Payer PolicyActive
Gait Analysis - (0315)
CIGNA-0315
Cigna
Effective: April 15, 2025
Updated: December 6, 2025
created · Dec 2, 2025
Policy Summary
Cigna covers computerized (instrumented) gait analysis only for children or adolescents with cerebral palsy (ICD‑10 G80.x) when performed as part of a preoperative assessment and used in surgical planning; all other indications/diagnoses are excluded. Coverage requires documentation that the patient is ambulatory for ≥10 consecutive steps, cooperative, that gait data are correlated with an extensive clinical exam, a comprehensive interdisciplinary report per APTA elements, and appropriate CPT/ICD coding (96000, 96001, 96002, 96004; 96003 deleted 12/31/2024).
Coverage Criteria Preview
Key requirements from the full policy
"Computerized gait analysis is considered medically necessary when BOTH of the following criteria are met:"
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