Cigna · PayerPolicy · CIGNA-A004
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 |
|---|---|---|
| 36415 | CPT | Covered |
| 36416 | CPT | Covered |
| 45330 | CPT | Covered |
| 45331 | CPT | Covered |
| 45333 | CPT | Covered |
| 45338 | CPT | Covered |
| 45346 | CPT | Covered |
| 45378 | CPT | Covered |
| 45380 | CPT | Covered |
| 45381 | CPT | Covered |
| 45384 | CPT | Covered |
| 45385 | CPT | Covered |
| 45388 | CPT | Covered |
| 45390 | CPT | Covered |
| 71271 | CPT | Covered |
| 74270 | CPT | Covered |
| 74280 | CPT | Covered |
| 76706 | CPT | Covered |
| 76977 | CPT | Covered |
| 77065 | CPT | Covered |
| 77066 | CPT | Covered |
| 77067 | CPT | Covered |
| 77078 | CPT | Covered |
| 77080 | CPT | Covered |
| 77081 | CPT | Covered |
| 77085 | CPT | Covered |
| 77086 | CPT | Covered |
| 81162 | CPT | Covered |
| 81163 | CPT | Covered |
| 81164 | CPT | Covered |
| 81165 | CPT | Covered |
| 81166 | CPT | Covered |
| 81167 | CPT | Covered |
| 81212 | CPT | Covered |
| 81215 | CPT | Covered |
| 81216 | CPT | Covered |
| 81217 | CPT | Covered |
| 81528 | CPT | Covered |
| 82565 | CPT | Covered |
| 82575 | CPT | Covered |
| 82610 | CPT | Covered |
| 82950 | CPT | Covered |
| 82951 | CPT | Covered |
| 82952 | CPT | Covered |
| 83655 | CPT | Covered |
| 84152 | CPT | Covered |
| 84153 | CPT | Covered |
| 84154 | CPT | Covered |
| 86480 | CPT | Covered |
| 86481 | CPT | Covered |
| 86580 | CPT | Covered |
| 86592 | CPT | Covered |
| 86593 | CPT | Covered |
| 86780 | CPT | Covered |
| 86900 | CPT | Covered |
| 86901 | CPT | Covered |
| 87624 | CPT | Covered |
| 87625 | CPT | Covered |
| 87626 | CPT | Covered |
| 88141 | CPT | Covered |
| 88142 | CPT | Covered |
| 88143 | CPT | Covered |
| 88144 | CPT | Covered |
| 88145 | CPT | Covered |
| 88146 | CPT | Covered |
| 88147 | CPT | Covered |
| 88148 | CPT | Covered |
| 88149 | CPT | Covered |
| 88150 | CPT | Covered |
| 88151 | CPT | Covered |
| 88152 | CPT | Covered |
| 88153 | CPT | Covered |
| 88154 | CPT | Covered |
| 88155 | CPT | Covered |
| 88156 | CPT | Covered |
| 88157 | CPT | Covered |
| 88158 | CPT | Covered |
| 88159 | CPT | Covered |
| 88160 | CPT | Covered |
| 88161 | CPT | Covered |
| 88162 | CPT | Covered |
| 88163 | CPT | Covered |
| 88164 | CPT | Covered |
| 88165 | CPT | Covered |
| 88166 | CPT | Covered |
| 88167 | CPT | Covered |
| 88168 | CPT | Covered |
| 88169 | CPT | Covered |
| 88170 | CPT | Covered |
| 88171 | CPT | Covered |
| 88172 | CPT | Covered |
| 88173 | CPT | Covered |
| 88174 | CPT | Covered |
| 88175 | CPT | Covered |
| 96041 | CPT | Covered |
| 96110 | CPT | Covered |
| 96127 | CPT | Covered |
| 96156 | CPT | Covered |
| 96158 | CPT | Covered |
| 96159 | CPT | Covered |
| 96160 | CPT | Covered |
| 96161 | CPT | Covered |
| 96164 | CPT | Covered |
| 96165 | CPT | Covered |
| 96166 | CPT | Covered |
| 96167 | CPT | Covered |
| 96168 | CPT | Covered |
| 97802 | CPT | Covered |
| 97803 | CPT | Covered |
| 97804 | CPT | Covered |
| 99173 | CPT | Covered |
| 99174 | CPT | Covered |
| 99177 | CPT | Covered |
| 99188 | CPT | Covered |
| 99381 | CPT | Covered |
| 99382 | CPT | Covered |
| 99383 | CPT | Covered |
| 99384 | CPT | Covered |
| 99385 | CPT | Covered |
| 99386 | CPT | Covered |
| 99387 | CPT | Covered |
| 99391 | CPT | Covered |
| 99392 | CPT | Covered |
| 99393 | CPT | Covered |
| 99394 | CPT | Covered |
| 99395 | CPT | Covered |
| 99396 | CPT | Covered |
| 99397 | CPT | Covered |
| 99401 | CPT | Covered |
| 99402 | CPT | Covered |
| 99403 | CPT | Covered |
| 99404 | CPT | Covered |
| 99411 | CPT | Covered |
| 99412 | CPT | Covered |
| 99461 | CPT | Covered |
| A4281 | HCPCS | Covered |
| A4282 | HCPCS | Covered |
| A4283 | HCPCS | Covered |
| A4284 | HCPCS | Covered |
| A4285 | HCPCS | Covered |
| A4286 | HCPCS | Covered |
| A4287 | HCPCS | Covered |
| A4288 | HCPCS | Covered |
| A4660 | HCPCS | Covered |
| A4663 | HCPCS | Covered |
| A4670 | HCPCS | Covered |
| A9293 | HCPCS | Covered |
| E0602 | HCPCS | Covered |
| E0603 | HCPCS | Covered |
| E0604 | HCPCS | Covered |
| G0011 | HCPCS | Covered |
| G0012 | HCPCS | Covered |
| G0013 | HCPCS | Covered |
| G0101 | HCPCS | Covered |
| G0103 | HCPCS | Covered |
| G0104 | HCPCS | Covered |
| G0105 | HCPCS | Covered |
| G0121 | HCPCS | Covered |
| G0123 | HCPCS | Covered |
| G0124 | HCPCS | Covered |
| G0130 | HCPCS | Covered |
| G0141 | HCPCS | Covered |
| G0143 | HCPCS | Covered |
| G0144 | HCPCS | Covered |
| G0145 | HCPCS | Covered |
| G0146 | HCPCS | Covered |
| G0147 | HCPCS | Covered |
| G0148 | HCPCS | Covered |
| G0296 | HCPCS | Covered |
| G0396 | HCPCS | Covered |
| G0397 | HCPCS | Covered |
| G0402 | HCPCS | Covered |
| G0438 | HCPCS | Covered |
| G0439 | HCPCS | Covered |
| G0442 | HCPCS | Covered |
| G0443 | HCPCS | Covered |
| G0444 | HCPCS | Covered |
| G0445 | HCPCS | Covered |
| G0446 | HCPCS | Covered |
| G0447 | HCPCS | Covered |
| G0451 | HCPCS | Covered |
| G0472 | HCPCS | Covered |
| G0473 | HCPCS | Covered |
| G0476 | HCPCS | Covered |
| G0499 | HCPCS | Covered |
| G0567 | HCPCS | Covered |
| G2011 | HCPCS | Covered |
| G9886 | HCPCS | Covered |
| G9887 | HCPCS | Covered |
| G9888 | HCPCS | Covered |
| G9890 | HCPCS | Covered |
| J0738 | HCPCS | Covered |
| J0739 | HCPCS | Covered |
| J0750 | HCPCS | Covered |
| J0751 | HCPCS | Covered |
| J0752 | HCPCS | Covered |
| J0799 | HCPCS | Covered |
| J3530 | HCPCS | Covered |
| J7294 | HCPCS | Covered |
| J7295 | HCPCS | Covered |
| J7296 | HCPCS | Covered |
| J7297 | HCPCS | Covered |
| J7298 | HCPCS | Covered |
| J7300 | HCPCS | Covered |
| J7301 | HCPCS | Covered |
| J7304 | HCPCS | Covered |
| J7307 | HCPCS | Covered |
| M0201 | HCPCS | Covered |
| P3000 | HCPCS | Covered |
| P3001 | HCPCS | Covered |
| Q0091 | HCPCS | Covered |
| Q0516 | HCPCS | Covered with conditions |
| Q0517 | HCPCS | Covered with conditions |
| Q0518 | HCPCS | Covered with conditions |
| Q0519 | HCPCS | Covered with conditions |
| Q0520 | HCPCS | Covered with conditions |
| Q2034 | HCPCS | Covered |
| Q2035 | HCPCS | Covered |
| Q2036 | HCPCS | Covered |
| Q2037 | HCPCS | Covered |
| Q2038 | HCPCS | Covered |
| Q2039 | HCPCS | Covered |
| S0265 | HCPCS | Covered |
| S0302 | HCPCS | Covered |
| S0610 | HCPCS | Covered |
| S0612 | HCPCS | Covered |
| S0613 | HCPCS | Covered |
| S4981 | HCPCS | Covered |
| S9443 | HCPCS | Covered |
| S9470 | HCPCS | Covered |
| Z00.00 | ICD10CM | Covered |
| Z00.01 | ICD10CM | Covered |
| Z01.411 | ICD10CM | Covered |
| Z01.419 | ICD10CM | Covered |
| Z11.51 | ICD10CM | Covered |
| Z12.10 | ICD10CM | Covered |
| Z12.11 | ICD10CM | Covered |
| Z12.12 | ICD10CM | Covered |
| Z12.13 | ICD10CM | Covered |
| Z12.4 | ICD10CM | Covered |
| Z13.820 | ICD10CM | Covered |
| Z80.0 | ICD10CM | Covered |
| Z83.710 | ICD10CM | Covered |
| Z83.711 | ICD10CM | Covered |
| Z83.712 | ICD10CM | Covered |
| Z83.713 | ICD10CM | Covered |
| Z83.714 | ICD10CM | Covered |
| Z83.715 | ICD10CM | Covered |
| Z83.716 | ICD10CM | Covered |
| Z83.717 | ICD10CM | Covered |
| Z83.718 | ICD10CM | Covered |
| Z83.719 | ICD10CM | Covered |