Cigna · PayerPolicy · CIGNA-CPG129
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 |
|---|---|---|
| 95874 | CPT | Covered |
| 95907 | CPT | Covered |
| 95908 | CPT | Covered |
| 95909 | CPT | Covered |
| 95910 | CPT | Covered |
| 95911 | CPT | Covered |
| 95912 | CPT | Covered |
| 95913 | CPT | Covered |
| 95925 | CPT | Covered |
| 95926 | CPT | Covered |
| 95927 | CPT | Covered |
| 95937 | CPT | Covered |
| 95938 | CPT | Covered |
| A05.1 | ICD10CM | Covered |
| A48.52 | ICD10CM | Covered |
| C72.0 | ICD10CM | Covered |
| C72.1 | ICD10CM | Covered |
| C79.31 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| D33.4 | ICD10CM | Covered |
| D43.0 | ICD10CM | Covered |
| D43.1 | ICD10CM | Covered |
| D43.2 | ICD10CM | Covered |
| D43.4 | ICD10CM | Covered |
| E03.5 | ICD10CM | Covered |
| E71.50 | ICD10CM | Covered |
| E71.548 | ICD10CM | Covered |
| E75.23 | ICD10CM | Covered |
| E75.25 | ICD10CM | Covered |
| E75.29 | ICD10CM | Covered |
| G04.1 | ICD10CM | Covered |
| G11.0 | ICD10CM | Covered |
| G11.10 | ICD10CM | Covered |
| G11.11 | ICD10CM | Covered |
| G11.19 | ICD10CM | Covered |
| G11.2 | ICD10CM | Covered |
| G11.3 | ICD10CM | Covered |
| G11.4 | ICD10CM | Covered |
| G11.8 | ICD10CM | Covered |
| G11.9 | ICD10CM | Covered |
| G12.21 | ICD10CM | Covered |
| G12.22 | ICD10CM | Covered |
| G12.23 | ICD10CM | Covered |
| G12.24 | ICD10CM | Covered |
| G12.25 | ICD10CM | Covered |
| G12.29 | ICD10CM | Covered |
| G12.8 | ICD10CM | Covered |
| G12.9 | ICD10CM | Covered |
| G25.3 | ICD10CM | Covered |
| G32.0 | ICD10CM | Covered |
| G32.81 | ICD10CM | Covered |
| G37.0 | ICD10CM | Covered |
| G37.1 | ICD10CM | Covered |
| G37.2 | ICD10CM | Covered |
| G37.3 | ICD10CM | Covered |
| G37.4 | ICD10CM | Covered |
| G37.5 | ICD10CM | Covered |
| G37.89 | ICD10CM | Covered |
| G37.9 | ICD10CM | Covered |
| G51.0 | ICD10CM | Covered |
| G56.01 | ICD10CM | Covered |
| G56.02 | ICD10CM | Covered |
| G56.03 | ICD10CM | Covered |
| G61.0 | ICD10CM | Covered |
| G62.81 | ICD10CM | Covered |
| G70.01 | ICD10CM | Covered |
| G70.1 | ICD10CM | Covered |
| G70.80 | ICD10CM | Covered |
| G70.81 | ICD10CM | Covered |
| G70.9 | ICD10CM | Covered |
| G71.11 | ICD10CM | Covered |
| G71.12 | ICD10CM | Covered |
| G71.13 | ICD10CM | Covered |
| G71.19 | ICD10CM | Covered |
| G71.3 | ICD10CM | Covered |
| G71.8 | ICD10CM | Covered |
| G71.9 | ICD10CM | Covered |
| G72.3 | ICD10CM | Covered |
| G72.49 | ICD10CM | Covered |
| G72.81 | ICD10CM | Covered |
| G72.89 | ICD10CM | Covered |
| G72.9 | ICD10CM | Covered |
| G73.1 | ICD10CM | Covered |
| G82.20 | ICD10CM | Covered |
| G82.21 | ICD10CM | Covered |
| G82.22 | ICD10CM | Covered |
| G93.1 | ICD10CM | Covered |
| G93.82 | ICD10CM | Covered |
| G95.0 | ICD10CM | Covered |
| G95.20 | ICD10CM | Covered |
| G95.29 | ICD10CM | Covered |
| G95.9 | ICD10CM | Covered |
| G96.9 | ICD10CM | Covered |
| H02.401 | ICD10CM | Covered |
| H02.402 | ICD10CM | Covered |
| H02.403 | ICD10CM | Covered |
| H53.2 | ICD10CM | Covered |
| I89.0 | ICD10CM | Covered |
| I89.1 | ICD10CM | Covered |
| I89.8 | ICD10CM | Covered |
| I89.9 | ICD10CM | Covered |
| I97.2 | ICD10CM | Covered |
| M62.81 | ICD10CM | Covered |
| P11.5 | ICD10CM | Covered |
| Q06.0 | ICD10CM | Covered |
| Q06.1 | ICD10CM | Covered |
| Q06.3 | ICD10CM | Covered |
| Q06.8 | ICD10CM | Covered |
| Q06.9 | ICD10CM | Covered |
| R13.0 | ICD10CM | Covered |
| R13.10 | ICD10CM | Covered |
| R13.11 | ICD10CM | Covered |
| R13.12 | ICD10CM | Covered |
| R13.13 | ICD10CM | Covered |
| R13.14 | ICD10CM | Covered |
| R13.19 | ICD10CM | Covered |
| R40.20 | ICD10CM | Covered |
| R47.02 | ICD10CM | Covered |
| R47.1 | ICD10CM | Covered |
| R47.81 | ICD10CM | Covered |
| R47.89 | ICD10CM | Covered |
| R47.9 | ICD10CM | Covered |
| Z79.01 | ICD10CM | Covered |