Cigna Knee Arthroscopy prior authorization requirements (2026)
What Cigna generally requires to approve Knee Arthroscopy (CPT 29875, 29876, 29877, 29879), for Commercial plans. Yes. Cigna generally requires prior authorization for Knee Arthroscopy (CPT 29875, 29876, 29877, 29879).
Medical-necessity criteria Cigna generally applies
Cigna administers knee-surgery prior authorization through eviCore Comprehensive Musculoskeletal Management guideline CMM-312 (Knee Surgery, Arthroscopic and Open). Arthroscopic knee surgery may be considered medically necessary for documented symptomatic intra-articular pathology (e.g. meniscal tear, loose body, fracture/tumor/infection, or symptomatic chondral lesion) confirmed on exam and imaging, after an appropriate course of non-operative care where indicated. Specific per-procedure indications are defined in CMM-312.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Knee Arthroscopy. Confirm the covered diagnosis list against the current Cigna policy.
Sources & verification
- BindingPayer medical policy.View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-13.
Frequently asked questions
Does Cigna require prior authorization for Knee Arthroscopy?
Yes. Cigna generally requires prior authorization for Knee Arthroscopy (CPT 29875, 29876, 29877, 29879).
What does Cigna require to approve Knee Arthroscopy?
Cigna administers knee-surgery prior authorization through eviCore Comprehensive Musculoskeletal Management guideline CMM-312 (Knee Surgery, Arthroscopic and Open). Arthroscopic knee surgery may be considered medically necessary for documented symptomatic intra-articular pathology (e.g. meniscal tear, loose body, fracture/tumor/infection, or symptomatic chondral lesion) confirmed on exam and imagi… 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 Knee Arthroscopy 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.