CurrentCignaPolicy A006

Administrative Policy: Coverage for Abortion Services

Governs coverage and administration of abortion services under standard Cigna benefit plans, including elective and therapeutic abortion and treatment of complications; applies to members covered by standard Cigna plans and subject to plan terms and state regulations.

Policy Summary

PayerCigna

PolicyCoverage for Abortion Services (Administrative Policy)

Policy CodePolicy A006

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionVerify member coverage under the applicable benefit plan and any applicable state regulations before authorizing abortion-related services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

elective & therapeuticcovered benefit types

yescomplications covered

CPT/HCPCS & ICD-10coding examples

listedrelated resources

Coverage Criteria and Guidance

Coverage criteria and coding guidance

Covered when the following conditions and coding guidance are met:

Standard Cigna benefit plans consider both elective and therapeutic abortion to be covered benefits.

Coverage is subject to the terms, conditions and limitations of the applicable benefit plan and may be subject to state regulations.

Clinical and coding conditions

Certain CPT and CPT/HCPCS procedure codes reflect therapeutic abortion when accompanied by diagnosis code(s) indicating an underlying condition related to maternal health or fetal disease (e.g., treatment of ectopic pregnancy, life‑threatening maternal conditions, fetal disease).
Specific CPT codes that may reflect therapeutic abortion include (non‑exhaustive): 59100; 59120; 59121; 59130; 59136; 59140; 59150; 59151; 59812; 59820; 59821; 59830; 59870; 59840; 59841; 59850; 59851; 59852; 59855; 59856; 59857; 59866.

Policy Summary

PayerCigna

PolicyCoverage for Abortion Services (Administrative Policy)

Policy CodePolicy A006

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionVerify member coverage under the applicable benefit plan and any applicable state regulations before authorizing abortion-related services.

SourceLink

On This Page

Example Codes and Coding Notes

Example CPT/HCPCS/ICD-10 codes for abortion services - therapeutic/induced/medicalmixed

59100	Hysterotomy, abdominal (eg, for hydatidiform mole, abortion)
59120	Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach
59121	Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy
59130	Surgical treatment of ectopic pregnancy; abdominal pregnancy
59136	Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus
59140	Surgical treatment of ectopic pregnancy; cervical, with evacuation
59150	Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or oophorectomy
59151	Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy
59812	Treatment of incomplete abortion, any trimester, completed surgically
59820	Treatment of missed abortion, completed surgically; first trimester

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Example CPT codes identified in brief summary (subset)CPT

59812	Treatment of incomplete abortion, any trimester, completed surgically
59840	Induced abortion, by dilation and curettage
59100	Hysterotomy, abdominal (eg, for hydatidiform mole, abortion)

Therapeutic abortion coding condition

ConditionCertain CPT/HCPCS codes reflect therapeutic abortion when accompanied by diagnosis code(s) indicating an underlying condition related to maternal health or fetal disease.

Representative procedure codesExamples include 59840, 59841, 59850–59857, 59866 (induced abortion and related procedures) and 59812, 59820–59821, 59830, 59870 (treatment of incomplete/missed/septic abortion and hydatidiform mole).

Medical abortion drug codesS0190 (Mifepristone 200 mg), S0191 (Misoprostol 200 mcg), S0199 (medically induced abortion by oral ingestion including associated services).

Use with diagnosis codesThese procedure/drug codes should be billed with ICD-10 diagnosis codes that document maternal health conditions or fetal disease to reflect therapeutic abortion per policy guidance.

Provider Responsibilities and Plan Governance

Note

Coverage governed by plan terms; verify eligibility and document indications

Coverage for abortion is governed by the member's applicable benefit plan and may also be affected by state regulations. Providers should verify plan terms and applicable law when determining coverage and submitting claims. Cigna's standard benefit plans consider both elective and therapeutic abortion to be covered benefits, and Cigna covers medically necessary treatment of complications following an abortion.

Confirm coverage by checking the member's specific benefit plan terms and any relevant state regulations before performing or billing for abortion services.
Document clinical indications clearly to support whether a procedure is elective, therapeutic, or treatment of complications.
Ensure claims reflect the appropriate procedure and diagnosis codes consistent with plan requirements and state law.

Definitions

Elective abortion

DefinitionElective abortion: termination of pregnancy at the discretion of the woman for reasons other than maternal health or fetal disease.

Coding signalElective abortion is reflected when ICD-10-CM code Z33.2 (Encounter for elective termination of pregnancy) is billed alone or with Z32.01 (Encounter for pregnancy test, result positive).

Coverage stanceStandard Cigna benefit plans consider elective abortion a covered benefit subject to plan terms and applicable state regulations.

Therapeutic abortion

DefinitionTherapeutic abortion: termination of pregnancy due to underlying conditions related to maternal health or fetal disease (includes cancer, cardiovascular/hematologic/pulmonary disease, fetal genetic abnormalities, pregnancy due to rape or incest, ectopic pregnancy, and others).

Coding guidanceSeveral CPT/HCPCS codes (see lists of induced abortion and treatment codes) reflect therapeutic abortion when billed with diagnosis codes indicating maternal/fetal conditions.

Examples of indicationsIndications listed in policy include cancer, congenital heart disease, diabetes mellitus, exposure to teratogens, fetal structural defects, infectious disease with significant complications, mental health/addiction disorders, renal disease, and fetal death prior to viability.

Spontaneous abortion

DefinitionSpontaneous abortion: early loss of pregnancy (e.g., miscarriage) not caused by medical or surgical intervention; includes missed or incomplete abortion and infected/septic abortion.

Clinical implicationPresence of spontaneous abortion and resulting complications may require medical or surgical treatment (e.g., procedures listed such as treatment of incomplete or septic abortion).

Related procedure codesCodes cited for treatment include 59812 (treatment of incomplete abortion), 59820–59821 (treatment of missed abortion), and 59830 (treatment of septic abortion).

Ectopic pregnancy

DefinitionEctopic pregnancy: a pregnancy in which the fertilized egg implants outside the uterus (e.g., fallopian tube or abdomen), resulting in a nonviable pregnancy and a life‑threatening condition.

Clinical urgencyEctopic pregnancy constitutes a life‑threatening condition and may require immediate surgical intervention.

Procedure codesPolicy lists multiple CPT codes for surgical treatment of ectopic pregnancy, including 59120, 59121, 59130, 59136, 59140, 59150, and 59151 to reflect operative management.