Cigna Prior Authorization Requirements: What Changed in 2026

An earlier version of this page said Cigna widened prior authorization in May 2026 for specialty drugs, behavioral health intensive outpatient programs and musculoskeletal services. We could not find those changes in Cigna's precertification lists or provider notices, so this version sticks to what Cigna, HealthSpring and CMS have put in writing, with links, plus how to submit and appeal.

What changed on Cigna's commercial precertification list

Cigna's Master Precertification List gives each code a precertification effective date, any removal date, a separate effective date for ACA individual and family (ACA/IFP) plans, and the care-management models the requirement applies to. The October 2026 edition shows:

• Added May 14, 2026: nine genomic sequencing codes used to profile solid tumors and blood cancers: 0036U, 0037U, 0244U, 0250U, 0334U, 0379U, 0444U, 81445 and 81450. They apply to the Complete/PHS+ and Preferred care-management models, not Basic Standard. ACA/IFP plans follow on January 1, 2027.
• Added April 10, 2026: the tier 2 molecular pathology codes, 81400 through 81408, on the same pattern (Complete/PHS+ and Preferred now, ACA/IFP from January 1, 2027).
• Removed May 14, 2026: 0441T and 0442T (two Category III codes for image-guided nerve cryoablation) and J0349 (rezafungin injection), per the removed-codes list.
• Further additions took effect July 1 and October 1, 2026, many of them drug and lab codes, so a code that was clear in the spring may need precertification now.

Codes marked with an asterisk may be delegated to EviCore by Evernorth for certain clients, and all of the new molecular codes carry one. Cigna's molecular laboratory program page says obtaining precertification is the provider's responsibility and that a request needs the patient's name, date of birth and Cigna ID number; the ordering provider's name, NPI, TIN and address; the same details for the rendering facility; and supporting clinical information. Cigna's precertification page puts the request on the referring (ordering) provider for in-network services and requires the rendering provider or facility to confirm approval before an elective service, so the ordering practice and the lab should agree on who submits and who confirms.

The care-management columns matter: the same code can need precertification for one Cigna member and not another, and ACA/IFP plans can start later, as they do here. Check the member's plan along with the code.

Other Cigna prior authorization announcements, 2025 to 2026

• May 31, 2025: Cigna removed 96 codes from the precertification list, including commonly requested cardiology and ENT services.
• June 23, 2025: Cigna Healthcare listed commitments to be delivered in 2026 and 2027, including standardized electronic prior authorization, fewer services subject to prior authorization, honoring a new member's existing prior authorizations for 90 days, and more real-time responses.
• April 1, 2026: Cigna announced commercial formulary changes effective July 1, 2026, including prior authorization and quantity limit updates for select medications. The full list of changes is on CignaforHCP.com.
• April 24, 2026: The Cigna Group said it will standardize electronic prior authorization submission requirements for commonly reviewed medical services and expects the standard to cover services representing more than 70% of its prior authorization volume by the end of 2026.

Medicare Advantage is now HealthSpring

HCSC completed its purchase of Cigna's Medicare Advantage, Medicare supplemental benefits, Part D and CareAllies businesses on March 19, 2025, and on January 1, 2026 Cigna Healthcare Medicare Advantage became HealthSpring (Cigna provider notice).

• Since January 1, 2026, HealthSpring handles prior authorization for skilled nursing, inpatient rehabilitation, long-term acute care and home health, through the provider portal on Availity (same notice).
• Since March 1, 2026, DME requests go to HealthSpring through the portal on Availity, and DME approvals EviCore granted before the move stay active through their end dates. EviCore still takes radiology, cardiovascular, oncology and MSK requests for HealthSpring (EviCore).
• As a Medicare Advantage plan, HealthSpring falls under CMS-0057-F: since January 1, 2026, standard prior authorization decisions within 7 calendar days, expedited within 72 hours, and a specific reason for any prior authorization denial. Drugs are excluded, and these timeframes do not apply to Cigna's employer or individual commercial plans.

Submitting a request that is complete the first time

Cigna's precertification page takes requests through the EDI 278 transaction from your practice management system, by phone, or by fax with the intake form. It routes several categories to EviCore, including radiology imaging, musculoskeletal and spine procedures, oncology, radiation therapy, sleep studies, home health care, DME and molecular lab testing. For drugs it lists electronic prior authorization through EviCore, Surescripts and CoverMyMeds. Cigna warns that a request missing important details may be denied.

Before you submit:

• Confirm the member's plan type and care-management model, whether the code is on the current list, and whether it is delegated to EviCore.
• Read the criteria that will be applied: Cigna's public coverage policies or, for delegated services, EviCore's guidelines. Cigna notes that the member's plan terms control when they conflict with a coverage policy.
• Send what Cigna's page asks for on every request (a description of the service, start and end dates, and the CPT or HCPCS code if available), plus units and the ICD-10-CM codes the chart supports.
• Attach notes that answer each criterion: prior treatment with dates and duration, test and imaging results, alternatives tried or ruled out, and for a genetic test, how the result will change management.
• Record the reference number, approved units and date span. If the service date moves outside the span, update the authorization before the service.

For behavioral health, the same page says emergency services need no precertification, but an emergency that leads to an inpatient admission must be reported within one business day unless a state mandate says otherwise.

When Cigna denies

Cigna's appeals page sorts denials by who appeals:

• A precertification denial for services not yet rendered is a customer appeal. A provider can file it on the patient's behalf.
• Precertification not obtained, with services denied, is a health care provider appeal.
• A medical necessity denial can be appealed by either.

The same page says that when an initial appeal denial offers an external review by an Independent Review Organization, the provider must get the patient's approval before going ahead.

Deadlines

• Cigna commercial, provider appeal: within 180 calendar days of the initial payment or denial notice (or of the last payment adjustment), using Cigna's Request for Health Care Provider Payment Review form. Cigna asks you to call customer service first, says the review is completed in 60 days, and says its time periods are subject to applicable law and the provider agreement. California providers follow a separate dispute resolution policy.
• Member appeal, ACA-compliant commercial and ERISA group plans: at least 180 days from the adverse benefit determination. After a final internal denial, federal external review must be requested within 4 months; state processes vary.
• HealthSpring: the enrollee, or a non-contracted provider with a waiver of liability, requests plan reconsideration within 60 calendar days after receiving the notice, and receipt is presumed to be 5 days after the notice date, so in practice 65 days from the date on the notice (42 CFR 422.582). A treating physician can request a standard pre-service reconsideration on the enrollee's behalf after notifying the enrollee (42 CFR 422.578). If the plan upholds the denial, the case goes to the Independent Review Entity automatically. Contracted providers' payment disputes follow their contract.

Building the appeal

• On the 835, a missing authorization commonly posts as CARC 197 and a medical necessity denial as CARC 50. The code tells you which path above applies.
• Find the exact criterion the denial says was not met and answer it with a citation to the chart page that meets it. Restating the original request adds nothing.
• If a peer-to-peer conversation is offered, check the denial notice or the reviewing vendor for how and by when to request it. The treating clinician should take the call with the policy criteria and the chart in hand.

Staying current

Cigna posts provider notices on its Provider Newsroom, and HealthSpring notices have appeared in its Medicare Network Insider section. The October 2026 edition of the Master Precertification List shows 2026 effective dates in January, April, May, July and October, so re-check your highest-volume codes against the current edition on a schedule and whenever an unexpected CARC 197 posts.

EZAppeal sorts the denials on an 835 into next steps for free, and drafts prior authorization and appeal letters in a few minutes, citing the payer's policy when one is on file, for your team to review and send. Every account signs a BAA, and new accounts get 6 free documents.