Cigna Autologous Chondrocyte Implantation prior authorization requirements (2026)
What Cigna generally requires to approve Autologous Chondrocyte Implantation (CPT 27412, J7330, S2112), for Commercial plans. Yes. Cigna generally requires prior authorization for Autologous Chondrocyte Implantation (CPT 27412, J7330, S2112).
Medical-necessity criteria Cigna generally applies
Cigna administers autologous chondrocyte implantation (ACI/ACT) prior authorization through eviCore CMM-312 (Knee Surgery). ACI may be considered medically necessary for a symptomatic full-thickness articular cartilage defect of the knee meeting the size, location, and failed-prior-treatment indications defined in CMM-312.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Autologous Chondrocyte Implantation. Confirm the covered diagnosis list against the current Cigna policy.
Source
Summarized from eviCore/Cigna CMM-312 (Knee Surgery), ACI section. Sources: and https://static.cigna.com/assets/chcp/resourceLibrary/preCertification/musculoskeletal.html View the source policy. Last verified 2026-06-13.
Frequently asked questions
Does Cigna require prior authorization for Autologous Chondrocyte Implantation?
Yes. Cigna generally requires prior authorization for Autologous Chondrocyte Implantation (CPT 27412, J7330, S2112).
What does Cigna require to approve Autologous Chondrocyte Implantation?
Cigna administers autologous chondrocyte implantation (ACI/ACT) prior authorization through eviCore CMM-312 (Knee Surgery). ACI may be considered medically necessary for a symptomatic full-thickness articular cartilage defect of the knee meeting the size, location, and failed-prior-treatment indications defined in CMM-312. 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 Autologous Chondrocyte Implantation 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.