Does Cigna require prior authorization for CPT 81216?

Yes. Cigna requires prior authorization for CPT 81216 (Genetic test for BRCA2 gene full sequencing) under Standard commercial plans per its published clinical policy.

What documentation does Cigna require for CPT 81216?

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

What if Cigna denies the PA for CPT 81216?

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 81216

Genetic test for BRCA2 gene full sequencing · Standard commercial plans

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

Source

Cigna Lab Management Prior Authorization CPT Code List - Effective 05/15/2026

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 Lab Management Prior Authorization CPT Code List - Effective 05/15/2026 lists 81216 as requiring prior authorization for commercial plans, effective 2026-05-15. 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 81216

CPT 81216 is not priced under the 2026 Medicare Physician Fee Schedule (status X) — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT 81216 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 81216?: Yes. Cigna requires prior authorization for CPT 81216 (Genetic test for BRCA2 gene full sequencing) under Standard commercial plans per its published clinical policy.
What documentation does Cigna require for CPT 81216?: Clinical notes supporting medical necessity; Relevant diagnostic, imaging, lab, or treatment records for the requested service
What if Cigna denies the PA for CPT 81216?: 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 80053 CPT 83036 CPT 85025 CPT 80061 CPT 88305 CPT 80307 CPT 82306 CPT 81003

All Cigna prior-authorization requirements →

CPT 81216 prior authorization by payer

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