Prior Authorization
Cigna Prior Authorization for CPT 15772
Grafting of autologous soft tissue or fat harvested by liposuction technique to various body areas · Standard commercial plans
Source
Cigna Master Precertification List for Providers - May 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 Master Precertification List for Providers identifies 15772 as requiring prior authorization for both Complete/PHS+/Preferred and Basic Standard commercial care management models, effective 2020-01-01. 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 15772
Office (non-facility)
$205.75
Facility
$126.26
Total RVUs (office)
6.16
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 15772 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 15772?
- Yes. Cigna requires prior authorization for CPT 15772 (Grafting of autologous soft tissue or fat harvested by liposuction technique to various body areas) under Standard commercial plans per its published clinical policy.
- What documentation does Cigna require for CPT 15772?
- Clinical notes supporting medical necessity; Relevant diagnostic, imaging, lab, or treatment records for the requested service
- How much does Medicare pay for CPT 15772 in 2026?
- In 2026, the national Medicare allowable for CPT 15772 is $205.75 in an office setting and $126.26 in a facility. Commercial allowables for Cigna are typically negotiated against this benchmark.
- What if Cigna denies the PA for CPT 15772?
- 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 15772 prior authorization by payer
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