Patient Assessments: Medical Necessity Decision Ass… | Cigna

Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations and Re-evaluations

Cigna · PayerPolicy · CIGNA-CPG111

Status: Active
Effective: July 15, 2026
Last checked by Backwork: September 30, 2026

Summary of the payer’s published policy. Not a coverage determination — confirm with Cigna before submitting.

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Codes in this policy

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.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
92521	CPT	Covered with conditions
92522	CPT	Covered with conditions
92523	CPT	Covered with conditions
92524	CPT	Covered with conditions
92610	CPT	Covered with conditions
95851	CPT	Covered with conditions
95852	CPT	Covered with conditions
97039	CPT	Covered with conditions
97139	CPT	Covered with conditions
97161	CPT	Covered with conditions
97162	CPT	Covered with conditions
97163	CPT	Covered with conditions
97164	CPT	Covered with conditions
97165	CPT	Covered with conditions
97166	CPT	Covered with conditions
97167	CPT	Covered with conditions
97168	CPT	Covered with conditions
97169	CPT	Covered with conditions
97170	CPT	Covered with conditions
97171	CPT	Covered with conditions
97172	CPT	Covered with conditions
97750	CPT	Covered with conditions
97755	CPT	Covered with conditions
97799	CPT	Covered with conditions
S9152	HCPCS	Not covered