Plasmapheresis - (0153) — MM 0153 | CIGNA Coverage Update

Cigna modified MM 0153 for plasmapheresis (therapeutic plasma exchange), effective September 26, 2025. Here's what billing teams need to do.

Cigna Healthcare updated its plasmapheresis coverage policy under MM 0153, with CPT 36514 as the primary affected billing code. The policy clarifies that plasmapheresis — also known as therapeutic plasma exchange (TPE) — is the only procedure addressed under MM 0153. Other therapeutic apheresis procedures are explicitly out of scope. If your team bills CPT 36514 for Cigna patients, the medical necessity criteria under this coverage policy now govern your reimbursement.

Quick-Reference Table

Cigna Plasmapheresis Coverage Criteria and Medical Necessity Requirements 2025

The Cigna plasmapheresis coverage policy under MM 0153 covers therapeutic plasma exchange when medical necessity criteria are met. CPT 36514 — billed for therapeutic apheresis for plasmapheresis — is considered medically necessary when the applicable selection criteria are satisfied. That phrase "applicable selection criteria" is doing a lot of work here, and your documentation needs to back it up directly.

Plasmapheresis is defined in this policy as a process where plasma is removed via a cell separator. The red cells, white cells, platelets, and a sterile plasma substitute — typically plasma protein fractions or albumin with sterile saline — are transfused back into the patient. That's the clinical definition that governs what Cigna will and won't pay for under this code.

Prior authorization requirements for plasmapheresis under Cigna vary by plan. Check your specific plan contracts before scheduling procedures. If your practice treats a high volume of Cigna patients needing TPE, build prior auth verification into your intake workflow now — before the September 26, 2025 effective date creates any billing gaps.

The MM 0153 Cigna system designation applies here, and this is a modified policy — not a new one. That means Cigna has existing claims history on this code. If your denial rate on CPT 36514 has been climbing, this update is worth reading closely against your current documentation templates.

Cigna Plasmapheresis Exclusions and Non-Covered Indications

This is where MM 0153 gets precise — and where billing errors are most likely to happen.

The policy is explicit: it only addresses plasmapheresis (therapeutic plasma exchange). All other therapeutic apheresis procedures are out of scope for MM 0153. That list is long, and some of these procedures are commonly confused with TPE in clinical settings.

The following procedures are not addressed under MM 0153:

If your clinical team is performing any of these and billing CPT 36514, stop. That's a claim denial waiting to happen. These procedures have different coverage rules under separate Cigna policies — or may not be covered at all under the patient's plan.

The real issue here is clinical-billing alignment. Physicians and infusion nurses often use "apheresis" and "plasmapheresis" interchangeably. They're not the same under MM 0153. Your charge capture and documentation templates need to reflect that distinction clearly.

Double filtration plasmapheresis is a specific example worth flagging. It sounds like plasmapheresis. It's a plasma-based procedure. But Cigna explicitly calls it out as a separate procedure — not covered under MM 0153. If your facility performs DFPP, talk to your compliance officer before the effective date to confirm you have the right billing pathway.

Coverage Indications at a Glance

Cigna Plasmapheresis Billing Guidelines and Action Items 2025

Here's what your billing team needs to do before and after September 26, 2025.

CPT, HCPCS, and ICD-10 Codes for Plasmapheresis Under MM 0153

Covered CPT Codes (When Selection Criteria Are Met)

This is the only code listed under MM 0153. The coverage group designation for CPT 36514 specifies: "Considered Medically Necessary when criteria in the applicable [selection criteria are met]." That conditional language is the entire gate. No documentation of medical necessity, no reimbursement.

No HCPCS codes are listed in the MM 0153 policy data. No ICD-10-CM codes are specified in the policy document. Your diagnosis coding for plasmapheresis claims should reflect the underlying condition driving the medical necessity for TPE — but Cigna does not enumerate covered diagnoses within MM 0153 itself. Work with your medical director to confirm diagnosis coding aligns with the conditions Cigna recognizes as warranting TPE.