Cigna Announces Rollback of Prior Authorization Requirements

Sep 5, 2023 | Industry Insights

Cigna has taken a significant step towards simplifying the healthcare process by eliminating prior authorization requirements for 25 medical procedure codes. This decision is in line with Cigna’s ongoing efforts to enhance patient care and reduce administrative complexities for healthcare providers.

The 25 procedure codes affected by this change cover a range of medical services, including diagnostic tests, minor surgeries, and medical imaging. By removing prior authorization for these codes, Cigna aims to streamline the process of obtaining necessary medical care, making it easier for patients to access essential services without unnecessary delays.

This decision is particularly beneficial for healthcare providers who often find themselves navigating a complex web of paperwork and administrative hurdles when seeking prior authorization. By simplifying the process, Cigna seeks to improve collaboration between providers and insurers, ultimately leading to a more efficient healthcare system.

Cigna’s move to eliminate prior authorization requirements for these 25 codes reflects a broader industry trend towards prioritizing patient-centric care and reducing the burden of administrative tasks on healthcare professionals. It sets a positive example for other insurers, encouraging them to reevaluate their authorization processes and focus on improving the overall healthcare experience for patients and providers alike.

This move may have a particularly positive impact on laboratories and their billing processes. Laboratories often perform diagnostic tests and procedures covered by these codes. With prior authorization requirements eased, labs can expect smoother interactions with insurance providers, potentially reducing billing disputes and delays in receiving payment. This change could ultimately lead to more efficient billing processes for labs, allowing them to focus on delivering critical diagnostic services promptly.

Laboratory CPT Codes Removed from Cigna Prior-Authorization Master ListDescription
81173AR (androgen receptor) (eg, spinal and bulbar muscular
atrophy, Kennedy disease, X chromosome inactivation)
gene analysis; full gene sequence
81176ASXL1 (additional sex combs like 1, transcriptional
regulator) (eg, myelodysplastic syndrome,
myeloproliferative neoplasms, chronic myelomonocytic
leukemia), gene analysis; targeted sequence analysis
(eg, exon 12)
81185CACNA1A (calcium voltage-gated channel subunit alpha1
A) (eg, spinocerebellar ataxia) gene analysis; full gene
81201APC (adenomatous polyposis coli) (eg, familial
adenomatosis polyposis [FAP], attenuated FAP) gene
analysis; full gene sequence
81202APC (adenomatous polyposis coli) (eg, familial
adenomatosis polyposis [FAP], attenuated FAP) gene
analysis; known familial variants81203
81203APC (adenomatous polyposis coli) (eg, familial
adenomatosis polyposis [FAP], attenuated FAP) gene
analysis; duplication/deletion variants
81219CALR (calreticulin) (eg, myeloproliferative disorders),
gene analysis, common variants in exon 9
81229Cytogenomic constitutional (genome-wide) microarray
analysis; interrogation of genomic regions for copy
number and single nucleotide polymorphism (SNP)
variants for chromosomal abnormalities
81232DPYD (dihydropyrimidine dehydrogenase) (eg, 5-
fluorouracil/5-FU and capecitabine drug metabolism),
gene analysis, common variant(s) (eg, *2A, *4, *5, *6)
81236EZH2 (enhancer of zeste 2 polycomb repressive complex
2 subunit) (eg, myelodysplastic syndrome,
myeloproliferative neoplasms) gene analysis, full gene
81237EZH2 (enhancer of zeste 2 polycomb repressive complex
2 subunit) (eg, dif fuse large B-cell lymphoma) gene
analysis, common variant(s) (eg, codon 646)
81306NUDT15 (nudix hydrolase 15) (eg, drug metabolism)
gene analysis, common variant(s) (eg, *2, *3, *4, *5,
81335TPMT (thiopurine S-methyltransferase) (eg, drug
metabolism), gene analysis, common variants (eg, *2,
81427Genome (eg, unexplained constitutional or heritable
disorder or syndrome); re-evaluation of previously
obtained genome sequence (eg, updated knowledge or
unrelated condition/syndrome)
81523Oncology (breast), mRNA, next-generation sequencing
gene expression profiling of 70 content genes and 31
housekeeping genes, utilizing formalin-fixed paraf finembedded tissue, algorithm reported as index related to
risk to distant metastasis
81539Oncology (high-grade prostate cancer), biochemical
assay of four proteins (Total PSA, Free PSA, Intact PSA,
and human kallikrein-2 [hK2]), utilizing plasma or
serum, prognostic algorithm reported as a probability
81551Oncology (prostate), promoter methylation profiling by
real-time PCR of 3 genes (GSTP1, APC, RASSF1),
utilizing formalin-fixed paraf fin-embedded tissue,
algorithm reported as a likelihood of prostate cancer
detection on repeat biopsy
81560Transplantation medicine (allograf t rejection, pediatric
liver and small bowel), measurement of donor and thirdparty-induced CD154+T-cytotoxic memory cells, utilizing
whole peripheral blood, algorithm reported as a rejection
risk score
81599Unlisted multianalyte assay with algorithmic analysis
85999Unlisted hematology or coag procedure
86486Skin test; unlisted antigen, each
86849Unlisted immunology procedure
88375Optical endomicroscopic image(s), interpretation and
report, real-time or referred, each endoscopic session
89240Unlisted miscellaneous pathology test
89398Unlisted reprod med lab proc
G0428Collagen meniscus implant procedure for filling meniscal
defects (e.g., cmi, collagen scaf fold, menaflex)
G0448Insertion or replacement of a permanent pacing
cardioverter-defibrillator system with transvenous
lead(s), single or dual chamber with insertion of pacing
electrode, cardiac venous system, for lef t ventricular
G0455Preparation with instillation of fecal microbiota by any
method, including assessment of donor specimen
G2000Ultrasonic guidance for placement of radiation therapy



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