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Cigna (eviCore) — CT Angiography (CTA)

This page shows prior authorization criteria extracted from Cigna (eviCore)'s published imaging guidelines. 128 matching coverage rules found for this procedure.

Coverage Rules from Cigna (eviCore) Policy

Abdominal Aortic Aneurysm (AAA)

Indication Code: PVD-6.3

Abdominal Veins Other than Hepatic and Portal Veins

Indication Code: AB-43.2

Abnormal Blood Clotting

Indication Code: HD-11.9

Acute deep venous thrombosis (DVT)

Indication Code: PVD-12.2

Aortic and Arterial Dissection and Other Aortic Conditions

Indication Code: PVD-6.7

Aortic Congenital Vascular Malformations

Indication Code: PEDPVD-4.2

Arteriovenous Malformations (AVMs) and Related Lesions

Indication Code: HD-12.2

Autoimmune/Paraneoplastic Encephalitis & Neuroinflammatory Disorders

Indication Code: HD-14.3

Bariatric Post-Operative Complications

Indication Code: AB-9.1

Basilar Impression/Basilar Invagination

Indication Code: HD-5.4

Breast Reconstruction

Indication Code: BR-3.1

Cardiac CT and CTA-General information and Coding

Indication Code: CD-4.1

Cardiac Trauma Imaging

Indication Code: CD-10.1

Cardiac Trauma Imaging

Indication Code: CD-10.1

CCTA – Indications for CCTA

Indication Code: CD-4.3

CCTA – Regardless of Symptoms

Indication Code: CD-4.4

Cerebral Aneurysms

Indication Code: HD-12.1

Cerebral Vasculitis

Indication Code: HD-22.1

Cerebral Venous Sinus Thrombosis

Indication Code: HD-21.8

Cerebrovascular and Carotid Disease - Initial Imaging

Indication Code: PVD-3.1

CHF – Imaging

Indication Code: CD-9.1

Chiari III and IV Malformations

Indication Code: HD-5.3

Chronic DVT with incompletely lysed or residual DVT

Indication Code: PVD-13.1

Claudication and Critical Limb Ischemia

Indication Code: PVD-7.1

CNS and Head Infection

Indication Code: HD-14.1

CNS Vasculitis

Indication Code: PEDHD-12.6

Colonic ischemia (including ischemic colitis)

Indication Code: AB-6.2

Congenital Heart Disease Coding

Indication Code: PEDCD-2.2

Congenital Heart Disease Modality Considerations

Indication Code: PEDCD-2.3

COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C)

Indication Code: PEDHD-12.7

Craniopharyngioma and Other Tumors of the Sellar Region

Indication Code: PEDONC-4.10

CT Heart for Evaluation of Cardiac Structure and Morphology

Indication Code: CD-4.6

CT or MRI Perfusion

Indication Code: HD-24.5

Dizziness/Vertigo

Indication Code: HD-23.1

Dysphagia

Indication Code: PEDNECK-5.1

Dysphagia and Upper Digestive Tract Disorders

Indication Code: NECK-3.1

Eagle Syndrome

Indication Code: NECK-10.3

Epistaxis

Indication Code: HD-25.1

Eye Disorders and Visual Loss

Indication Code: HD-32.1

Facial Palsy

Indication Code: HD-6.1

Fungal Infections (Suspected or Known)

Indication Code: CH-14.2

General Guidelines

Indication Code: PEDCD-1.0

General Guidelines – CT and MR Angiography (CTA/CTV and MRA/MRV)

Indication Code: HD-1.5

General Guidelines – CTA Chest (CPT® 71275)

Indication Code: CH-1.4

GI Bleeding

Indication Code: AB-22.1

Head Trauma

Indication Code: HD-13.1

Headache and Suspected Vascular Dissection

Indication Code: HD-11.1

Headache General Guidelines

Indication Code: HD-11.0

Hemifacial Spasm

Indication Code: HD-6.2

Hemodialysis access imaging

Indication Code: PVD-8.2

Hemophagocytic Lymphohistiocytosis (HLH)

Indication Code: PEDONC-18.3

Hemoptysis

Indication Code: CH-6.1

Hemoptysis – Imaging

Indication Code: PEDCH-4.1

Hepatic Arteries and Veins

Indication Code: AB-43.1

Histiocytic Disorders – General Considerations

Indication Code: PEDONC-18.1

Iliac Artery Aneurysm (IAA)

Indication Code: PVD-6.4

Imaging in Pregnancy with Congenital Heart Disease (CHD)

Indication Code: CD-15.4

Imaging Indications in Sinusitis

Indication Code: PEDHD-5.2

Implantable Contraceptive Devices

Indication Code: PV-10.3

Indications for Cardiac MRI

Indication Code: PEDCD-9.3

IVC filters – Treatment

Indication Code: PVD-16.2

Kawasaki Disease Initial Imaging

Indication Code: PEDCD-6.1

Kidney Transplant, Pre-Transplant Imaging Studies

Indication Code: AB-42.5

Langerhans Cell Histiocytosis (LCH)

Indication Code: PEDONC-18.2

Large Vessel Vasculitis

Indication Code: PVD-6.9

Left Ventricular Assist Devices (LVAD)

Indication Code: CD-9.4

Liver Transplant, Pre-Transplant

Indication Code: AB-42.1

Maternal Imaging in Individuals with Aortopathy

Indication Code: CD-15.3

May-Thurner syndrome

Indication Code: PVD-13.3

Mesenteric Ischemia

Indication Code: AB-6.1

Minimally Invasive or Robotic Cardiac Surgery

Indication Code: CD-13.4

Modality General Considerations

Indication Code: PEDNECK-1.3

Moyamoya Syndrome/Disease

Indication Code: HD-21.5

Neck Trauma

Indication Code: NECK-10.4

Neuro-COVID-19 and Sars-CoV-2 Vaccines

Indication Code: HD-14.2

Neuronavigation

Indication Code: HD-28.2

Non-Cardiac Chest Pain – Imaging

Indication Code: CH-4.1

Non-Langerhans Cell Histiocytoses

Indication Code: PEDONC-18.4

Papilledema/Pseudotumor Cerebri

Indication Code: HD-17.1

Pediatric Head Imaging Modality General Considerations

Indication Code: PEDHD-1.3

Pediatric Headache

Indication Code: PEDHD-3.1

Pediatric Intracranial Aneurysms and Subarachnoid Hemorrhage

Indication Code: PEDHD-10.1

Pediatric Intracranial Arteriovenous Malformations (AVM)

Indication Code: PEDHD-10.2

Pediatric Pulmonary Hypertension General

Indication Code: PEDCD-7.1

Pediatric Stroke Initial Imaging

Indication Code: PEDHD-12.2

Pediatric Stroke Subsequent Imaging

Indication Code: PEDHD-12.3

Pelvic congestion syndrome

Indication Code: PVD-13.4

Physical Exertion

Indication Code: HD-11.11

Pituitary

Indication Code: HD-19.1

Platybasia

Indication Code: HD-5.5

Pleural-Based Nodules and Other Abnormalities

Indication Code: CH-17.1

Post Aortic Endovascular/Open Surgery Surveillance Studies

Indication Code: PVD-6.8

Post-Transplant Imaging Studies

Indication Code: CH-32.2

Pre-operative Assessment for Robotic Kidney Surgery

Indication Code: AB-35.2

Pre-Transplant Imaging Studies

Indication Code: CH-32.1

Pregnancy

Indication Code: HD-11.10

Primary Central Nervous System Tumors – General Considerations

Indication Code: ONC-2.1

Pulmonary AVM

Indication Code: CH-24.1

Pulmonary Embolism

Indication Code: CH-25.1

Pulmonary Sequestration

Indication Code: PEDCH-14.4

Pulmonary Vein Imaging – Indications

Indication Code: CD-8.2

Pupillary Abnormalities Including Horner’s Syndrome

Indication Code: HD-32.2

Revision Anterior Fusion Surgery

Indication Code: SP-15.4

Revision Anterior Spinal Deformity Surgery

Indication Code: SP-14.2

Screening for TAA with bicuspid aortic valves

Indication Code: PVD-2.3

Screening for Vascular related genetic connective tissue Disorders

Indication Code: PVD-2.2

Sickle Cell Disease

Indication Code: HD-21.6

Skull Base Osteomyelitis (SBO)

Indication Code: HD-20.2

Solitary Pulmonary Nodule

Indication Code: CH-16.0

Solitary Pulmonary Nodule – Imaging

Indication Code: CH-16.1

Special Imaging Studies in Evaluation for Epilepsy Surgery

Indication Code: PEDHD-6.3

Stroke/TIA

Indication Code: HD-21.1

Sudden Onset of Headache

Indication Code: HD-11.3

Surveillance Imaging WITH History of Carotid Surgery or Intervention

Indication Code: PVD-3.3

Surveillance Imaging with NO History of Carotid Surgery or Intervention

Indication Code: PVD-3.2

Suspected Retroperitoneal Bleed

Indication Code: PVD-20

Syncope

Indication Code: HD-23.2

Thoracic Aortic Aneurysm (TAA)

Indication Code: PVD-6.2

Tinnitus

Indication Code: PEDHD-16.5

Tinnitus

Indication Code: HD-27.2

Transcatheter Aortic Valve Replacement (TAVR)

Indication Code: CD-4.8

Transcatheter Valve Interventions

Indication Code: CD-13.5

Trigeminal Neuralgia/Trigeminal Neuropathy

Indication Code: HD-10.1

Unilateral lower extremity edema

Indication Code: PVD-12.6

Upper Extremity PVD – Imaging

Indication Code: PVD-4.1

Upper Extremity Venous – Imaging

Indication Code: PVD-4.2

Vascular Ring

Indication Code: PEDCH-13.1

Venous Malformations

Indication Code: PEDPVD-2.3

How to Submit a Prior Authorization Request

Submit via: Cigna Provider Portal (provider.cigna.com) or eviCore at 1-800-252-2021

📄 Required Documentation Checklist

  • Patient demographics and insurance information
  • Ordering provider NPI and contact information
  • Specific clinical indication with ICD-10 diagnosis code(s)
  • Relevant clinical history and physical exam findings
  • Results of prior conservative treatment (if applicable)
  • Prior imaging results relevant to the indication
  • Supporting lab or diagnostic results where applicable

⏱ Turnaround Times

Standard prior authorization requests are typically processed within 3–5 business days. Urgent/expedited requests may be processed within 24–72 hours when clinically necessary.

📣 Appeal Window

Most plans allow 30–60 days to file a first-level appeal. Expedited appeals for urgent cases are typically processed within 72 hours.

⚠ Common Denial Reasons

  • Insufficient clinical documentation to establish medical necessity
  • Clinical criteria not met per payer guidelines
  • Lack of documented prior conservative treatment
  • Missing required prior imaging as step therapy
  • Incorrect or unsupported ICD-10 diagnosis code pairing
  • Request submitted outside of authorization timeframe

⚠ This study uses ionizing radiation. Payers may ask that non-ionizing alternatives (MRI, ultrasound) be considered first when clinically appropriate.

Clinical Approval Criteria

✓ Generally Approved When:

  • Acute vascular emergency: no prior auth required
  • Elective: document clinical indication, prior non-invasive testing results
  • Coronary CTA: document intermediate pre-test probability for CAD, typical symptom profile
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Disclaimer: Coverage criteria shown on this page are sourced from publicly available payer guidelines and are provided for informational and educational purposes only. Prior authorization requirements change frequently. Always verify current criteria directly with the payer or their delegated utilization management company before submitting an authorization request. This page does not constitute medical or legal advice.