Why Cigna Denies CT Abdomen and Pelvis
Prior imaging not performed first (ultrasound, X-ray)
Diagnosis does not support advanced imaging
Duplicate study within short timeframe
Know Cigna / Evernorth's Criteria
Cigna uses their own Coverage Policies and InterQual criteria. Medical directors are generally accessible for P2P review.
Key policies to know:
- Coverage Policies available on cigna.com/coverage-policies
- Uses eviCore for specialty benefits management
- Known for step therapy requirements on specialty drugs
- Collaborative care approach with emphasis on outcomes data
Building Your Medical Necessity Argument
Document why less invasive imaging is insufficient
Note acute clinical findings requiring CT
Reference abnormal lab values or physical exam findings
Cite clinical suspicion for specific pathology (abscess, mass, obstruction)
P2P Call Tips for Cigna
Reference Cigna Coverage Policy by number
Cigna medical directors tend to be collaborative -- frame it as shared decision-making
Emphasize outcomes data and evidence-based medicine
Be prepared to discuss alternatives and why they were insufficient
Guidelines to Reference
- ACR Appropriateness Criteria
- Choosing Wisely Recommendations for Abdominal Imaging
Relevant CPT Codes
Specialty: Internal Medicine / Emergency Medicine
Want the full strategy?
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