Cigna Prior Authorization Template: Complete Cigna PA Form Guide 2025

Understanding Cigna Prior Authorization Requirements 2025

Cigna is rapidly transitioning to electronic prior authorizations through CoverMyMeds, moving away from fax and phone submissions. This shift saves time—CoverMyMeds submissions are 35% faster than traditional methods and show 70% user-reported time savings.

For detailed guidance on handling prior authorization denials across all insurers, including Cigna, see our comprehensive prior authorization denial guide.

For independent practices, Cigna prior authorizations create administrative burden but also represent opportunity. Understanding Cigna's medical policy framework, CoverMyMeds integration, and recent PA list reductions (96 codes removed effective May 31, 2025) allows you to minimize denials and streamline approvals.

The key challenge: Cigna's coverage policies require alignment with "generally accepted standards of medical practice" and evidence-based medicine—generic justifications without clinical guideline support frequently fail.

What's New in 2025: Cigna Prior Authorization Changes

May 31, 2025: 96 Codes Removed from PA List Cigna Healthcare removed 96 procedure codes from services requiring prior authorization, focusing PA requirements on higher-complexity services. This reduces paperwork for routine procedures.

CoverMyMeds Integration Cigna transitioned from PromptPA to CoverMyMeds for electronic prior authorizations. Benefits:

• 35% faster approval decisions
• 70% of users report time savings
• Available at no charge to providers
• Integrated with major EHR systems via SureScripts
• Over 950,000 providers use the platform

Electronic Submission Priority Cigna strongly encourages electronic PA submissions through CoverMyMeds rather than fax or phone. Electronic submissions provide real-time status tracking and faster processing.

Cigna Prior Authorization Template (Medical Services)

Use this template for medical services and procedures requiring Cigna prior authorization. Submit via CoverMyMeds (preferred), phone, or fax.

CIGNA PRIOR AUTHORIZATION REQUEST

PATIENT INFORMATION
Patient Name: [Last, First, Middle Initial]
Date of Birth: [MM/DD/YYYY]
Cigna Member ID: [ID number from insurance card]
Group Number: [Group number if applicable]
Patient Address: [Full address]
Patient Phone: [Phone number]

PROVIDER INFORMATION
Requesting Provider Name: [Physician name]
Provider NPI: [10-digit NPI]
Tax ID Number (TIN): [TIN]
Practice Name: [Practice name]
Practice Address: [Address]
Phone: [Phone number]
Fax: [Fax number]
Contact Person: [Name and title for follow-up]

SERVICE INFORMATION
Service Requested: [Detailed description of procedure/service]
CPT/HCPCS Code(s): [Primary code and any additional codes]
ICD-10 Diagnosis Code(s):
  Primary: [Code] - [Description]
  Secondary: [Code] - [Description]
  Additional: [List all relevant diagnoses affecting treatment decision]

Place of Service: [Inpatient/Outpatient/Office/Facility name]
Frequency/Duration: [One-time procedure OR ongoing: X sessions per week for Y weeks]
Anticipated Start Date: [MM/DD/YYYY]
Total Number of Sessions/Units: [If applicable]

Service Provider (if different from requesting provider):
  Name: [Provider or facility name]
  NPI: [NPI number]
  Address: [Facility address]

CLINICAL INFORMATION - MEDICAL NECESSITY JUSTIFICATION

Patient Clinical Presentation:
[Provide detailed clinical history including onset, duration, progression of condition]

**Chief Complaint:**
[Patient's primary presenting symptom or concern]

**History of Present Illness:**
[Detailed timeline of condition development, previous treatments, current status]

**Relevant Medical History:**
- [Pertinent past medical history]
- [Surgical history relevant to current condition]
- [Medications currently prescribed]
- [Allergies]
- [Comorbidities affecting treatment approach]

Objective Clinical Findings:
- **Lab Results**: [Test name], [Value], [Date], [Normal range]
- **Imaging Results**: [Study type], [Key findings], [Date]
- **Physical Examination**: [Measurable findings with objective assessments]
- **Functional Assessment**: [Objective limitations—ROM measurements, strength grades, validated scales]

Conservative Treatment Attempts (if applicable):
[Cigna often requires documented trial of conservative treatment before approving advanced procedures]

**Treatment 1:** [Name]
- Dates: [Start date] to [End date] ([Total duration])
- Dosage/Frequency: [Specific dosing regimen]
- Compliance: [Patient adherence confirmed]
- Outcome: [Specific reason for inadequacy—insufficient symptom relief, adverse effects, contraindication developed]
- Documentation: [Prescription records/visit notes from [date]]

**Treatment 2:** [Name]
- Dates: [Start date] to [End date]
- Dosage/Frequency: [Specific dosing]
- Outcome: [Quantify failure—"Pain decreased from 9/10 to 7/10 only, inadequate for functional restoration"]
- Documentation: [Records from [date]]

**Treatment 3:** [Name] (if applicable)
- [Same detailed structure]

Total Conservative Treatment Duration: [X weeks/months]
Result: Patient continues to experience [specific symptoms with objective measurements] despite appropriate conservative management.

Medical Necessity Rationale:
The requested [service] is medically necessary based on the following clinical justification:

**1. Evidence-Based Clinical Indication**
[Service] is indicated for [diagnosis] according to [medical specialty society] clinical practice guidelines ([year]). The guidelines recommend [service] when [specific criteria], which this patient meets through [clinical findings].

**2. Cigna Medical Policy Compliance**
[If you can reference a specific Cigna medical policy number, include it here. Otherwise state:]
This request aligns with generally accepted standards of medical practice for [condition] and meets criteria for reasonable and medically necessary care.

**3. Expected Clinical Outcome**
[Service] is expected to achieve: [Specific measurable outcome—pain reduction, functional improvement, prevent disease progression, reduce hospitalization risk]. Without this intervention, the patient faces: [Specific clinical risks—progression to Stage X disease, permanent functional loss, increased pain/disability].

**4. No Reasonable Alternative**
[Explain why less intensive alternatives are inappropriate for this patient:]
- [Alternative 1] is not appropriate because: [Medical reason]
- [Alternative 2] was attempted and failed (documented above)
- [Alternative 3] is contraindicated due to: [Clinical reason]

Risk if Service Denied:
Without [requested service], this patient will experience: [Specific clinical consequences—disease progression, functional deterioration, increased symptoms, hospitalization risk, decreased quality of life].

SUPPORTING DOCUMENTATION ATTACHED
☐ Complete clinical notes from [dates]
☐ [Diagnostic test] results from [date]
☐ [Imaging study] report from [date]
☐ Failed conservative treatment documentation (prescription records)
☐ Specialist consultation note from [date]
☐ Clinical practice guideline excerpts
☐ [Additional supporting documents]

URGENCY CLASSIFICATION
☐ Standard Review (5 business days)
☐ Urgent Request - Requires expedited review

[If urgent]: This request requires expedited processing because: [Explain how standard 5-day timeline would harm patient—rapidly progressing condition, severe uncontrolled symptoms, upcoming necessary surgery that cannot be delayed]

PHYSICIAN CERTIFICATION
I certify that the information provided is accurate and complete. The requested service is medically necessary and appropriate for this patient's condition based on my clinical judgment, evidence-based medicine, and generally accepted standards of medical practice.

The service will be provided by a qualified healthcare professional in accordance with applicable clinical guidelines and Cigna's coverage policies.

Physician Signature: _______________________________
Physician Name (Printed): [Name], [Credentials: MD/DO/etc.]
Medical License Number: [State license number]
Date: [MM/DD/YYYY]

SUBMISSION INFORMATION
Submission Method:
☐ CoverMyMeds (www.covermymeds.com)
☐ Phone: 1-800-882-4462
☐ Fax: 1-855-840-1678

Date Submitted: [MM/DD/YYYY]
Confirmation Number (if applicable): [Number from submission]

Cigna Pharmacy Prior Authorization Template

For prescription medications requiring prior authorization, use Cigna's pharmacy PA process:

CIGNA PHARMACY PRIOR AUTHORIZATION REQUEST

PATIENT INFORMATION
Patient Name: [Last, First, Middle Initial]
Date of Birth: [MM/DD/YYYY]
Cigna Member ID: [Pharmacy ID number]
Patient Phone: [Phone number]

PRESCRIBER INFORMATION
Prescriber Name: [Physician name]
Prescriber NPI: [NPI]
Phone: [Phone]
Fax: [Fax]

MEDICATION INFORMATION
Medication Requested: [Drug name]
Strength: [Dosage strength]
Quantity: [Quantity per fill]
Days Supply: [Days supply]
Directions for Use: [Sig]
ICD-10 Diagnosis: [Code] - [Description]

CLINICAL JUSTIFICATION
Diagnosis and Clinical Presentation:
[Detailed description of condition requiring medication]

Previous Medications Tried:
[List medications tried with dates, dosages, outcomes—required for step therapy drugs]

1. [Medication 1]: [Dates], [Outcome/reason for failure]
2. [Medication 2]: [Dates], [Outcome/reason for failure]

Medical Necessity for Requested Medication:
[Explain why this specific medication is necessary vs alternatives]

Prescriber Signature: _______________________
Date: [MM/DD/YYYY]

SUBMIT VIA:
CoverMyMeds: www.covermymeds.com (fastest)
Fax: 1-855-840-1678
Phone: 1-800-882-4462 (for urgent requests)

How to Submit Cigna Prior Authorization Requests

Method 1: CoverMyMeds (Strongly Recommended)

Access: www.covermymeds.com or via SureScripts in your EHR

Advantages:

• 35% faster than fax/phone
• 70% of providers report time savings
• Real-time status tracking
• Free for providers (no charge)
• Available 24/7
• Electronic document upload
• Integrated with 950,000+ providers

How to Submit:

1. Create free account at www.covermymeds.com (takes minutes)
2. Verify your NPI to unlock pharmacy requests from your patients
3. Search for patient by name or Cigna ID
4. Select medication/service requiring PA
5. Complete online PA form
6. Upload supporting clinical documentation
7. Submit—receive confirmation number
8. Track status via dashboard

Best For: All Cigna PA submissions (medical and pharmacy)

Method 2: Phone Submission

Phone: 1-800-882-4462

Advantages:

• Direct contact with Cigna representative
• Can explain complex clinical situations
• Useful when CoverMyMeds unavailable
• Immediate confirmation

How to Submit:

1. Call 1-800-882-4462
2. Have patient information ready (Cigna ID, DOB)
3. Provide service/medication details and CPT codes
4. Explain medical necessity verbally
5. Fax supporting documentation to number provided
6. Receive verbal confirmation and reference number

Best For: Urgent requests requiring immediate processing, complex cases needing discussion

Method 3: Fax Submission

Fax: 1-855-840-1678 (general medical PA)

Advantages:

• No internet access required
• Can submit after business hours
• Paper trail with fax confirmation

Disadvantages:

• Slowest processing method
• No real-time status tracking
• Being phased out in favor of electronic submission

How to Submit:

1. Complete PA request form (template above)
2. Attach all supporting clinical documentation
3. Include cover sheet with page count
4. Fax to 1-855-840-1678
5. Keep fax confirmation receipt
6. Call to confirm receipt if no response in 3 business days

Best For: Backup method when CoverMyMeds unavailable, practices without internet access

Decision Timelines

Standard Requests: 5 business days Urgent Requests: Variable—call 1-800-882-4462 to request expedited review and explain clinical urgency CoverMyMeds Electronic: Typically faster than 5 days, often 2-3 business days

Common Cigna Prior Authorization Denial Reasons

Understanding denial patterns helps you prevent them upfront:

Denial Reason 1: "Does Not Meet Medical Policy Criteria"

What It Means: Your request didn't satisfy Cigna's specific coverage policy criteria for the service.

How to Prevent:

• Review Cigna medical policies at CignaforHCP.com → Coverage Policies
• Search by CPT code or service name
• Address each coverage criterion in your PA request
• Reference the specific medical policy number in your justification

Appeal Strategy: Cite the specific Cigna coverage policy and demonstrate how your patient meets each listed criterion with clinical evidence.

Denial Reason 2: "Conservative Treatment Not Documented"

What It Means: Cigna requires trial and failure of less intensive treatments before approving advanced procedures or medications.

How to Prevent:

• Document specific medications/therapies tried with dates, dosages, duration
• Explain outcome of each treatment (insufficient relief, adverse effects, contraindication)
• Provide prescription records or visit notes showing conservative attempts
• If conservative treatment contraindicated, explain why

Appeal Strategy: Provide detailed failed treatment documentation with prescription records and clinical notes showing appropriate conservative management was attempted.

Denial Reason 3: "Insufficient Clinical Documentation"

What It Means: PA request lacked adequate clinical information for Cigna to assess medical necessity.

How to Prevent:

• Include complete clinical notes from relevant visits
• Provide diagnostic test results and imaging reports
• Document objective clinical findings (not just subjective symptoms)
• Include specialist consultation notes if applicable
• Use measurable outcome data and functional assessments

Appeal Strategy: Resubmit with comprehensive clinical documentation addressing the specific information gaps Cigna identified.

Denial Reason 4: "Service is Experimental/Investigational"

What It Means: Cigna considers the service not yet proven effective or not widely accepted as standard of care.

How to Prevent:

• Verify FDA approval status for the indication
• Reference clinical practice guidelines showing service is standard of care
• Cite peer-reviewed evidence supporting efficacy
• Avoid requesting truly experimental treatments without strong justification

Appeal Strategy: Provide FDA approval documentation, clinical guideline citations, and peer-reviewed literature demonstrating the service is established standard of care (not experimental).

Cigna Medical Policy Citations

Cigna's medical policies are critical for PA approval. Reference these in your requests:

How to Access Cigna Policies:

1. Visit www.cigna.com/health-care-providers
2. Navigate to Coverage and Claims → Policies
3. Search by CPT code, diagnosis, or service name
4. Review coverage criteria and documentation requirements

Common Cigna Policy Categories:

• Medical Coverage Policies (numbered: MM_0XXX)
• Clinical Reimbursement Policies
• Pharmacy Coverage Policies
• Behavioral Health Policies

How to Reference in PA Requests: "This request meets criteria outlined in Cigna Medical Coverage Policy MM_[number] for [service], specifically: [list relevant criteria from policy and how patient meets each]."

How Muni Appeals Automates Cigna Prior Authorizations

Independent practices spend 8-12 hours weekly on Cigna prior authorizations. A single PA request takes 25-40 minutes: reviewing coverage policies, documenting failed treatments, gathering clinical records, and navigating CoverMyMeds or fax submission.

Even with CoverMyMeds' 35% speed improvement over fax, manual PA preparation remains time-intensive. For a $300 service, spending 30 minutes of staff time (worth $30) cuts into margins—and that's before accounting for denials requiring appeals.

Muni Appeals automates the entire Cigna prior authorization process.

How It Works for Cigna Prior Authorizations

1. Service Entry (1 minute) Enter the requested service (CPT code), patient Cigna ID, and diagnosis. Muni automatically:

• Checks if service requires Cigna PA (updated with May 2025 96-code removal)
• Identifies applicable Cigna medical policy
• Determines if CoverMyMeds vs traditional submission is optimal

2. AI Compiles PA Request (3 minutes) Muni's AI assembles everything Cigna requires:

• Patient clinical data from your EMR
• Failed conservative treatment documentation from medication/visit history
• Relevant Cigna medical policy citations (MM_ policy numbers)
• Clinical practice guideline references
• Proper formatting for CoverMyMeds or fax submission

3. Physician Review (1 minute) Review the compiled PA for clinical accuracy. Add case-specific clinical judgment. Edit as needed.

4. Submission (Automated) Muni submits directly via CoverMyMeds (if available) or prepares fax submission package. Tracks the 5-day decision timeline and notifies you of approval/denial.

Why Muni Wins More Cigna Prior Authorizations

Cigna Medical Policy Integration: Muni maintains current Cigna coverage policies (MM_ numbered policies) and automatically references which policy applies to your service—and how your patient meets specific policy criteria.

Failed Treatment Documentation: Muni pulls prescription history and prior visit notes to create detailed failed treatment timelines—the #1 missing element causing Cigna PA denials.

CoverMyMeds Optimization: Muni formats requests specifically for CoverMyMeds electronic submission when available, leveraging the 35% faster processing time while falling back to fax for urgent cases requiring immediate reviewer contact.

96-Code Tracking: Muni updated its Cigna PA requirement database with the May 31, 2025 changes (96 codes removed), preventing unnecessary PA submissions for services no longer requiring authorization.

ROI for Practices with Cigna Patients

Manual Cigna Prior Authorization:

• Time: 25-40 minutes per PA (even with CoverMyMeds)
• Cost: $25-40 in staff time
• Approval rate: ~88% (when done properly)
• Annual time cost: 8-12 hours/week × $60/hour × 52 weeks = $24,960-37,440

With Muni Appeals:

• Time: 5 minutes per PA (80-87% time reduction)
• Cost: $5 in review time
• Approval rate: 92% (Cigna policy integration improves approval rates)
• Annual time savings: $21,000-34,000 in reclaimed staff time

Revenue Recovery from Denials: When PAs are denied despite medical necessity, Muni's automated appeal process recovers 86% of denied claims—adding $12,000-20,000 in annual revenue recovery for typical practices with Cigna patient volume.

Total Annual Benefit: $33,000-54,000 (time savings + revenue recovery)

Start 3 Free Appeals →

Frequently Asked Questions

How do I submit a Cigna prior authorization?

Submit Cigna prior authorizations via: (1) CoverMyMeds (preferred—www.covermymeds.com, 35% faster than fax/phone, free for providers), (2) Phone 1-800-882-4462 (for urgent requests or complex cases), or (3) Fax 1-855-840-1678 (being phased out). Include patient Cigna ID, requested service with CPT/HCPCS codes, ICD-10 diagnosis, clinical justification with medical necessity, failed conservative treatments, and supporting documentation. Standard decision: 5 business days. CoverMyMeds provides real-time status tracking.

What is CoverMyMeds for Cigna prior authorization?

CoverMyMeds is Cigna's preferred electronic prior authorization platform (replacing PromptPA). It's a free service for providers that streamlines PA submissions through web portal or EHR integration via SureScripts. Benefits: 35% faster approvals than fax/phone, 70% user-reported time savings, real-time status tracking, 24/7 access. Over 950,000 providers use CoverMyMeds. Sign up at www.covermymeds.com, verify your NPI, then submit PAs electronically. Cigna strongly encourages CoverMyMeds over fax/phone submissions.

How long does Cigna take to decide prior authorization?

Cigna prior authorization decision timeline: Standard requests: 5 business days. Urgent requests: Variable—call 1-800-882-4462 to request expedited review explaining clinical urgency (rapidly progressing condition, severe symptoms, upcoming necessary surgery). CoverMyMeds electronic submissions: Often 2-3 business days (faster than standard 5 days). Complex cases requiring additional clinical review may take longer. Track status via CoverMyMeds dashboard or call 1-800-882-4462 with your reference number for updates.

What services require Cigna prior authorization?

Check if a service requires Cigna PA: (1) Visit www.cigna.com/health-care-providers → Coverage and Claims → Precertification, (2) Search by CPT code or service description, (3) Download Cigna's PA list for your plan type (commercial, Medicare Advantage, Medicaid). May 31, 2025 update: 96 codes removed from PA requirement list for routine services. PA requirements vary by plan type and state. Common services requiring PA: advanced imaging (MRI, CT, PET), surgeries, durable medical equipment, home health, inpatient admissions, specialty medications.

Where can I find Cigna coverage policies?

Access Cigna coverage policies at: www.cigna.com/health-care-providers → Coverage and Claims → Policies, or CignaforHCP.com → Coverage Policies. Search by CPT code, diagnosis, or service name. Cigna policies include: Medical Coverage Policies (MM_numbered), Clinical Reimbursement Policies, Pharmacy Coverage Policies, Behavioral Health Policies. Each policy lists coverage criteria and documentation requirements. Reference specific policy numbers (e.g., "MM_0415") in your PA requests to demonstrate compliance with Cigna's coverage standards.

How do I appeal a Cigna prior authorization denial?

To appeal a Cigna PA denial: (1) Review denial notice for specific reason, (2) Gather additional clinical documentation addressing denial reason, (3) Write appeal letter citing Cigna coverage policy criteria your patient meets, (4) Include failed treatment documentation if applicable, (5) Submit appeal via CoverMyMeds, fax, or mail within deadline stated on denial (typically 180 days commercial, 65 days Medicare Advantage). For urgent appeals, call 1-800-882-4462. Include: denial notice copy, clinical notes, test results, physician letter explaining medical necessity, relevant guidelines/studies.

What should I include in a Cigna PA request?

Include: (1) Patient information (name, DOB, Cigna member ID, group number), (2) Provider details (requesting provider NPI, TIN, contact info), (3) Service details (CPT/HCPCS codes, ICD-10 diagnoses, place of service, frequency/duration), (4) Medical necessity (clinical presentation, objective findings, Cigna policy compliance), (5) Failed conservative treatments (dates, dosages, outcomes), (6) Supporting documentation (clinical notes, test results, imaging reports), (7) Physician certification (signature with credentials). Use templates above for proper formatting.

Can Muni Appeals automate Cigna prior authorizations?

Yes. Muni Appeals specializes in Cigna prior authorization automation. Enter the requested service and patient info, and Muni compiles the PA in 5 minutes including: automatic PA requirement checking (updated with May 2025 96-code removal), Cigna medical policy integration (MM_ policy citations), failed treatment timeline from EMR, CoverMyMeds optimization (electronic submission when available), clinical guideline references, and direct submission tracking. Approval rate: 92% vs ~88% baseline. Time savings: 20-35 minutes per PA. Annual benefit: $33,000-54,000 (time savings + denial recovery).

Does Cigna require prior authorization for routine services?

Effective May 31, 2025, Cigna removed 96 codes from the prior authorization requirement list, eliminating PA requirements for many routine services. Cigna's goal: reduce paperwork for straightforward procedures while focusing PA reviews on higher-complexity services. Check current PA requirements at www.cigna.com/health-care-providers → Precertification or CignaforHCP.com. Download the updated PA list specific to your plan type (commercial, MA, Medicaid). When in doubt, verify PA requirement before providing service to avoid claim denials.

Ready to Eliminate Cigna Prior Authorization Burden?

Cigna prior authorizations consume 8-12 hours weekly for independent practices—$25,000-37,000 annually in staff time. Even with CoverMyMeds' 35% speed improvement, each PA takes 25-40 minutes when done properly with Cigna medical policy compliance, failed treatment documentation, and comprehensive clinical justification.

Muni Appeals eliminates this burden while improving approval rates.

With Muni Appeals for Cigna, you get:

• ⚡ 5-minute PA generation (vs 25-40 minutes manual)
• 📋 Cigna medical policy integration (MM_ policy citations)
• 🎯 CoverMyMeds optimization (electronic when available)
• ✅ 96-code removal tracking (May 2025 update)
• 📈 92% approval rate (vs ~88% baseline)
• 💰 $33,000-54,000 annual benefit (time savings + revenue recovery)
• 🔄 Automatic appeal generation for denials (86% overturn rate)
• ⏱️ Failed treatment documentation from EMR

Independent practices using Muni Appeals save $21,000-34,000 annually in staff time while recovering an additional $12,000-20,000 in denied Cigna claims—freeing up 400+ hours per year for patient care instead of PA paperwork.

Start 3 Free Appeals and see how much Cigna administrative burden you can eliminate.

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This guide reflects 2025 Cigna prior authorization procedures including the May 31, 2025 96-code removal and CoverMyMeds integration. Cigna policies may vary by plan type (Commercial, Medicare Advantage, Medicaid) and by state. Muni Appeals maintains current Cigna PA requirements and medical policies for all plan types.