Plantar Fasciitis Treatments - (0097) — MM 0097 | CIGNA Coverage Update

Cigna modified MM 0097 for plantar fasciitis treatments, effective March 5, 2026. Every code on this policy lands in either "Experimental/Investigational" or "Not Medically Necessary" — there are no covered indications in this update.

If your billing team submits plantar fasciitis claims to Cigna Healthcare for CPT 0232T, 28890, or the amniotic tissue HCPCS codes, you're looking at systematic claim denial under this coverage policy. The Cigna plantar fasciitis coverage policy MM 0097 in the Cigna system consolidates all minimally invasive plantar fasciitis treatments — from platelet-rich plasma injections to extracorporeal shock wave therapy — under a blanket non-coverage stance. Here's what changes for billing teams.

Quick-Reference Table

Cigna Plantar Fasciitis Coverage Criteria and Medical Necessity Requirements 2026

The real issue here is what this coverage policy doesn't cover. Every treatment addressed by MM 0097 is classified as either Experimental/Investigational/Unproven or Not Medically Necessary. There are no affirmatively covered indications in this policy.

That's not a gray area. It means Cigna has made a blanket determination that the clinical evidence doesn't support reimbursement for any of the minimally invasive treatments in this policy's scope — regardless of diagnosis severity, prior treatment history, or physician recommendation.

For billing teams, this has a direct implication: prior authorization won't save you here. When a payer classifies a service as Experimental/Investigational, prior auth approval is not a guarantee of payment. In fact, many Cigna plans explicitly exclude experimental services regardless of prior authorization status. If you're not sure how your specific plan agreements handle this, talk to your compliance officer before submitting claims for any of these codes.

The distinction between the two non-coverage categories matters for your denial management workflow. "Experimental/Investigational/Unproven" applies to CPT 0232T (platelet-rich plasma injections), CPT 28890 (high-energy extracorporeal shock wave therapy), and all six HCPCS amniotic/skin substitute codes. "Not Medically Necessary" applies to CPT 38230, 38232, 38240, 38241 — the bone marrow harvesting and hematopoietic progenitor cell transplantation codes — and the now-deleted CPT 77401.

Those are different denial reasons, and they require different appeal strategies.

Cigna Plantar Fasciitis Exclusions and Non-Covered Indications

The experimental/investigational classification is the higher-stakes category for most podiatry and orthopedic billing teams. CPT 0232T covers platelet-rich plasma (PRP) injections at any site, including image guidance, harvesting, and preparation. This code lands squarely in Cigna's "unproven" bucket for plantar fasciitis.

CPT 28890 covers high-energy extracorporeal shock wave therapy (ESWT) performed by a physician or qualified health care professional on the plantar fascia. This is a well-established treatment in podiatry — which makes this classification frustrating. But Cigna's position is clear, and billing it expecting reimbursement is a claim denial waiting to happen.

The six HCPCS codes covering amniotic and skin substitute products are all experimental under this policy. These include Q4100 (skin substitute, not otherwise specified), Q4139 (AmnioMatrix or BioDMatrix injectable), Q4155 (Neox Flo or Clarix Flo), Q4174 (PalinGen or ProMatrX), Q4192 (Restorigin), and Q4215 (Axolotl Ambient or Axolotl Cryo). If your practice uses any of these products for plantar fasciitis injections, none of them have a path to reimbursement under Cigna.

The bone marrow and HPC transplant codes — CPT 38230, 38232, 38240, and 38241 — are classified as Not Medically Necessary for plantar fasciitis specifically. These aren't standard plantar fasciitis billing codes, but if your practice has been testing any regenerative or stem cell protocols for plantar fasciitis and coding them here, stop. Cigna won't pay, and these claims will generate denials that consume your appeals team's time.

Finally, CPT 77401 — radiation treatment delivery, superficial and/or ortho voltage — was deleted December 31, 2025. It's listed in this policy as Not Medically Necessary, but the code no longer exists as a billable CPT. If this code is still sitting in your charge capture or superbill templates, remove it immediately.

Coverage Indications at a Glance

Cigna Plantar Fasciitis Billing Guidelines and Action Items 2026

This policy update doesn't give you wiggle room. The action items below are about protecting your revenue and avoiding appeals that won't win.

CPT, HCPCS, and ICD-10 Codes for Plantar Fasciitis Treatments Under MM 0097

Experimental / Investigational / Unproven Codes

Not Medically Necessary Codes

Note on ICD-10 codes: MM 0097 does not specify ICD-10-CM diagnosis codes in the policy data. Your team should apply the appropriate plantar fasciitis diagnosis codes (M72.2 is the standard code for plantar fascial fibromatosis) per your standard billing guidelines, but coverage status is driven by the procedure codes above — not the diagnosis code.