procedure code 97530 — prior authorization under Cigna Healthcare
Billing code 97530 · Category: therapy
In our reference, this procedure typically requires prior authorization.
Typical turnaround is 5 day(s); Cigna Healthcare's
standard turnaround is 14 calendar days (48 hours if urgent).
How to submit
Availity portal, Cigna for HCP portal, 800-768-4695
Documentation typically required
OT/PT evaluation
Functional goals
Progress documentation
Common reasons this gets denied
Plateau in progress
Maintenance therapy
Cigna Healthcare-specific notes
eviCore for imaging and cardiology PA
Faster urgent turnaround (48h)
No PA for first 6 outpatient behavioral health visits on most plans
Coverage limits: this page does not confirm authorization for any specific member's plan, and does not cover state-specific plan variants, out-of-network requests, or every payer x procedure pair in existence. For a definitive answer, contact Cigna Healthcare directly using the submission method above.
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