Unlisted Procedure Codes - (0583)

Cigna covers unlisted CPT/HCPCS codes only when no accurate existing code describes the service and the service is not addressed by another coverage policy; services primarily for convenience, that are more costly than equivalent alternatives, or that do not meet all policy criteria are excluded. Key requirements: all criteria must be met and fully documented (specific written report, invoices for unlisted items when applicable, medical necessity and site/separation details), use current CPT/HCPCS codes, and follow plan terms and any required prior authorization or state/federal mandates—failure to provide required documentation or meet criteria will result in denial.

"Use of an unlisted CPT or HCPCS code when there is an absence of an available CPT or HCPCS procedure code that accurately describes the service."

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