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Master Precertification List - Cigna

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company and Express Scripts, Inc. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 2020 Cigna . Some content provided under license. 1 0f Master Precertification LIST For Health Care Providers Effective January 2022 Complete/PHS+ - The most comprehensive care management model that includes all the components of our Preferred level, plus additional digital tools and the highest level of engagement and potential savings. Preferred - A comprehensive care management model that includes all the components of our existing care management model, including comprehensive outpatient Precertification , plus higher intensity of care coordination and more customer engagement opportunities. Basic Standard - A lower touch care management model that includes many of the components of our existing care management model, such as higher intensity of care coordination and more customer engagement opportunities.

Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar, each additional interspace X X 0165T* Revision of total disc arthroplasty, anterior approach, lumbar, each additional interspace Removed 11/07/2020 X X

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