Cigna modified MM 0276 for manipulation under anesthesia (MUA), effective September 26, 2025. Here's what billing teams need to do.
Cigna Healthcare updated its manipulation under anesthesia coverage policy under policy code MM 0276, affecting 26 CPT codes across spinal, joint, and extremity procedures. The change establishes explicit medical necessity criteria for procedures ranging from CPT 22505 (spinal manipulation requiring anesthesia) to CPT 27570 (knee manipulation under general anesthesia). Two codes—CPT 21073 for TMJ manipulation and CPT 26989 for unlisted hand or finger procedures—are now explicitly designated as not medically necessary when used to report MUA.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Manipulation Under Anesthesia (MUA) |
| Policy Code | MM 0276 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | Medium-High |
| Specialties Affected | Orthopedic surgery, anesthesiology, chiropractic, pain management, physical medicine and rehabilitation |
| Key Action | Audit active MUA claims for criteria compliance and flag CPT 21073 and CPT 26989 before billing |
Cigna Manipulation Under Anesthesia Coverage Criteria and Medical Necessity Requirements 2025
The Cigna Healthcare manipulation under anesthesia coverage policy under MM 0276 in the Cigna system covers MUA when specific medical necessity criteria are met. The policy draws a clear line: most MUA procedures are covered when selection criteria apply, but two codes carry a blanket "not medically necessary" designation regardless of clinical documentation.
This matters because Cigna MUA prior authorization requirements typically accompany procedures this complex. If your team bills MUA regularly, assume prior auth is on the table. Check the current authorization requirements for your specific plan contracts before the September 26, 2025 effective date.
The covered codes span the full musculoskeletal spectrum. Spinal MUA under CPT 22505 is covered when criteria are met. So are shoulder procedures under CPT 23655 and CPT 23700, elbow procedures under CPT 24300 and CPT 24605, and wrist manipulation under CPT 25259. Hip manipulation under CPT 27275 requiring general anesthesia is covered, as is knee manipulation under CPT 27570 and ankle manipulation under CPT 27860.
The phrase "when criteria in the applicable coverage policy are met" appears across all 24 covered codes. That's the crux. Cigna isn't saying these procedures are always covered—it's saying your documentation has to prove the patient met those criteria. If it doesn't, you're looking at a claim denial.
The real issue here is documentation specificity. MUA involves both a procedural physician and an anesthesia provider. Both sides of that claim need to reflect the same medical necessity story. Misaligned documentation between the surgeon's op note and the anesthesia record is one of the fastest ways to trigger a denial on these codes.
On reimbursement: MUA procedures carry meaningful facility and professional fees. A denied CPT 27570 or CPT 22505 isn't a minor write-off. Get the documentation right before you submit.
Cigna Manipulation Under Anesthesia Exclusions and Non-Covered Indications
Two codes under MM 0276 are explicitly designated as not medically necessary when used to report manipulation under anesthesia procedures.
CPT 21073 — Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service — is not covered for MUA under this policy. This is a notable designation. TMJ manipulation is already a contested coverage area across most payers. Cigna's position here is unambiguous: if you're billing CPT 21073 for MUA, expect denial.
CPT 26989 — Unlisted procedure, hands or fingers — is also designated not medically necessary for MUA reporting. Unlisted codes require special justification under any circumstances. Using CPT 26989 to report MUA on hands or fingers won't fly under MM 0276. If you have a legitimate hand or finger MUA case, CPT 26340 (finger joint manipulation under anesthesia) or CPT 26641, CPT 26675, CPT 26705, or CPT 26775 for specific dislocation treatments may be the appropriate route depending on the procedure performed.
If your billing team has been using CPT 26989 as a catch-all for hand MUA cases, audit those claims now. Retroactive denials and recoupment requests are a real risk if this practice has been ongoing.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Spinal manipulation requiring anesthesia | Covered | CPT 22505 | Criteria must be met |
| Shoulder dislocation, closed treatment with manipulation | Covered | CPT 23655 | Criteria must be met |
| Shoulder joint manipulation under anesthesia | Covered | CPT 23700 | Criteria must be met |
| Elbow manipulation under anesthesia | Covered | CPT 24300 | Criteria must be met |
| Closed elbow dislocation treatment requiring anesthesia | Covered | CPT 24605 | Criteria must be met |
| Wrist manipulation under anesthesia | Covered | CPT 25259 | Criteria must be met |
| Lunate dislocation, closed treatment with manipulation | Covered | CPT 25690 | Criteria must be met |
| Finger joint manipulation under anesthesia | Covered | CPT 26340 | Per joint; criteria must be met |
| Carpometacarpal dislocation, thumb, with manipulation | Covered | CPT 26641 | Criteria must be met |
| Carpometacarpal dislocation (non-thumb), with manipulation requiring anesthesia | Covered | CPT 26675 | Per joint; criteria must be met |
| Metacarpophalangeal dislocation with manipulation requiring anesthesia | Covered | CPT 26705 | Criteria must be met |
| Interphalangeal joint dislocation with manipulation requiring anesthesia | Covered | CPT 26775 | Criteria must be met |
| Posterior pelvic ring fracture/dislocation, closed treatment | Covered | CPT 27198 | Criteria must be met |
| Traumatic hip dislocation, closed treatment requiring anesthesia | Covered | CPT 27252 | Criteria must be met |
| Hip joint manipulation requiring general anesthesia | Covered | CPT 27275 | Criteria must be met |
| Knee dislocation, closed treatment requiring anesthesia | Covered | CPT 27552 | Criteria must be met |
| Patellar dislocation, closed treatment requiring anesthesia | Covered | CPT 27562 | Criteria must be met |
| Knee joint manipulation under general anesthesia | Covered | CPT 27570 | Criteria must be met |
| Proximal tibiofibular joint dislocation, closed treatment requiring anesthesia | Covered | CPT 27831 | Criteria must be met |
| Ankle manipulation under general anesthesia | Covered | CPT 27860 | Criteria must be met |
| Tarsal bone dislocation, closed treatment requiring anesthesia | Covered | CPT 28545 | Criteria must be met |
| Metatarsophalangeal joint dislocation, closed treatment requiring anesthesia | Covered | CPT 28635 | Criteria must be met |
| Interphalangeal joint dislocation (foot), closed treatment requiring anesthesia | Covered | CPT 28665 | Criteria must be met |
| Unlisted procedure, foot or toes | Covered | CPT 28899 | Criteria must be met |
| TMJ manipulation requiring anesthesia service | Not Covered | CPT 21073 | Explicitly not medically necessary for MUA |
| Unlisted procedure, hands or fingers (for MUA) | Not Covered | CPT 26989 | Explicitly not medically necessary for MUA |
Cigna Manipulation Under Anesthesia Billing Guidelines and Action Items 2025
These steps apply to any practice billing MUA procedures to Cigna Healthcare plans. The effective date is September 26, 2025—audit your processes before claims start going out under the updated policy.
| # | Action Item |
|---|---|
| 1 | Pull every active Cigna MUA claim billed after September 26, 2025 and verify criteria documentation. Every covered CPT code under MM 0276 carries the same condition: criteria must be met. If your clinical documentation doesn't explicitly address those criteria, the claim is vulnerable. |
| 2 | Remove CPT 21073 and CPT 26989 from your MUA charge capture templates. These two codes are now explicitly not medically necessary for MUA reporting under MM 0276. Using them will generate denials. If your team has been defaulting to CPT 26989 for unusual hand or finger MUA cases, map those to the appropriate specific CPT code—CPT 26340, CPT 26641, CPT 26675, CPT 26705, or CPT 26775—based on the actual procedure. |
| 3 | Confirm prior authorization requirements with each Cigna plan contract before scheduling MUA. MUA requires general anesthesia and carries significant reimbursement value. A missing prior auth is a full-claim denial, not just a documentation issue. Call the plan or check the provider portal before the procedure date. |
| 4 | Align documentation between the procedural physician and the anesthesia provider. Both claims need to tell the same clinical story. The surgeon's operative note, the anesthesia record, and any pre-procedure evaluation should all point to the same medical necessity rationale. Misalignment between these documents is a common audit trigger for MUA claims. |
| 5 | Audit retroactive claims if CPT 21073 or CPT 26989 have been billed for MUA. If these codes have been used before the effective date to report MUA, check whether those claims are at risk under the updated policy language. Talk to your compliance officer before the effective date if you're unsure how this applies to your existing billing patterns. |
| 6 | Update your billing guidelines documentation internally. The MM 0276 Cigna system change affects 26 codes across multiple specialties. Make sure your orthopedic surgery, pain management, and anesthesia billing teams all have updated guidance before September 26, 2025. |
| 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 Manipulation Under Anesthesia Under MM 0276
Covered CPT Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 22505 | CPT | Manipulation of spine requiring anesthesia, any region |
| 23655 | CPT | Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia |
| 23700 | CPT | Manipulation under anesthesia, shoulder joint, including application of fixation apparatus |
| 24300 | CPT | Manipulation, elbow, under anesthesia |
| 24605 | CPT | Treatment of closed elbow dislocation; requiring anesthesia |
| 25259 | CPT | Manipulation, wrist, under anesthesia |
| 25690 | CPT | Closed treatment of lunate dislocation, with manipulation |
| 26340 | CPT | Manipulation, finger joint, under anesthesia, each joint |
| 26641 | CPT | Closed treatment of carpometacarpal dislocation, thumb, with manipulation |
| 26675 | CPT | Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; requiring anesthesia |
| 26705 | CPT | Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia |
| 26775 | CPT | Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesia |
| 27198 | CPT | Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation |
| 27252 | CPT | Closed treatment of hip dislocation, traumatic; requiring anesthesia |
| 27275 | CPT | Manipulation, hip joint, requiring general anesthesia |
| 27552 | CPT | Closed treatment of knee dislocation; requiring anesthesia |
| 27562 | CPT | Closed treatment of patellar dislocation; requiring anesthesia |
| 27570 | CPT | Manipulation of knee joint under general anesthesia (includes application of traction or other fixation apparatus) |
| 27831 | CPT | Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesia |
| 27860 | CPT | Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus) |
| 28545 | CPT | Closed treatment of tarsal bone dislocation, other than talotarsal; requiring anesthesia |
| 28635 | CPT | Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia |
| 28665 | CPT | Closed treatment of interphalangeal joint dislocation; requiring anesthesia |
| 28899 | CPT | Unlisted procedure, foot or toes |
Not Covered CPT Codes — Explicitly Not Medically Necessary for MUA
| Code | Type | Description | Reason |
|---|---|---|---|
| 21073 | CPT | Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service | Considered not medically necessary when used to report manipulation under anesthesia |
| 26989 | CPT | Unlisted procedure, hands or fingers | Considered not medically necessary when used to report manipulation under anesthesia |
No ICD-10-CM codes are specified in the MM 0276 policy data. Diagnosis code selection should follow standard MUA documentation practice and any plan-specific requirements.
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