Does Cigna require prior authorization for CPT 78430?

Yes. Cigna requires prior authorization for CPT 78430 (Heart muscle PET imaging at rest or stress with CT) under Standard commercial plans per its published clinical policy.

What documentation does Cigna require for CPT 78430?

Clinical notes supporting medical necessity; Relevant diagnostic, imaging, lab, or treatment records for the requested service

What if Cigna denies the PA for CPT 78430?

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 78430

Heart muscle PET imaging at rest or stress with CT · Standard commercial plans

Prior authorization REQUIREDApplies to all statesLast verified May 9, 2026 · Reviewed by the D3rx Clinical Billing Team

Source

Cigna Commercial Radiology Code List - Effective 03/07/2026

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.

Clinical criteria

Cigna/EviCore Cigna Commercial Radiology Code List - Effective 03/07/2026 lists 78430 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 78430

CPT 78430 is not priced under the 2026 Medicare Physician Fee Schedule (status C) — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT 78430 code page for pricing detail.

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 78430?: Yes. Cigna requires prior authorization for CPT 78430 (Heart muscle PET imaging at rest or stress with CT) under Standard commercial plans per its published clinical policy.
What documentation does Cigna require for CPT 78430?: Clinical notes supporting medical necessity; Relevant diagnostic, imaging, lab, or treatment records for the requested service
What if Cigna denies the PA for CPT 78430?: 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 70450 CPT 72148 CPT 73721 CPT 74177 CPT 73221 CPT 76641 CPT 76942 CPT 70551

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CPT 78430 prior authorization by payer

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