I71.50-I71.52 | ICD10CM | Covered |
| I71.60-I71.62 | ICD10CM | Covered |
| I71.8 | ICD10CM | Covered |
| I71.9 | ICD10CM | Covered |
| I74.01-I74.9 | ICD10CM | Covered |
| I75.011-I75.013 | ICD10CM | Covered |
| I75.021-I75.023 | ICD10CM | Covered |
| I75.81 | ICD10CM | Covered |
| I75.89 | ICD10CM | Covered |
| I76 | ICD10CM | Covered |
| I77.810 | ICD10CM | Covered |
| I77.812 | ICD10CM | Covered |
| I77.82 | ICD10CM | Covered |
| I95.0 | ICD10CM | Covered |
| I95.1 | ICD10CM | Covered |
| I95.3 | ICD10CM | Covered |
| I95.81 | ICD10CM | Covered |
| I97.0 | ICD10CM | Covered |
| I97.110-I97.191 | ICD10CM | Covered |
| I97.410-I97.418 | ICD10CM | Covered |
| I97.42 | ICD10CM | Covered |
| I97.610-I97.618 | ICD10CM | Covered |
| I97.620 | ICD10CM | Covered |
| I97.710 | ICD10CM | Covered |
| I97.711 | ICD10CM | Covered |
| I97.790 | ICD10CM | Covered |
| I97.791 | ICD10CM | Covered |
| I97.88 | ICD10CM | Covered |
| I97.89 | ICD10CM | Covered |
| J80 | ICD10CM | Covered |
| J95.1 | ICD10CM | Covered |
| J95.2 | ICD10CM | Covered |
| J95.3 | ICD10CM | Covered |
| J95.821 | ICD10CM | Covered |
| J95.822 | ICD10CM | Covered |
| J96.00-J96.02 | ICD10CM | Covered |
| J96.20-J96.22 | ICD10CM | Covered |
| J96.90-J96.92 | ICD10CM | Covered |
| M30.3 | ICD10CM | Covered |
| M31.4 | ICD10CM | Covered |
| M32.11 | ICD10CM | Covered |
| M32.12 | ICD10CM | Covered |
| M34.0-M34.9 | ICD10CM | Covered |
| M35.81 | ICD10CM | Covered |
| M35.89 | ICD10CM | Covered |
| O90.3 | ICD10CM | Covered |
| Q20.0-Q20.9 | ICD10CM | Covered |
| Q21.0-Q21.9 | ICD10CM | Covered |
| Q21.3 | ICD10CM | Covered with conditions |
| Q22.0-Q22.9 | ICD10CM | Covered |
| Q22.5 | ICD10CM | Covered with conditions |
| Q22.6 | ICD10CM | Covered with conditions |
| Q23.0-Q23.9 | ICD10CM | Covered |
| Q23.4 | ICD10CM | Covered with conditions |
| Q24.0-Q24.9 | ICD10CM | Covered |
| Q24.2 | ICD10CM | Covered with conditions |
| Q24.4 | ICD10CM | Covered with conditions |
| Q25.0-Q25.9 | ICD10CM | Covered |
| Q25.3 | ICD10CM | Covered with conditions |
| Q25.43 | ICD10CM | Covered with conditions |
| Q25.44 | ICD10CM | Covered with conditions |
| Q26.0 | ICD10CM | Covered |
| Q26.1 | ICD10CM | Covered |
| Q26.2 | ICD10CM | Covered |
| Q26.3 | ICD10CM | Covered |
| Q26.4 | ICD10CM | Covered |
| Q26.8 | ICD10CM | Covered |
| Q26.9 | ICD10CM | Covered |
| Q67.6 | ICD10CM | Covered |
| Q67.7 | ICD10CM | Covered |
| Q87.40 | ICD10CM | Covered with conditions |
| Q87.40-Q87.43 | ICD10CM | Covered |
| Q87.410 | ICD10CM | Covered with conditions |
| Q87.418 | ICD10CM | Covered with conditions |
| Q89.3 | ICD10CM | Covered |
| Q89.7 | ICD10CM | Covered |
| Q89.81 | ICD10CM | Covered |
| Q89.89 | ICD10CM | Covered |
| Q89.9 | ICD10CM | Covered |
| Q90.0 | ICD10CM | Covered |
| Q90.1 | ICD10CM | Covered |
| Q90.2 | ICD10CM | Covered |
| Q90.9 | ICD10CM | Covered |
| Q96.0-Q96.9 | ICD10CM | Covered |
| R00.0 | ICD10CM | Covered |
| R00.1 | ICD10CM | Covered |
| R00.2 | ICD10CM | Covered |
| R01.1 | ICD10CM | Covered |
| R06.00 | ICD10CM | Covered |
| R06.01 | ICD10CM | Covered |
| R06.02 | ICD10CM | Covered |
| R06.03 | ICD10CM | Covered |
| R06.09 | ICD10CM | Covered |
| R06.3 | ICD10CM | Covered |
| R07.2 | ICD10CM | Covered |
| R07.82 | ICD10CM | Covered |
| R07.89 | ICD10CM | Covered |
| R07.9 | ICD10CM | Covered |
| R09.01 | ICD10CM | Covered |
| R09.02 | ICD10CM | Covered |
| R09.2 | ICD10CM | Covered |
| R42 | ICD10CM | Covered |
| R55 | ICD10CM | Covered |
| R57.0-R57.9 | ICD10CM | Covered |
| R60.0 | ICD10CM | Covered |
| R60.9 | ICD10CM | Covered |
| R65.20 | ICD10CM | Covered |
| R65.21 | ICD10CM | Covered |
| R78.81 | ICD10CM | Covered |
| R93.1 | ICD10CM | Covered |
| R94.31 | ICD10CM | Covered |
| S21.301A-S21.359S | ICD10CM | Covered |
| S22.5XXA | ICD10CM | Covered |
| S22.5XXB | ICD10CM | Covered |
| S22.5XXG | ICD10CM | Covered |
| S22.5XXK | ICD10CM | Covered |
| S22.5XXS | ICD10CM | Covered |
| S25.00XAS25.09XS | ICD10CM | Covered |
| S25.20XAS25.29XS | ICD10CM | Covered |
| S25.401AS25.499S | ICD10CM | Covered |
| S26.00XAS26.99XS | ICD10CM | Covered |
| S27.9XXAS27.9XXS | ICD10CM | Covered |
| T45.1X5A-T45.1X5S | ICD10CM | Covered with conditions |
| T45.1X5AT45.1X5S | ICD10CM | Covered |
| T79.4XXAT79.4XXS | ICD10CM | Covered |
| T80.218AT80.218S | ICD10CM | Covered |
| T80.219AT80.219S | ICD10CM | Covered |
| T81.10XAT81.19XS | ICD10CM | Covered |
| T81.44XAT81.44XS | ICD10CM | Covered |
| T82.01XAT82.09XS | ICD10CM | Covered |
| T82.110AT82.199S | ICD10CM | Covered |
| T82.211AT82.228S | ICD10CM | Covered |
| T82.310AT82.399S | ICD10CM | Covered |
| T82.41XAT82.49XS | ICD10CM | Covered |
| T82.510AT82.599S | ICD10CM | Covered |
| T82.6XXAT82.6XXS | ICD10CM | Covered |
| T82.7XXAT82.7XXS | ICD10CM | Covered |
| T82.817AT82.818S | ICD10CM | Covered |
| T82.827AT82.827S | ICD10CM | Covered |
| T82.837AT82.837S | ICD10CM | Covered |
| T82.847AT82.847S | ICD10CM | Covered |
| T82.855AT82.855S | ICD10CM | Covered |
| T82.857AT82.857S | ICD10CM | Covered |
| T82.867AT82.867S | ICD10CM | Covered |
| T82.897AT82.897S | ICD10CM | Covered |
| T82.9XXAT82.9XXS | ICD10CM | Covered |
| T85.730AT85.738S | ICD10CM | Covered |
| T86.20 | ICD10CM | Covered with conditions |
| T86.20-T86.298 | ICD10CM | Covered |
| T86.21 | ICD10CM | Covered with conditions |
| T86.22 | ICD10CM | Covered with conditions |
| T86.23 | ICD10CM | Covered with conditions |
| T86.298 | ICD10CM | Covered with conditions |
| T86.30-T86.39 | ICD10CM | Covered |
| Z01.810 | ICD10CM | Covered |
| Z01.811 | ICD10CM | Covered |
| Z01.812 | ICD10CM | Covered |
| Z01.818 | ICD10CM | Covered |
| Z08 | ICD10CM | Covered |
| Z17.0 | ICD10CM | Covered |
| Z48.21 | ICD10CM | Covered |
| Z48.24 | ICD10CM | Covered |
| Z48.280 | ICD10CM | Covered |
| Z51.0 | ICD10CM | Covered |
| Z51.11 | ICD10CM | Covered |
| Z51.12 | ICD10CM | Covered |
| Z51.81 | ICD10CM | Covered |
| Z79.01-Z79.899 | ICD10CM | Covered |
| Z82.41 | ICD10CM | Covered |
| Z82.49 | ICD10CM | Covered |
| Z82.79 | ICD10CM | Covered |
| Z86.003 | ICD10CM | Covered |
| Z86.005 | ICD10CM | Covered |
| Z86.73 | ICD10CM | Covered |
| Z86.74 | ICD10CM | Covered |
| Z92.21 | ICD10CM | Covered |
| Z92.22 | ICD10CM | Covered |
| Z92.25 | ICD10CM | Covered |
| Z92.3 | ICD10CM | Covered |
| Z92.850 | ICD10CM | Covered |
| Z92.858 | ICD10CM | Covered |
| Z92.859 | ICD10CM | Covered |
| Z92.86 | ICD10CM | Covered |
| Z94.1 | ICD10CM | Covered |
| Z94.2 | ICD10CM | Covered |
| Z94.3 | ICD10CM | Covered |
| Z95.0 | ICD10CM | Covered |
| Z95.2 | ICD10CM | Covered |
| Z95.3 | ICD10CM | Covered |
| Z95.4 | ICD10CM | Covered |
| Z95.811 | ICD10CM | Covered |
| Z95.812 | ICD10CM | Covered |
| Z95.818 | ICD10CM | Covered |
| Z98.85 | ICD10CM | Covered |