Cigna · PayerPolicy · CIGNA-0538
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 |
|---|---|---|
| A02.1 | ICD10CM | Covered |
| A07.2 | ICD10CM | Covered |
| A07.3 | ICD10CM | Covered |
| A15.0-A19.9 | ICD10CM | Covered |
| A31.0 | ICD10CM | Covered |
| A31.2 | ICD10CM | Covered |
| A31.8 | ICD10CM | Covered |
| A81.2 | ICD10CM | Covered |
| B00.0 | ICD10CM | Covered |
| B00.1 | ICD10CM | Covered |
| B00.2 | ICD10CM | Covered |
| B00.89 | ICD10CM | Covered |
| B20 | ICD10CM | Covered |
| B25.0-B25.9 | ICD10CM | Covered |
| B37.1 | ICD10CM | Covered |
| B37.81 | ICD10CM | Covered |
| B37.89 | ICD10CM | Covered |
| B38.9 | ICD10CM | Covered |
| B39.2 | ICD10CM | Covered |
| B39.3 | ICD10CM | Covered |
| B39.4 | ICD10CM | Covered |
| B45.0-B45.9 | ICD10CM | Covered |
| B58.2 | ICD10CM | Covered |
| B59 | ICD10CM | Covered |
| B97.33 | ICD10CM | Covered |
| B97.34 | ICD10CM | Covered |
| B97.35 | ICD10CM | Covered |
| C46.0-C46.9 | ICD10CM | Covered |
| C53.0-C53.9 | ICD10CM | Covered |
| C58 | ICD10CM | Covered |
| C81.00-C81.9A | ICD10CM | Covered |
| C82.00-C82.9A | ICD10CM | Covered |
| C83.00-C83.9A | ICD10CM | Covered |
| C84.00-C84.9A | ICD10CM | Covered |
| C85.10-C85.9A | ICD10CM | Covered |
| C86.00-C86.61 | ICD10CM | Covered |
| C88.00-C88.91 | ICD10CM | Covered |
| C90.00-C90.32 | ICD10CM | Covered |
| C91.00-C91.92 | ICD10CM | Covered |
| C92.00-C92.92 | ICD10CM | Covered |
| C93.00-C93.92 | ICD10CM | Covered |
| C94.00-C94.82 | ICD10CM | Covered |
| C95.00-C95.92 | ICD10CM | Covered |
| C96.0-C96.9 | ICD10CM | Covered |
| D39.2 | ICD10CM | Covered |
| D45 | ICD10CM | Covered |
| D46.0-D46.9 | ICD10CM | Covered |
| D47.01 | ICD10CM | Covered |
| D47.02 | ICD10CM | Covered |
| D47.09 | ICD10CM | Covered |
| D47.1 | ICD10CM | Covered |
| D47.2 | ICD10CM | Covered |
| D47.3 | ICD10CM | Covered |
| D47.4 | ICD10CM | Covered |
| D47.Z1 | ICD10CM | Covered |
| D47.Z2 | ICD10CM | Covered |
| D47.Z9 | ICD10CM | Covered |
| D50.0 | ICD10CM | Covered |
| D50.8 | ICD10CM | Covered |
| D50.9 | ICD10CM | Covered |
| D51.0-D51.9 | ICD10CM | Covered |
| D52.9 | ICD10CM | Covered |
| D53.0 | ICD10CM | Covered |
| D53.1 | ICD10CM | Covered |
| D53.8 | ICD10CM | Covered |
| D53.9 | ICD10CM | Covered |
| D56.0 | ICD10CM | Covered |
| D56.1 | ICD10CM | Covered |
| D56.3 | ICD10CM | Covered |
| D56.9 | ICD10CM | Covered |
| D57.00-D57.819 | ICD10CM | Covered |
| D58.0 | ICD10CM | Covered |
| D58.2 | ICD10CM | Covered |
| D58.9 | ICD10CM | Covered |
| D59.0 | ICD10CM | Covered |
| D59.10 | ICD10CM | Covered |
| D59.11 | ICD10CM | Covered |
| D59.12 | ICD10CM | Covered |
| D59.13 | ICD10CM | Covered |
| D59.19 | ICD10CM | Covered |
| D59.2 | ICD10CM | Covered |
| D59.4 | ICD10CM | Covered |
| D59.5 | ICD10CM | Covered |
| D59.6 | ICD10CM | Covered |
| D59.8 | ICD10CM | Covered |
| D59.9 | ICD10CM | Covered |
| D60.0-D60.9 | ICD10CM | Covered |
| D61.01-D61.9 | ICD10CM | Covered |
| D62 | ICD10CM | Covered |
| D63.0-D63.8 | ICD10CM | Covered |
| D64.0-D64.9 | ICD10CM | Covered |
| D65 | ICD10CM | Covered |
| D66 | ICD10CM | Covered |
| D67 | ICD10CM | Covered |
| D68.00-D68.09 | ICD10CM | Covered |
| D68.1 | ICD10CM | Covered |
| D68.2 | ICD10CM | Covered |
| D68.311 | ICD10CM | Covered |
| D68.51 | ICD10CM | Covered |
| D68.52 | ICD10CM | Covered |
| D68.59 | ICD10CM | Covered |
| D68.61 | ICD10CM | Covered |
| D68.62 | ICD10CM | Covered |
| D68.69 | ICD10CM | Covered |
| D68.8 | ICD10CM | Covered |
| D68.9 | ICD10CM | Covered |
| D69.1 | ICD10CM | Covered |
| D69.2 | ICD10CM | Covered |
| D69.3 | ICD10CM | Covered |
| D69.41 | ICD10CM | Covered |
| D69.42 | ICD10CM | Covered |
| D69.49 | ICD10CM | Covered |
| D69.51 | ICD10CM | Covered |
| D69.59 | ICD10CM | Covered |
| D69.6 | ICD10CM | Covered |
| D69.8 | ICD10CM | Covered |
| D69.9 | ICD10CM | Covered |
| D70.0-D70.9 | ICD10CM | Covered |
| D71.1-D71.9 | ICD10CM | Covered |
| D72.0-D72.9 | ICD10CM | Covered |
| D73.0-D73.9 | ICD10CM | Covered |
| D75.0-D75.9 | ICD10CM | Covered |
| D76.1-D76.3 | ICD10CM | Covered |
| D80.0-D80.9 | ICD10CM | Covered |
| D81.0-D81.9 | ICD10CM | Covered |
| D82.0-D82.9 | ICD10CM | Covered |
| D83.0-D83.9 | ICD10CM | Covered |
| D84.0-D84.9 | ICD10CM | Covered |
| D86.0 | ICD10CM | Covered |
| D86.1 | ICD10CM | Covered |
| D86.2 | ICD10CM | Covered |
| D86.85 | ICD10CM | Covered |
| D89.0-D89.9 | ICD10CM | Covered |
| E34.00-E34.09 | ICD10CM | Covered |
| E85.0-E85.9 | ICD10CM | Covered |
| E88.01 | ICD10CM | Covered |
| E88.02 | ICD10CM | Covered |
| E88.09 | ICD10CM | Covered |
| G93.49 | ICD10CM | Covered |
| I88.0-I88.9 | ICD10CM | Covered |
| I89.1 | ICD10CM | Covered |
| I89.8 | ICD10CM | Covered |
| I89.9 | ICD10CM | Covered |
| J15.3 | ICD10CM | Covered |
| J15.4 | ICD10CM | Covered |
| J90 | ICD10CM | Covered |
| J91.0 | ICD10CM | Covered |
| J91.8 | ICD10CM | Covered |
| J94.0 | ICD10CM | Covered |
| M02.30-M02.39 | ICD10CM | Covered |
| O01.0-O01.9 | ICD10CM | Covered |
| O02.0 | ICD10CM | Covered |
| O98.711-O98.719 | ICD10CM | Covered |
| R59.0-R59.9 | ICD10CM | Covered |
| R64 | ICD10CM | Covered |
| R75 | ICD10CM | Covered |
| R76.9 | ICD10CM | Covered |
| T86.00-T86.09 | ICD10CM | Covered |
| T86.10-T86.19 | ICD10CM | Covered |
| T86.20-T86.298 | ICD10CM | Covered |
| T86.30-T86.39 | ICD10CM | Covered |
| T86.40-T86.49 | ICD10CM | Covered |
| T86.5 | ICD10CM | Covered |
| T86.810-T86.819 | ICD10CM | Covered |
| T86.850-T86.859 | ICD10CM | Covered |
| T86.890 | ICD10CM | Covered |
| T86.891 | ICD10CM | Covered |
| T86.892 | ICD10CM | Covered |
| T86.898 | ICD10CM | Covered |
| Z21 | ICD10CM | Covered |
| Z48.21-Z48.298 | ICD10CM | Covered |
| Z52.001 | ICD10CM | Covered |
| Z52.011 | ICD10CM | Covered |
| Z52.091 | ICD10CM | Covered |
| Z52.3 | ICD10CM | Covered |
| Z52.4 | ICD10CM | Covered |
| Z52.6 | ICD10CM | Covered |
| Z52.89 | ICD10CM | Covered |
| Z76.82 | ICD10CM | Covered |
| Z85.6 | ICD10CM | Covered |
| Z85.71 | ICD10CM | Covered |
| Z85.72 | ICD10CM | Covered |
| Z85.79 | ICD10CM | Covered |
| Z94.0 | ICD10CM | Covered |
| Z94.1 | ICD10CM | Covered |
| Z94.2 | ICD10CM | Covered |
| Z94.3 | ICD10CM | Covered |
| Z94.4 | ICD10CM | Covered |
| Z94.81 | ICD10CM | Covered |
| Z94.82 | ICD10CM | Covered |
| Z94.83 | ICD10CM | Covered |
| Z94.84 | ICD10CM | Covered |
| Z94.89 | ICD10CM | Covered |