Cigna modified MM 0141 for corneal remodeling procedures used to correct refractive errors, effective November 15, 2025. Here's what changes for billing teams.
Cigna Healthcare updated its corneal remodeling coverage policy under MM 0141 in the Cigna system. This policy governs how CPT codes 65760, 65772, and 66999 are covered—or not covered—when used for refractive error correction. If your practice bills for intrastromal corneal ring segments, corneal relaxing incisions, or other refractive error correction procedures, this update affects your charge capture and claim denial risk starting November 15, 2025.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Corneal Remodeling for Refractive Errors |
| Policy Code | MM 0141 |
| Change Type | Modified |
| Effective Date | November 15, 2025 |
| Impact Level | Medium |
| Specialties Affected | Ophthalmology, Optometry |
| Key Action | Audit active claims for CPT 65760 and 66999 before November 15, 2025 — both carry experimental/not medically necessary designations under this policy |
Cigna Corneal Remodeling Coverage Criteria and Medical Necessity Requirements 2025
MM 0141 in the Cigna system is a coverage policy that draws a clear line. It covers procedures used to correct refractive errors—myopia, hyperopia, presbyopia, and astigmatism. It does not cover corneal procedures performed to treat eye disease, including corneal transplantation.
That distinction matters. If your ophthalmology practice bills the same CPT codes for both disease treatment and refractive correction, you need separate documentation protocols for each. Claims for disease-related corneal work belong under a different policy framework entirely.
Medical necessity under this coverage policy is narrow. Only CPT 65772—corneal relaxing incision for correction of surgically induced astigmatism—meets the Cigna medical necessity threshold, and only when applicable selection criteria are documented. Everything else in this policy either carries an experimental designation or gets flagged as not medically necessary for refractive indications.
Prior authorization requirements are not explicitly detailed in the modified policy summary. That doesn't mean prior auth is off the table. Given that CPT 65760 is classified experimental/investigational and CPT 66999 is considered not medically necessary, attempting to bill these without checking Cigna's prior authorization workflows first is a fast path to denial. Confirm current prior auth requirements directly with Cigna before billing.
Reimbursement for corneal remodeling procedures under this policy is largely blocked for anything beyond 65772. If your revenue cycle team has been expecting reimbursement on 65760 or 66999 claims submitted to Cigna for refractive indications, those expectations need to be adjusted now—before the effective date.
Cigna Corneal Remodeling Exclusions and Non-Covered Indications
This is where MM 0141 gets direct, and billing teams need to pay attention.
CPT 65760—Keratomileusis Implantation of intrastromal corneal ring segments—is designated experimental, investigational, and unproven when used to correct refractive errors. Cigna does not consider this procedure proven for refractive indications. Submitting 65760 for myopia or astigmatism correction is a claim denial waiting to happen.
CPT 66999—unlisted procedure, anterior segment of eye—is considered not medically necessary when used to report corneal refractive correction procedures. This one is particularly tricky. Practices sometimes default to 66999 when a procedure doesn't map cleanly to a named CPT code. Cigna's updated policy signals that this workaround will not survive review for refractive indications.
There's also a reference to a 2023 publication in the code data—formatted oddly in the source document. The raw source data includes an entry formatted as "2023a Dec;39(12):856-862" in the code field. Its role in the policy is not determinable from the available summary. Review the full MM 0141 document for context.
The experimental designation on 65760 is not new territory in ophthalmology billing. This is the same pattern you see across payers on emerging refractive technologies—procedures with early clinical data get flagged investigational until long-term outcomes evidence accumulates. Don't expect Cigna to budge on 65760 anytime soon without significant literature support.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Correction of surgically induced astigmatism via corneal relaxing incision | Covered (Medical Necessity Criteria Required) | CPT 65772 | Selection criteria must be documented; confirm prior auth requirements with Cigna |
| Keratomileusis Implantation of intrastromal corneal ring segments for refractive errors | Experimental / Investigational / Unproven | CPT 65760 | Not covered for myopia, hyperopia, presbyopia, or astigmatism correction |
| Unlisted anterior segment procedure used to report corneal refractive correction | Not Medically Necessary | CPT 66999 | Cigna will not pay this code when used as a workaround for refractive procedures |
| Corneal procedures for eye disease (e.g., corneal transplantation) | Not addressed by this policy | N/A | MM 0141 explicitly excludes disease-related corneal procedures from its scope |
Cigna Corneal Remodeling Billing Guidelines and Action Items 2025
These are the specific steps your billing team and practice manager need to take before November 15, 2025.
| # | Action Item |
|---|---|
| 1 | Pull all open and pending Cigna claims for CPT 65760 and 66999 now. Any claim using these codes for refractive indications is at high denial risk under the updated MM 0141 coverage policy. Don't wait until post-effective-date remits to find out what was denied. |
| 2 | Confirm your CPT 65772 documentation meets Cigna's selection criteria. This is the only code in this policy with a covered designation. If your providers aren't documenting the criteria that justify 65772 for surgically induced astigmatism, fix that before the effective date of November 15, 2025. |
| 3 | Stop using CPT 66999 to report corneal refractive procedures for Cigna patients. The not medically necessary designation makes this billing approach indefensible on appeal. If a procedure genuinely doesn't have a matching CPT code, your coding team needs to escalate to a certified ophthalmology coder—not default to the unlisted code. |
| 4 | Check Cigna's prior authorization requirements for CPT 65772. The policy does not specify prior authorization requirements. Confirm current prior auth requirements directly with Cigna before billing CPT 65772. |
| 5 | Update your charge capture system to flag CPT 65760 and 66999 for Cigna patients. Add an alert that routes these codes to a billing review step before claim submission. That one workflow change will save your team from writing appeals on denials that were predictable. |
| 6 | Pull the full MM 0141 document and have your compliance officer review it. The published summary includes a source data entry—"2023a Dec;39(12):856-862"—whose role in the coverage policy is not determinable from the available summary. If there are coverage criteria tied to that reference, you want to know that before billing, not after a denial. Talk to your compliance officer before the effective date. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Corneal Remodeling Under MM 0141
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 65772 | CPT | Corneal relaxing incision for correction of surgically induced astigmatism |
Not Covered / Experimental Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 65760 | CPT | Keratomileusis Implantation of intrastromal corneal ring segments | Considered Experimental / Investigational / Unproven when used to correct refractive errors |
| 66999 | CPT | Unlisted procedure, anterior segment of eye | Considered Not Medically Necessary when used to report corneal refractive correction procedures |
Note on the policy document source data: The raw source data includes an entry formatted as "2023a Dec;39(12):856-862" in the code field. Its role in the policy is not determinable from the available summary. Review the full MM 0141 document for context. It is not a billable CPT code.
Key ICD-10-CM Diagnosis Codes
The MM 0141 policy data does not list specific ICD-10-CM codes. Consult your ophthalmology coder to confirm appropriate diagnosis code mapping for each procedure.
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