Why Cigna Denies Epidural Steroid Injection
Exceeds frequency limit (usually 3 per year per region)
Conservative therapy not documented
Prior injection did not provide documented relief
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 radicular symptoms correlating with imaging
Note percentage and duration of relief from prior injection
Show failure of oral medications and PT
Reference imaging confirming nerve compression at the targeted level
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
- ASIPP Guidelines for Interventional Pain Management
- NASS Coverage Recommendations for ESI
Relevant CPT Codes
Specialty: Pain Management / Anesthesiology
Want the full strategy?
The P2P Playbook covers payer-specific approaches for Epidural Steroid Injection denied by Cigna -- plus 15 denial objections with word-for-word responses, what reviewers are actually thinking, and the 60-second prep framework. Written by a medical director who reviewed cases for major payers.
Get The P2P Playbook -- $39Get a personalized P2P script in 60 seconds
Enter your specific case details and our AI generates a structured prep script tailored to Cigna's criteria.