Does Cigna require prior authorization for CPT 19367?

Status not confirmed in our dataset. Confirm against the current Cigna clinical policy before submitting.

What documentation does Cigna require for CPT 19367?

Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.

How much does Medicare pay for CPT 19367 in 2026?

In 2026, the national Medicare allowable for CPT 19367 is $1559.15 in an office setting and $1559.15 in a facility. Commercial allowables for Cigna are typically negotiated against this benchmark.

What if Cigna denies the PA for CPT 19367?

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.

Prior Authorization

Cigna Prior Authorization for CPT 19367

Breast reconstruction (non-mastectomy) - not required for mastectomy diagnosis codes · Standard commercial plans

Status not confirmed

Source

Data pending source-document linkage. Verify against Cigna's current clinical policy before submission.

Not 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.

We don't have a source-backed prior-authorization verdict for CPT 19367 with Cigna under Standard commercial plans yet — confirm directly with the payer. The 2026 Medicare reference rate for this code is below, and you can draft the request free in Ask D3.

2026 Medicare rate for CPT 19367

Office (non-facility)

$1559.15

Facility

$1559.15

Total RVUs (office)

46.68

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 19367 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather patient history, prior conservative treatment, and clinical justification.
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 19367?: Status not confirmed in our dataset. Confirm against the current Cigna clinical policy before submitting.
What documentation does Cigna require for CPT 19367?: Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.
How much does Medicare pay for CPT 19367 in 2026?: In 2026, the national Medicare allowable for CPT 19367 is $1559.15 in an office setting and $1559.15 in a facility. Commercial allowables for Cigna are typically negotiated against this benchmark.
What if Cigna denies the PA for CPT 19367?: 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

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All Cigna prior-authorization requirements →

CPT 19367 prior authorization by payer

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