Cigna updated Medical Coverage Policy 0558 effective 4/15/2026 to consolidate Category III and related CPT code guidance under the Dermatology & Plastic Surgery (Skin/Breast) resource listing. The revision enumerates multiple Category III codes (e.g., 0960T, 0967T–0980T, 0351T, 0489T and others) that are designated experimental/investigational in this policy excerpt while calling out coding descriptions, reporting constraints, and cross‑coding guidance (for example, percutaneous laser ablation, cryoablation, and intraoperative OCT of excised breast tissue). The update cross‑references related Cigna coverage resources where certain Category III codes are considered medically necessary for specific indications (for example Scar Revision and select cardiac or cellular therapy policies), so providers should consult those indication‑specific policies for coverage determination. Review the policy text for precise code‑level reporting notes and do‑not‑report combinations prior to claim submission.
April 15, 2026 Revision: Category III Code and Resource Updates
Summary of changes effective 4/15/2026
This revision to Cigna Medical Coverage Policy 0558 lists updates effective 4/15/2026 and consolidates related Category III and other codes under the Dermatology & Plastic Surgery (Skin/Breast) resource listing. The document explicitly adds or reiterates a set of Category III and other CPT codes designated as considered experimental, investigational, or unproven and flags several Category III codes as medically necessary in related coverage policies.
The effective date is displayed prominently as 4/15/2026, and several specific Category III codes (for example 0960T, 0967T, 0968T, 0970T, 0977T–0980T) are enumerated in the update text. The revision also clarifies cross-references to other Cigna coverage resources such as Ablative Treatments for Malignant Breast Tumors and Scar Revision within the related resources list.
Category III Codes Marked Experimental/Investigational
Codes designated Considered Experimental/Investigational/Unproven
The policy explicitly enumerates several Category III and other codes that are considered experimental, investigational, or unproven. Examples include 0207T (meibomian gland evacuation), 0338T/0339T (transcatheter renal sympathetic denervation, unilateral and bilateral), 0342T (selective HDL delipidation apheresis), 0351T (intraoperative optical coherence tomography of excised breast/axillary tissue), and 0439T (myocardial contrast perfusion echocardiography). The list continues with procedures such as autologous adipose-derived regenerative cell therapy (0489T), and other Category III descriptors listed in the document.
This section of the policy clarifies that these codes are not considered established within the scope of this policy excerpt. The document includes code descriptions and, in some cases, notes (for example contraindications or coding guidance associated with reporting combinations), which frame these entries as not supported by the policy’s coverage stance in their current state.
Procedural Descriptions and Coding Clarifications Included in Update
Specific Category III codes and procedural clarifications called out in the effective 4/15/2026 list
The revision includes several Category III CPT codes with descriptive clarifications and reporting notes. For instance, 0970T is described as percutaneous laser ablation of benign breast tumor (e.g., fibroadenoma) and includes reporting constraints (do not report with certain imaging codes). The policy also references 0581T for cryoablation of malignant breast tumors and 19105 for cryosurgical ablation of fibroadenoma in cross‑coding guidance. Additionally, codes 0960T, 0967T, 0968T, and 0967T–0980T appear with procedural descriptions (e.g., replacement of sub‑scalp implanted electrode arrays, transanal insertion of colorectal anastomosis protection devices, insertion/replacement of epicranial neurostimulator systems, and various submucosal cryolysis therapy codes).
These entries provide specific coding language and cross‑references (such as “do not report in conjunction with…”) that clarify how these codes relate to other procedures and when alternative existing CPT codes should be used. The inclusion of these procedural descriptors emphasizes coding nuance and interoperability with other Cigna coverage documents included in the related resources list.
Related Policies that Recognize Certain Category III Codes as Medically Necessary
Cross-references to related policies that accept specific Category III codes as medically necessary
The document lists related coverage policies that consider particular Category III CPT codes medically necessary for certain indications. Examples include Ambulatory External and Implantable Electrocardiographic Monitoring (code 0650T), Scar Revision (codes 0479T, 0480T), and several cellular therapy or CAR‑T related policies that share codes (0537T–0540T) across Brexucabtagene autoleucel, Idecabtagene vicleucel, Lisocabtagene maraleucel, Tisagenlecleucel, and Yescarta entries.
This cross‑reference mapping indicates that while some codes are listed as experimental/investigational in this policy excerpt, other Cigna policies explicitly consider certain Category III codes medically necessary for defined indications. The policy therefore functions as a hub that directs readers to the applicable, indication‑specific coverage documents where some Category III codes may be supported.
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