Cigna · PayerPolicy · CIGNA-0567
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 |
|---|---|---|
| 82746 | CPT | Covered |
| 82747 | CPT | Covered |
| C92.00 | ICD10CM | Covered |
| C92.01 | ICD10CM | Covered |
| C92.02 | ICD10CM | Covered |
| C92.10 | ICD10CM | Covered |
| C92.11 | ICD10CM | Covered |
| C92.12 | ICD10CM | Covered |
| C92.20 | ICD10CM | Covered |
| C92.21 | ICD10CM | Covered |
| C92.22 | ICD10CM | Covered |
| C92.30 | ICD10CM | Covered |
| C92.31 | ICD10CM | Covered |
| C92.32 | ICD10CM | Covered |
| C92.40 | ICD10CM | Covered |
| C92.41 | ICD10CM | Covered |
| C92.42 | ICD10CM | Covered |
| C92.50 | ICD10CM | Covered |
| C92.51 | ICD10CM | Covered |
| C92.52 | ICD10CM | Covered |
| C92.60 | ICD10CM | Covered |
| C92.61 | ICD10CM | Covered |
| C92.62 | ICD10CM | Covered |
| C92.90 | ICD10CM | Covered |
| C92.91 | ICD10CM | Covered |
| C92.92 | ICD10CM | Covered |
| C92.A0 | ICD10CM | Covered |
| C92.A1 | ICD10CM | Covered |
| C92.A2 | ICD10CM | Covered |
| C92.Z0 | ICD10CM | Covered |
| C92.Z1 | ICD10CM | Covered |
| C92.Z2 | ICD10CM | Covered |
| D46.0 | ICD10CM | Covered |
| D46.1 | ICD10CM | Covered |
| D46.20 | ICD10CM | Covered |
| D46.21 | ICD10CM | Covered |
| D46.22 | ICD10CM | Covered |
| D46.4 | ICD10CM | Covered |
| D46.9 | ICD10CM | Covered |
| D46.A | ICD10CM | Covered |
| D46.B | ICD10CM | Covered |
| D46.C | ICD10CM | Covered |
| D46.Z | ICD10CM | Covered |
| D50.8 | ICD10CM | Covered |
| D50.9 | ICD10CM | Covered |
| D51.0 | ICD10CM | Covered |
| D51.1 | ICD10CM | Covered |
| D51.2 | ICD10CM | Covered |
| D51.3 | ICD10CM | Covered |
| D51.8 | ICD10CM | Covered |
| D51.9 | ICD10CM | Covered |
| D52.0 | ICD10CM | Covered |
| D52.1 | ICD10CM | Covered |
| D52.8 | ICD10CM | Covered |
| D52.9 | ICD10CM | Covered |
| D53.0 | ICD10CM | Covered |
| D53.1 | ICD10CM | Covered |
| D53.2 | ICD10CM | Covered |
| D53.8 | ICD10CM | Covered |
| D53.9 | ICD10CM | Covered |
| D56.1 | ICD10CM | Covered |
| D58.2 | ICD10CM | Covered |
| D59.4 | ICD10CM | Covered |
| D59.8 | ICD10CM | Covered |
| D59.9 | ICD10CM | Covered |
| D61.818 | ICD10CM | Covered |
| D61.89 | ICD10CM | Covered |
| D61.9 | ICD10CM | Covered |
| D69.3 | ICD10CM | Covered |
| D69.49 | ICD10CM | Covered |
| D69.59 | ICD10CM | Covered |
| D69.6 | ICD10CM | Covered |
| D70.8 | ICD10CM | Covered |
| D70.9 | ICD10CM | Covered |
| D72.819 | ICD10CM | Covered |
| E40 | ICD10CM | Covered |
| E42 | ICD10CM | Covered |
| E43 | ICD10CM | Covered |
| E44.0 | ICD10CM | Covered |
| F02.80 | ICD10CM | Covered |
| F02.811 | ICD10CM | Covered |
| F02.818 | ICD10CM | Covered |
| F02.82 | ICD10CM | Covered |
| F02.83 | ICD10CM | Covered |
| F02.84 | ICD10CM | Covered |
| F02.A0 | ICD10CM | Covered |
| F02.A11 | ICD10CM | Covered |
| F02.A18 | ICD10CM | Covered |
| F02.A2 | ICD10CM | Covered |
| F02.A3 | ICD10CM | Covered |
| F02.A4 | ICD10CM | Covered |
| F02.B0 | ICD10CM | Covered |
| F02.B11 | ICD10CM | Covered |
| F02.B18 | ICD10CM | Covered |
| F02.B2 | ICD10CM | Covered |
| F02.B3 | ICD10CM | Covered |
| F02.B4 | ICD10CM | Covered |
| F02.C0 | ICD10CM | Covered |
| F02.C11 | ICD10CM | Covered |
| F02.C18 | ICD10CM | Covered |
| F02.C2 | ICD10CM | Covered |
| F02.C3 | ICD10CM | Covered |
| F02.C4 | ICD10CM | Covered |
| F03.90 | ICD10CM | Covered |
| F03.911 | ICD10CM | Covered |
| F03.918 | ICD10CM | Covered |
| F03.92 | ICD10CM | Covered |
| F03.93 | ICD10CM | Covered |
| F03.94 | ICD10CM | Covered |
| F03.A0 | ICD10CM | Covered |
| F03.A11 | ICD10CM | Covered |
| F03.A18 | ICD10CM | Covered |
| F03.A2 | ICD10CM | Covered |
| F03.A3 | ICD10CM | Covered |
| F03.A4 | ICD10CM | Covered |
| F03.B0 | ICD10CM | Covered |
| F03.B11 | ICD10CM | Covered |
| F03.B18 | ICD10CM | Covered |
| F03.B2 | ICD10CM | Covered |
| F03.B3 | ICD10CM | Covered |
| F03.B4 | ICD10CM | Covered |
| F03.C0 | ICD10CM | Covered |
| F03.C11 | ICD10CM | Covered |
| F03.C18 | ICD10CM | Covered |
| F03.C2 | ICD10CM | Covered |
| F03.C3 | ICD10CM | Covered |
| F03.C4 | ICD10CM | Covered |
| F10.10 | ICD10CM | Covered |
| F10.11 | ICD10CM | Covered |
| F10.120 | ICD10CM | Covered |
| F10.121 | ICD10CM | Covered |
| F10.129 | ICD10CM | Covered |
| F10.130 | ICD10CM | Covered |
| F10.131 | ICD10CM | Covered |
| F10.132 | ICD10CM | Covered |
| F10.139 | ICD10CM | Covered |
| F10.14 | ICD10CM | Covered |
| F10.150 | ICD10CM | Covered |
| F10.151 | ICD10CM | Covered |
| F10.159 | ICD10CM | Covered |
| F10.180 | ICD10CM | Covered |
| F10.181 | ICD10CM | Covered |
| F10.182 | ICD10CM | Covered |
| F10.188 | ICD10CM | Covered |
| F10.19 | ICD10CM | Covered |
| F10.20 | ICD10CM | Covered |
| F10.21 | ICD10CM | Covered |
| F10.220 | ICD10CM | Covered |
| F10.221 | ICD10CM | Covered |
| F10.229 | ICD10CM | Covered |
| F10.230 | ICD10CM | Covered |
| F10.231 | ICD10CM | Covered |
| F10.239 | ICD10CM | Covered |
| F10.24 | ICD10CM | Covered |
| F10.250 | ICD10CM | Covered |
| F10.251 | ICD10CM | Covered |
| F10.259 | ICD10CM | Covered |
| F10.26 | ICD10CM | Covered |
| F10.27 | ICD10CM | Covered |
| F10.280 | ICD10CM | Covered |
| F10.281 | ICD10CM | Covered |
| F10.282 | ICD10CM | Covered |
| F10.288 | ICD10CM | Covered |
| F10.29 | ICD10CM | Covered |
| F10.90 | ICD10CM | Covered |
| F10.91 | ICD10CM | Covered |
| F10.920 | ICD10CM | Covered |
| F10.921 | ICD10CM | Covered |
| F10.929 | ICD10CM | Covered |
| F10.931 | ICD10CM | Covered |
| F10.932 | ICD10CM | Covered |
| F10.939 | ICD10CM | Covered |
| F10.94 | ICD10CM | Covered |
| F10.950 | ICD10CM | Covered |
| F10.951 | ICD10CM | Covered |
| F10.959 | ICD10CM | Covered |
| F10.96 | ICD10CM | Covered |
| F10.97 | ICD10CM | Covered |
| F10.980 | ICD10CM | Covered |
| F10.981 | ICD10CM | Covered |
| F10.982 | ICD10CM | Covered |
| F10.988 | ICD10CM | Covered |
| F10.99 | ICD10CM | Covered |
| F50.00 | ICD10CM | Covered |
| F50.010 | ICD10CM | Covered |
| F50.011 | ICD10CM | Covered |
| F50.012 | ICD10CM | Covered |
| F50.013 | ICD10CM | Covered |
| F50.014 | ICD10CM | Covered |
| F50.019 | ICD10CM | Covered |
| F50.020 | ICD10CM | Covered |
| F50.021 | ICD10CM | Covered |
| F50.022 | ICD10CM | Covered |
| F50.023 | ICD10CM | Covered |
| F50.024 | ICD10CM | Covered |
| F50.029 | ICD10CM | Covered |
| F50.20 | ICD10CM | Covered |
| F50.21 | ICD10CM | Covered |
| F50.22 | ICD10CM | Covered |
| F50.23 | ICD10CM | Covered |
| F50.24 | ICD10CM | Covered |
| F50.25 | ICD10CM | Covered |
| F50.810 | ICD10CM | Covered |
| F50.811 | ICD10CM | Covered |
| F50.812 | ICD10CM | Covered |
| F50.813 | ICD10CM | Covered |
| F50.814 | ICD10CM | Covered |
| F50.819 | ICD10CM | Covered |
| F50.82 | ICD10CM | Covered |
| F50.83 | ICD10CM | Covered |
| F50.84 | ICD10CM | Covered |
| F50.89 | ICD10CM | Covered |
| F50.9 | ICD10CM | Covered |
| G31.01 | ICD10CM | Covered |
| G31.09 | ICD10CM | Covered |
| G31.1 | ICD10CM | Covered |
| G31.2 | ICD10CM | Covered |
| G31.81 | ICD10CM | Covered |
| G31.82 | ICD10CM | Covered |
| G31.83 | ICD10CM | Covered |
| G31.84 | ICD10CM | Covered |
| G31.85 | ICD10CM | Covered |
| G31.87 | ICD10CM | Covered |
| G31.89 | ICD10CM | Covered |
| G31.9 | ICD10CM | Covered |
| G60.3 | ICD10CM | Covered |
| G62.0 | ICD10CM | Covered |
| G62.1 | ICD10CM | Covered |
| G62.2 | ICD10CM | Covered |
| G62.81 | ICD10CM | Covered |
| G62.82 | ICD10CM | Covered |
| G62.89 | ICD10CM | Covered |
| G62.9 | ICD10CM | Covered |
| G64 | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K50.011 | ICD10CM | Covered |
| K50.012 | ICD10CM | Covered |
| K50.013 | ICD10CM | Covered |
| K50.014 | ICD10CM | Covered |
| K50.018 | ICD10CM | Covered |
| K50.019 | ICD10CM | Covered |
| K50.10 | ICD10CM | Covered |
| K50.111 | ICD10CM | Covered |
| K50.112 | ICD10CM | Covered |
| K50.113 | ICD10CM | Covered |
| K50.114 | ICD10CM | Covered |
| K50.118 | ICD10CM | Covered |
| K50.119 | ICD10CM | Covered |
| K50.80 | ICD10CM | Covered |
| K50.811 | ICD10CM | Covered |
| K50.812 | ICD10CM | Covered |
| K50.813 | ICD10CM | Covered |
| K50.814 | ICD10CM | Covered |
| K50.818 | ICD10CM | Covered |
| K50.819 | ICD10CM | Covered |
| K50.90 | ICD10CM | Covered |
| K50.911 | ICD10CM | Covered |
| K50.912 | ICD10CM | Covered |
| K50.913 | ICD10CM | Covered |
| K50.914 | ICD10CM | Covered |
| K50.918 | ICD10CM | Covered |
| K50.919 | ICD10CM | Covered |
| K70.0 | ICD10CM | Covered |
| K70.10 | ICD10CM | Covered |
| K70.11 | ICD10CM | Covered |
| K70.2 | ICD10CM | Covered |
| K70.30 | ICD10CM | Covered |
| K70.31 | ICD10CM | Covered |
| K70.40 | ICD10CM | Covered |
| K70.41 | ICD10CM | Covered |
| K70.9 | ICD10CM | Covered |
| K86.81 | ICD10CM | Covered |
| K90.0 | ICD10CM | Covered |
| K90.1 | ICD10CM | Covered |
| K90.81 | ICD10CM | Covered |
| K90.821 | ICD10CM | Covered |
| K90.822 | ICD10CM | Covered |
| K90.89 | ICD10CM | Covered |
| K90.9 | ICD10CM | Covered |
| K91.2 | ICD10CM | Covered |
| Q00.0 | ICD10CM | Covered |
| Q00.1 | ICD10CM | Covered |
| Q00.2 | ICD10CM | Covered |
| Q01.0 | ICD10CM | Covered |
| Q01.1 | ICD10CM | Covered |
| Q01.2 | ICD10CM | Covered |
| Q01.8 | ICD10CM | Covered |
| Q01.9 | ICD10CM | Covered |
| Q02 | ICD10CM | Covered |
| Q03.0 | ICD10CM | Covered |
| Q03.1 | ICD10CM | Covered |
| Q03.8 | ICD10CM | Covered |
| Q03.9 | ICD10CM | Covered |
| Q04.0 | ICD10CM | Covered |
| Q04.1 | ICD10CM | Covered |
| Q04.2 | ICD10CM | Covered |
| Q04.3 | ICD10CM | Covered |
| Q04.4 | ICD10CM | Covered |
| Q04.5 | ICD10CM | Covered |
| Q04.6 | ICD10CM | Covered |
| Q04.8 | ICD10CM | Covered |
| Q04.9 | ICD10CM | Covered |
| Q05.0 | ICD10CM | Covered |
| Q05.1 | ICD10CM | Covered |
| Q05.2 | ICD10CM | Covered |
| Q05.3 | ICD10CM | Covered |
| Q05.4 | ICD10CM | Covered |
| Q05.5 | ICD10CM | Covered |
| Q05.6 | ICD10CM | Covered |
| Q05.7 | ICD10CM | Covered |
| Q05.8 | ICD10CM | Covered |
| Q05.9 | ICD10CM | Covered |
| Q06.0 | ICD10CM | Covered |
| Q06.1 | ICD10CM | Covered |
| Q06.2 | ICD10CM | Covered |
| Q06.3 | ICD10CM | Covered |
| Q06.4 | ICD10CM | Covered |
| Q06.8 | ICD10CM | Covered |
| Q06.9 | ICD10CM | Covered |
| Q07.00 | ICD10CM | Covered |
| Q07.01 | ICD10CM | Covered |
| Q07.02 | ICD10CM | Covered |
| Q07.03 | ICD10CM | Covered |
| Q07.8 | ICD10CM | Covered |
| Q07.9 | ICD10CM | Covered |
| Z98.84 | ICD10CM | Covered |