Cigna · PayerPolicy · CIGNA-0548
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 |
|---|---|---|
| 76870 | CPT | Covered |
| C62.11-C62.12 | ICD10CM | Covered |
| C63.00-C63.02 | ICD10CM | Covered |
| C63.10-C63.12 | ICD10CM | Covered |
| C63.2 | ICD10CM | Covered |
| D29.21 | ICD10CM | Covered |
| D29.22 | ICD10CM | Covered |
| D29.30 | ICD10CM | Covered |
| D29.31 | ICD10CM | Covered |
| D29.32 | ICD10CM | Covered |
| D29.4 | ICD10CM | Covered |
| D29.8 | ICD10CM | Covered |
| D29.9 | ICD10CM | Covered |
| D40.10 | ICD10CM | Covered |
| D40.11 | ICD10CM | Covered |
| D40.12 | ICD10CM | Covered |
| I86.1 | ICD10CM | Covered |
| K40.00-K40.91 | ICD10CM | Covered |
| N43.0 | ICD10CM | Covered |
| N43.1 | ICD10CM | Covered |
| N43.2 | ICD10CM | Covered |
| N43.3 | ICD10CM | Covered |
| N43.40 | ICD10CM | Covered |
| N43.41 | ICD10CM | Covered |
| N43.42 | ICD10CM | Covered |
| N44.00 | ICD10CM | Covered |
| N44.01 | ICD10CM | Covered |
| N44.02 | ICD10CM | Covered |
| N44.03 | ICD10CM | Covered |
| N44.04 | ICD10CM | Covered |
| N45.1 | ICD10CM | Covered |
| N45.2 | ICD10CM | Covered |
| N45.3 | ICD10CM | Covered |
| N45.4 | ICD10CM | Covered |
| N46.01 | ICD10CM | Covered |
| N46.021 | ICD10CM | Covered |
| N46.022 | ICD10CM | Covered |
| N46.023 | ICD10CM | Covered |
| N46.024 | ICD10CM | Covered |
| N46.025 | ICD10CM | Covered |
| N46.029 | ICD10CM | Covered |
| N46.121 | ICD10CM | Covered |
| N46.122 | ICD10CM | Covered |
| N46.123 | ICD10CM | Covered |
| N46.124 | ICD10CM | Covered |
| N46.125 | ICD10CM | Covered |
| N46.129 | ICD10CM | Covered |
| N46.8 | ICD10CM | Covered |
| N46.9 | ICD10CM | Covered |
| N49.2 | ICD10CM | Covered |
| N49.3 | ICD10CM | Covered |
| N49.8 | ICD10CM | Covered |
| N50.0 | ICD10CM | Covered |
| N50.1 | ICD10CM | Covered |
| N50.3 | ICD10CM | Covered |
| N50.811 | ICD10CM | Covered |
| N50.812 | ICD10CM | Covered |
| N50.819 | ICD10CM | Covered |
| N50.82 | ICD10CM | Covered |
| N50.89 | ICD10CM | Covered |
| N50.9 | ICD10CM | Covered |
| P83.5 | ICD10CM | Covered |
| Q53.00 | ICD10CM | Covered |
| Q53.01 | ICD10CM | Covered |
| Q53.02 | ICD10CM | Covered |
| Q53.10 | ICD10CM | Covered |
| Q53.111 | ICD10CM | Covered |
| Q53.112 | ICD10CM | Covered |
| Q53.12 | ICD10CM | Covered |
| Q53.13 | ICD10CM | Covered |
| Q53.20 | ICD10CM | Covered |
| Q53.211 | ICD10CM | Covered |
| Q53.212 | ICD10CM | Covered |
| Q53.22 | ICD10CM | Covered |
| Q53.23 | ICD10CM | Covered |
| Q53.9 | ICD10CM | Covered |
| Q55.22 | ICD10CM | Covered |
| Q55.23 | ICD10CM | Covered |
| S30.22XA | ICD10CM | Covered |
| S30.22XD | ICD10CM | Covered |
| S30.22XS | ICD10CM | Covered |
| S30.94XA | ICD10CM | Covered |
| S30.94XD | ICD10CM | Covered |
| S30.94XS | ICD10CM | Covered |
| S31.30XA | ICD10CM | Covered |
| S31.30XD | ICD10CM | Covered |
| S31.30XS | ICD10CM | Covered |
| S31.31XA | ICD10CM | Covered |
| S31.31XD | ICD10CM | Covered |
| S31.31XS | ICD10CM | Covered |
| S31.32XA | ICD10CM | Covered |
| S31.32XD | ICD10CM | Covered |
| S31.32XS | ICD10CM | Covered |
| S31.33XA | ICD10CM | Covered |
| S31.33XD | ICD10CM | Covered |
| S31.33XS | ICD10CM | Covered |
| S31.34XA | ICD10CM | Covered |
| S31.34XD | ICD10CM | Covered |
| S31.34XS | ICD10CM | Covered |
| S31.35XA | ICD10CM | Covered |
| S31.35XD | ICD10CM | Covered |
| S31.35XS | ICD10CM | Covered |
| S38.02XA | ICD10CM | Covered |
| S38.02XD | ICD10CM | Covered |
| S38.02XS | ICD10CM | Covered |
| Z80.43 | ICD10CM | Covered |
| Z80.49 | ICD10CM | Covered |