Cigna · PayerPolicy · CIGNA-0514
Summary of the payer’s published policy. Not a coverage determination — confirm with Cigna before submitting.
Free account. Policy pages stay open to everyone.
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 |
|---|---|---|
| 81220 | CPT | Covered |
| 81257 | CPT | Covered |
| 81329 | CPT | Covered |
| 81361 | CPT | Covered |
| 81412 | CPT | Covered |
| 81420 | CPT | Covered |
| 81507 | CPT | Covered |
| O35.03X2 | ICD10CM | Covered |
| O35.04X0 | ICD10CM | Covered |
| O35.04X1 | ICD10CM | Covered |
| O35.04X2 | ICD10CM | Covered |
| O35.05X0 | ICD10CM | Covered |
| O35.05X1 | ICD10CM | Covered |
| O35.05X2 | ICD10CM | Covered |
| O35.06X0 | ICD10CM | Covered |
| O35.06X1 | ICD10CM | Covered |
| O35.06X2 | ICD10CM | Covered |
| O35.07X0 | ICD10CM | Covered |
| O35.07X1 | ICD10CM | Covered |
| O35.07X2 | ICD10CM | Covered |
| O35.08X0 | ICD10CM | Covered |
| O35.08X1 | ICD10CM | Covered |
| O35.08X2 | ICD10CM | Covered |
| O35.09X0 | ICD10CM | Covered |
| O35.09X1 | ICD10CM | Covered |
| O35.09X2 | ICD10CM | Covered |
| O35.10X0 - O35.19X2 | ICD10CM | Covered |
| O35.2XX0 - O35.2XX2 | ICD10CM | Covered |
| O35.3XX0 - O35.3XX2 | ICD10CM | Covered |
| O35.4XX0 - O35.4XX2 | ICD10CM | Covered |
| O35.5XX0 - O35.5XX2 | ICD10CM | Covered |
| O35.6XX0 - O35.6XX2 | ICD10CM | Covered |
| O35.7XX0 - O35.7XX2 | ICD10CM | Covered |
| O35.8XX0 - O35.8XX2 | ICD10CM | Covered |
| O35.9XX0 - O35.9XX2 | ICD10CM | Covered |
| O35.AXX0 - O35.HXX2 | ICD10CM | Covered |
| O36.20X0 - O36.23X2 | ICD10CM | Covered |
| O36.5110 - O36.5132 | ICD10CM | Covered |
| O36.5190 - O36.5192 | ICD10CM | Covered |
| O36.5910 - O36.5932 | ICD10CM | Covered |
| O36.5990 - O36.5992 | ICD10CM | Covered |
| O36.60X0 - O36.63X2 | ICD10CM | Covered |
| O36.70X0 - O36.73X2 | ICD10CM | Covered |
| O36.8120 - O36.8132 | ICD10CM | Covered |
| O36.8190 - O36.8192 | ICD10CM | Covered |
| O36.8310 - O36.8332 | ICD10CM | Covered |
| O36.8390 - O36.8392 | ICD10CM | Covered |
| O36.8910 - O36.8932 | ICD10CM | Covered |
| O36.8990 - O36.8992 | ICD10CM | Covered |
| O36.90X0 - O36.93X2 | ICD10CM | Covered |
| O40.1XX0 - O40.9XX2 | ICD10CM | Covered |
| O41.00X0 - O41.03X2 | ICD10CM | Covered |
| O41.1010 - O41.1092 | ICD10CM | Covered |
| O41.1210 - O41.1292 | ICD10CM | Covered |
| O41.1410 - O41.1492 | ICD10CM | Covered |
| O41.8X10 - O41.8X92 | ICD10CM | Covered |
| O41.90X0 - O41.93X2 | ICD10CM | Covered |
| O43.011 - O43.93 | ICD10CM | Covered |
| O44.00 - O44.53 | ICD10CM | Covered |
| O45.001 - O45.99 | ICD10CM | Covered |
| O45.8X1 - O45.8X9 | ICD10CM | Covered |
| O46.001 - O46.99 | ICD10CM | Covered |
| O46.8X1 - O46.8X9 | ICD10CM | Covered |
| O47.00 - O47.9 | ICD10CM | Covered |
| O48.0 | ICD10CM | Covered |
| O48.1 | ICD10CM | Covered |
| O60.00 - O60.03 | ICD10CM | Covered |
| O98.X | ICD10CM | Covered |
| O99.X | ICD10CM | Covered |
| Z31.430 | ICD10CM | Covered |
| Z31.438 | ICD10CM | Covered |
| Z31.440 | ICD10CM | Covered |
| Z31.448 | ICD10CM | Covered |
| Z3A.01-Z3A.49 | ICD10CM | Covered |