Prior Authorization
Cigna Prior Authorization for CPT L5973
Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source · Standard commercial plans
Source
Cigna Commercial DME Code List - Effective 03/07/2026Not 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/EviCore Cigna Commercial DME Code List - Effective 03/07/2026 lists L5973 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 L5973
CPT L5973 is not priced under the 2026 Medicare Physician Fee Schedule — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT L5973 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 L5973?
- Yes. Cigna requires prior authorization for CPT L5973 (Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source) under Standard commercial plans per its published clinical policy.
- What documentation does Cigna require for CPT L5973?
- Clinical notes supporting medical necessity; Relevant diagnostic, imaging, lab, or treatment records for the requested service
- What if Cigna denies the PA for CPT L5973?
- 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 L5973 prior authorization by payer
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