Cigna ACL Reconstruction prior authorization requirements (2026)
What Cigna generally requires to approve ACL Reconstruction (CPT 29888, 29889), for Commercial plans. Yes. Cigna generally requires prior authorization for ACL Reconstruction (CPT 29888, 29889).
Medical-necessity criteria Cigna generally applies
Prior authorization required; Cigna MSK is delegated to eviCore (CMM-312, Knee Surgery). ACL reconstruction (autograft or allograft) is medically necessary when ALL of: (1) MRI, CT arthrogram, or arthroscopy shows an ACL tear/disruption or significant laxity; (2) physical exam shows a positive Lachman, anterior drawer, OR pivot-shift test; (3) BOTH function-limiting knee pain/loss of function affecting activities of daily living, work, or cutting/pivoting activities AND reported instability (subjective weakness or buckling); AND (4) failure of at least 3 months of provider-directed non-surgical management. The 3-month conservative requirement is waived in an acute-injury setting with documented instability PLUS one of: need to return to cutting/pivoting activity, a confirmed ACL tear with a repairable meniscus tear, or a multi-ligamentous knee injury.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for ACL Reconstruction. Confirm the covered diagnosis list against the current Cigna policy.
Related procedure codes
Codes often billed alongside ACL Reconstruction: 29888, 29889. Verify the correct codes for your documentation.
Commonly required documentation
- MRI or arthroscopy confirming ACL tear
- documented exam instability findings (Lachman/anterior drawer/pivot shift)
- functional limitation and conservative-management history (or documentation of the acute-injury exception).
Situations to verify before submitting
Cigna may not cover ACL Reconstruction in these situations. Verify against the current policy rather than assuming a denial:
- Primary ACL repair (as opposed to reconstruction) is considered not medically necessary
- ACL reconstruction for any other indication or condition is not medically necessary
How to submit
- Method: eviCore (evicore.com)
- Portal: eviCore by Evernorth
Source
Source: Cigna eviCore CMM-312 Knee Surgery (eff 2026-03-07, pub 2025-12-11). CPT 29888 = ACL, 29889 = PCL. Last verified 2026-06-17.
Frequently asked questions
Does Cigna require prior authorization for ACL Reconstruction?
Yes. Cigna generally requires prior authorization for ACL Reconstruction (CPT 29888, 29889).
What does Cigna require to approve ACL Reconstruction?
Prior authorization required; Cigna MSK is delegated to eviCore (CMM-312, Knee Surgery). ACL reconstruction (autograft or allograft) is medically necessary when ALL of: (1) MRI, CT arthrogram, or arthroscopy shows an ACL tear/disruption or significant laxity; (2) physical exam shows a positive Lachman, anterior drawer, OR pivot-shift test; (3) BOTH function-limiting knee pain/loss of function affe… Always confirm against the current Cigna policy.
How long does a Cigna prior authorization take?
Turnaround varies by plan and submission method. Check the Cigna portal for current timeframes.
Submitting ACL Reconstruction to Cigna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.