Does Cigna require prior authorization for CPT J1745?

Yes. Cigna requires prior authorization for CPT J1745 (Infliximab - infliximab) under Standard commercial plans per its published clinical policy.

What documentation does Cigna require for CPT J1745?

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

What if Cigna denies the PA for CPT J1745?

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 J1745

Infliximab - infliximab · Standard commercial plans

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

Source

Cigna Master Precertification List for Providers - May 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 Master Precertification List for Providers identifies J1745 as requiring prior authorization for both Complete/PHS+/Preferred and Basic Standard commercial care management models, effective 2006-10-01. 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 J1745

CPT J1745 is not priced under the 2026 Medicare Physician Fee Schedule (status E) — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT J1745 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 J1745?: Yes. Cigna requires prior authorization for CPT J1745 (Infliximab - infliximab) under Standard commercial plans per its published clinical policy.
What documentation does Cigna require for CPT J1745?: Clinical notes supporting medical necessity; Relevant diagnostic, imaging, lab, or treatment records for the requested service
What if Cigna denies the PA for CPT J1745?: 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 J0897 CPT G2211 CPT J3301 CPT J0585 CPT G0402 CPT G0439 CPT G0438 CPT J1885

All Cigna prior-authorization requirements →

CPT J1745 prior authorization by payer

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