Cigna · PayerPolicy · CIGNA-CPG024
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 |
|---|---|---|
| 97810 | CPT | Covered |
| 97811 | CPT | Covered |
| 97813 | CPT | Covered |
| 97814 | CPT | Covered |
| G43 | ICD10CM | Covered |
| G44 | ICD10CM | Covered |
| G89 | ICD10CM | Covered |
| G89.3 | ICD10CM | Covered |
| K91.0 | ICD10CM | Covered |
| M16 | ICD10CM | Covered |
| M17 | ICD10CM | Covered |
| M18 | ICD10CM | Covered |
| M19 | ICD10CM | Covered |
| M25 | ICD10CM | Covered |
| M47 | ICD10CM | Covered |
| M50 | ICD10CM | Covered |
| M51 | ICD10CM | Covered |
| M54 | ICD10CM | Covered |
| M79 | ICD10CM | Covered |
| M79.7 | ICD10CM | Covered |
| M99.53 | ICD10CM | Covered |
| M99.54 | ICD10CM | Covered |
| M99.55 | ICD10CM | Covered |
| M99.56 | ICD10CM | Covered |
| M99.57 | ICD10CM | Covered |
| M99.58 | ICD10CM | Covered |
| M99.61 | ICD10CM | Covered |
| M99.62 | ICD10CM | Covered |
| M99.63 | ICD10CM | Covered |
| M99.64 | ICD10CM | Covered |
| M99.65 | ICD10CM | Covered |
| M99.66 | ICD10CM | Covered |
| M99.67 | ICD10CM | Covered |
| M99.68 | ICD10CM | Covered |
| M99.71 | ICD10CM | Covered |
| M99.72 | ICD10CM | Covered |
| M99.73 | ICD10CM | Covered |
| M99.74 | ICD10CM | Covered |
| M99.75 | ICD10CM | Covered |
| M99.76 | ICD10CM | Covered |
| M99.77 | ICD10CM | Covered |
| M99.78 | ICD10CM | Covered |
| O21 | ICD10CM | Covered |
| O21.0 | ICD10CM | Covered |
| O21.9 | ICD10CM | Covered |
| R07.82 | ICD10CM | Covered |
| R07.9 | ICD10CM | Covered |
| R11 | ICD10CM | Covered |
| R11.0 | ICD10CM | Covered |
| R11.10 | ICD10CM | Covered |
| R11.11 | ICD10CM | Covered |
| R11.12 | ICD10CM | Covered |
| R11.2 | ICD10CM | Covered |
| R51.0 | ICD10CM | Covered |
| R51.9 | ICD10CM | Covered |
| S13.4XXA | ICD10CM | Covered |
| S13.4XXD | ICD10CM | Covered |
| S13.4XXS | ICD10CM | Covered |
| S13.8XXA | ICD10CM | Covered |
| S13.8XXD | ICD10CM | Covered |
| S13.8XXS | ICD10CM | Covered |
| S16.1XXA | ICD10CM | Covered |
| S16.1XXD | ICD10CM | Covered |
| S16.1XXS | ICD10CM | Covered |
| S16.8XXA | ICD10CM | Covered |
| S16.8XXD | ICD10CM | Covered |
| S16.8XXS | ICD10CM | Covered |
| S23.3XXA | ICD10CM | Covered |
| S23.3XXD | ICD10CM | Covered |
| S23.3XXS | ICD10CM | Covered |
| S23.8XXA | ICD10CM | Covered |
| S23.8XXD | ICD10CM | Covered |
| S23.8XXS | ICD10CM | Covered |
| S29.011A | ICD10CM | Covered |
| S29.011D | ICD10CM | Covered |
| S29.011S | ICD10CM | Covered |
| S29.012A | ICD10CM | Covered |
| S29.012D | ICD10CM | Covered |
| S29.012S | ICD10CM | Covered |
| S33.5XXA | ICD10CM | Covered |
| S33.5XXD | ICD10CM | Covered |
| S33.5XXS | ICD10CM | Covered |
| S33.6XXA | ICD10CM | Covered |
| S33.6XXD | ICD10CM | Covered |
| S33.6XXS | ICD10CM | Covered |
| S33.8XXA | ICD10CM | Covered |
| S33.8XXD | ICD10CM | Covered |
| S33.8XXS | ICD10CM | Covered |
| S39.012A | ICD10CM | Covered |
| S39.012D | ICD10CM | Covered |
| S39.012S | ICD10CM | Covered |
| S39.013A | ICD10CM | Covered |
| S39.013D | ICD10CM | Covered |
| S39.013S | ICD10CM | Covered |
| S43.491A | ICD10CM | Covered |
| S43.491D | ICD10CM | Covered |
| S43.491S | ICD10CM | Covered |
| S43.492A | ICD10CM | Covered |
| S43.492D | ICD10CM | Covered |
| S43.492S | ICD10CM | Covered |
| S43.81XA | ICD10CM | Covered |
| S43.81XD | ICD10CM | Covered |
| S43.81XS | ICD10CM | Covered |
| S43.82XA | ICD10CM | Covered |
| S43.82XD | ICD10CM | Covered |
| S43.82XS | ICD10CM | Covered |
| S46.811A | ICD10CM | Covered |
| S46.811D | ICD10CM | Covered |
| S46.811S | ICD10CM | Covered |
| S46.812A | ICD10CM | Covered |
| S46.812D | ICD10CM | Covered |
| S46.812S | ICD10CM | Covered |
| S53.411A | ICD10CM | Covered |
| S53.411D | ICD10CM | Covered |
| S53.411S | ICD10CM | Covered |
| S53.412A | ICD10CM | Covered |
| S53.412D | ICD10CM | Covered |
| S53.412S | ICD10CM | Covered |
| S53.419A | ICD10CM | Covered |
| S53.419D | ICD10CM | Covered |
| S53.419S | ICD10CM | Covered |
| S53.421A | ICD10CM | Covered |
| S53.421D | ICD10CM | Covered |
| S53.421S | ICD10CM | Covered |
| S53.422A | ICD10CM | Covered |
| S53.422D | ICD10CM | Covered |
| S53.422S | ICD10CM | Covered |
| S53.429A | ICD10CM | Covered |
| S53.429D | ICD10CM | Covered |
| S53.429S | ICD10CM | Covered |
| S53.431A | ICD10CM | Covered |
| S53.431D | ICD10CM | Covered |
| S53.431S | ICD10CM | Covered |
| S53.432A | ICD10CM | Covered |
| S53.432D | ICD10CM | Covered |
| S53.432S | ICD10CM | Covered |
| S53.439A | ICD10CM | Covered |
| S53.439D | ICD10CM | Covered |
| S53.439S | ICD10CM | Covered |
| S53.441A | ICD10CM | Covered |
| S53.441D | ICD10CM | Covered |
| S53.441S | ICD10CM | Covered |
| S53.442A | ICD10CM | Covered |
| S53.442D | ICD10CM | Covered |
| S53.442S | ICD10CM | Covered |
| S53.449A | ICD10CM | Covered |
| S53.449D | ICD10CM | Covered |
| S53.449S | ICD10CM | Covered |
| S53.491A | ICD10CM | Covered |
| S53.491D | ICD10CM | Covered |
| S53.491S | ICD10CM | Covered |
| S53.492A | ICD10CM | Covered |
| S53.492D | ICD10CM | Covered |
| S53.492S | ICD10CM | Covered |
| S63.591A | ICD10CM | Covered |
| S63.591D | ICD10CM | Covered |
| S63.591S | ICD10CM | Covered |
| S63.592A | ICD10CM | Covered |
| S63.592D | ICD10CM | Covered |
| S63.592S | ICD10CM | Covered |
| S63.8X1A | ICD10CM | Covered |
| S63.8X1D | ICD10CM | Covered |
| S63.8X1S | ICD10CM | Covered |
| S63.8X2A | ICD10CM | Covered |
| S63.8X2D | ICD10CM | Covered |
| S63.8X2S | ICD10CM | Covered |
| S73.191A | ICD10CM | Covered |
| S73.191D | ICD10CM | Covered |