Prior Authorization
Cigna Prior Authorization for CPT 15271
Application of skin substitute graft to trunk, arms, legs or face/scalp/specialized areas in varying wound surface areas · Standard commercial plans
Source
Cigna Commercial Other Services Code List - Effective 03/07/2026Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Cigna/EviCore Cigna Commercial Other Services Code List - Effective 03/07/2026 lists 15271 as requiring prior authorization for commercial plans, effective 2026-03-07. Confirm member benefit, plan model, and delegated workflow before submission.
Documentation checklist
- ✓Clinical notes supporting medical necessity
- ✓Relevant diagnostic, imaging, lab, or treatment records for the requested service
2026 Medicare rate for CPT 15271
Office (non-facility)
$157.99
Facility
$75.15
Total RVUs (office)
4.73
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Cigna's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 15271 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Clinical notes supporting medical necessity, Relevant diagnostic, imaging, lab, or treatment records for the requested service.
- 3Submit via the payer's provider portal or designated PA channel.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Cigna require prior authorization for CPT 15271?
- Yes. Cigna requires prior authorization for CPT 15271 (Application of skin substitute graft to trunk, arms, legs or face/scalp/specialized areas in varying wound surface areas) under Standard commercial plans per its published clinical policy.
- What documentation does Cigna require for CPT 15271?
- Clinical notes supporting medical necessity; Relevant diagnostic, imaging, lab, or treatment records for the requested service
- How much does Medicare pay for CPT 15271 in 2026?
- In 2026, the national Medicare allowable for CPT 15271 is $157.99 in an office setting and $75.15 in a facility. Commercial allowables for Cigna are typically negotiated against this benchmark.
- What if Cigna denies the PA for CPT 15271?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Cigna PA lookups
CPT 15271 prior authorization by payer
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