Cigna modified MM 0276 for manipulation under anesthesia (MUA), effective September 26, 2025. Here's what changes for billing teams.
Cigna Healthcare updated its coverage policy for manipulation under anesthesia under policy code MM 0276. This update covers 25 CPT codes across joint manipulation and dislocation procedures — from shoulder MUA (CPT 23700) to knee manipulation (CPT 27570) to ankle manipulation (CPT 27860). Three codes — CPT 21073, 26989, and 28899 — are explicitly designated not medically necessary when used to report MUA. If your practice bills MUA for orthopedic, chiropractic, or physical medicine patients covered by Cigna, this coverage policy change directly affects your charge capture and denial risk.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Manipulation Under Anesthesia — MM 0276 |
| Policy Code | MM 0276 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Orthopedic surgery, chiropractic, physical medicine & rehabilitation, anesthesiology, podiatry, hand surgery |
| Key Action | Audit charge capture for CPT 21073, 26989, and 28899 — Cigna will deny these when used to report MUA |
Cigna Manipulation Under Anesthesia Coverage Criteria and Medical Necessity Requirements 2025
The Cigna manipulation under anesthesia coverage policy under MM 0276 draws a clear line. Twenty-two CPT codes are considered medically necessary — but only when specific criteria are met. Three codes are considered not medically necessary when used to report MUA, full stop.
That distinction matters for medical necessity documentation. If your team bills any of the 22 covered codes, the claim must satisfy Cigna's applicable coverage criteria. Cigna doesn't spell out that the criteria are generic across all codes — the policy language says "when criteria in the applicable Coverage Policy are met." That means your documentation needs to demonstrate medical necessity for each specific joint and procedure type billed.
The covered codes span the full body — shoulder, elbow, wrist, finger, hip, knee, ankle, foot, and pelvic joints. This is a broad policy. Any orthopedic or musculoskeletal practice with Cigna patients doing MUA procedures needs to map every code they bill against this list before September 26, 2025.
Prior authorization requirements are not explicitly detailed in the MM 0276 policy summary. However, anesthesia-involved procedures at this volume of anatomical sites often trigger prior auth workflows at the plan level. Check individual Cigna plan benefit designs for prior authorization requirements before scheduling MUA procedures. Don't assume the absence of a blanket PA requirement means PA isn't needed on a specific plan.
Reimbursement on the covered codes is contingent on meeting medical necessity criteria. If your documentation doesn't support the clinical indication — joint stiffness, failed conservative treatment, post-surgical contracture — expect a claim denial. Cigna's reviewers will look at whether the procedure was warranted and whether the right code was used.
Cigna MUA Exclusions and Non-Covered Indications
Three codes are explicitly called out as not medically necessary under MM 0276 when used to report manipulation under anesthesia:
| # | Excluded Procedure |
|---|---|
| 1 | CPT 21073 — Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring anesthesia |
| 2 | CPT 26989 — Unlisted procedure, hands or fingers |
| 3 | CPT 28899 — Unlisted procedure, foot or toes |
The real issue with CPT 26989 and 28899 isn't just that they're excluded — it's that they're unlisted codes. Some billing teams reach for unlisted codes when a specific procedure doesn't map cleanly to a named CPT. Under this policy, that approach will produce a claim denial for MUA if you're using 26989 or 28899 to describe the work.
For hand and finger MUA, the correct pathway runs through the named codes: CPT 26340 for finger joint manipulation under anesthesia, CPT 26641 for closed treatment of carpometacarpal dislocation with manipulation, CPT 26675 for other CMC dislocation with manipulation, CPT 26705 for metacarpophalangeal dislocation, and CPT 26775 for interphalangeal joint dislocation. Use those codes.
The TMJ exclusion for CPT 21073 is significant for oral and maxillofacial surgery practices. Cigna will not cover therapeutic TMJ manipulation under anesthesia under this code. If you've been billing 21073 for Cigna patients, pull your claims history now and assess your denial exposure.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Shoulder dislocation, closed treatment with manipulation requiring anesthesia | Covered | CPT 23655 | Medical necessity criteria must be met |
| Shoulder joint MUA including fixation apparatus | Covered | CPT 23700 | Medical necessity criteria must be met |
| Elbow manipulation under anesthesia | Covered | CPT 24300 | Medical necessity criteria must be met |
| Elbow dislocation, closed treatment requiring anesthesia | Covered | CPT 24605 | Medical necessity criteria must be met |
| Wrist manipulation under anesthesia | Covered | CPT 25259 | Medical necessity criteria must be met |
| Lunate dislocation, closed treatment with manipulation | Covered | CPT 25690 | Medical necessity criteria must be met |
| Finger joint manipulation under anesthesia, each joint | Covered | CPT 26340 | Medical necessity criteria must be met |
| CMC dislocation, thumb, closed treatment with manipulation | Covered | CPT 26641 | Medical necessity criteria must be met |
| CMC dislocation (non-thumb), closed treatment with manipulation requiring anesthesia | Covered | CPT 26675 | Medical necessity criteria must be met |
| MCP dislocation, closed treatment requiring anesthesia | Covered | CPT 26705 | Medical necessity criteria must be met |
| Interphalangeal joint dislocation, closed treatment requiring anesthesia | Covered | CPT 26775 | Medical necessity criteria must be met |
| Posterior pelvic ring fracture/dislocation, closed treatment | Covered | CPT 27198 | Medical necessity criteria must be met |
| Hip dislocation, closed treatment requiring anesthesia | Covered | CPT 27252 | Medical necessity criteria must be met |
| Hip joint manipulation requiring general anesthesia | Covered | CPT 27275 | Medical necessity criteria must be met |
| Knee dislocation, closed treatment requiring anesthesia | Covered | CPT 27552 | Medical necessity criteria must be met |
| Patellar dislocation, closed treatment requiring anesthesia | Covered | CPT 27562 | Medical necessity criteria must be met |
| Knee joint manipulation under general anesthesia | Covered | CPT 27570 | Medical necessity criteria must be met |
| Proximal tibiofibular joint dislocation, closed treatment requiring anesthesia | Covered | CPT 27831 | Medical necessity criteria must be met |
| Ankle manipulation under general anesthesia | Covered | CPT 27860 | Medical necessity criteria must be met |
| Tarsal bone dislocation (non-talotarsal), closed treatment requiring anesthesia | Covered | CPT 28545 | Medical necessity criteria must be met |
| MTP joint dislocation, closed treatment requiring anesthesia | Covered | CPT 28635 | Medical necessity criteria must be met |
| Interphalangeal joint dislocation (foot), closed treatment requiring anesthesia | Covered | CPT 28665 | Medical necessity criteria must be met |
| TMJ manipulation, therapeutic, requiring anesthesia | Not Covered | CPT 21073 | Not medically necessary when used to report MUA |
| Unlisted procedure, hands or fingers (when used to report MUA) | Not Covered | CPT 26989 | Not medically necessary when used to report MUA |
| Unlisted procedure, foot or toes (when used to report MUA) | Not Covered | CPT 28899 | Not medically necessary when used to report MUA |
Cigna Manipulation Under Anesthesia Billing Guidelines and Action Items 2025
These are concrete steps your billing team should complete before or immediately after the September 26, 2025 effective date.
| # | Action Item |
|---|---|
| 1 | Pull a 90-day lookback on CPT 21073, 26989, and 28899 billed to Cigna for MUA. Identify any paid claims that may now represent overpayment exposure and any pending claims headed for denial. Flag these for your compliance officer. |
| 2 | Update your charge capture to block CPT 26989 and 28899 for MUA indications. Replace them with the correct named codes — CPT 26340, 26641, 26675, 26705, or 26775 depending on the specific joint and procedure type. This is a charge router or CDM edit, not a coder judgment call. |
| 3 | Verify medical necessity documentation for all 22 covered codes. Each claim needs to show that conservative treatment failed, that the specific joint required manipulation, and that anesthesia was clinically justified. Vague documentation will produce a claim denial even on codes Cigna considers covered. |
| 4 | Check Cigna plan-level benefits for prior authorization requirements on MUA. The MM 0276 policy covers the medical necessity framework. Individual plan benefits control prior auth. Build a reference sheet for your schedulers listing which Cigna plan types require prior auth for MUA procedures. |
| 5 | Notify your providers who bill CPT 21073 for TMJ MUA. This is a hard stop under MM 0276. If your oral surgery or ENT practice has been billing 21073 for Cigna patients, those claims are now explicitly not medically necessary under this policy. Talk to your compliance officer before the September 26 effective date to assess your exposure and adjust your billing process. |
| 6 | Train your coders on the MUA code hierarchy for hand, finger, and foot procedures. The exclusion of CPT 26989 and 28899 signals that Cigna expects specificity. Coders reaching for unlisted codes because a procedure "doesn't quite fit" need to exhaust the named code options first. |
| 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 |
|---|---|---|
| 23655 | CPT | Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia |
| 23700 | CPT | Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation) |
| 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 of the ilium, sacroiliac joint, and/or sacrum |
| 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 |
Not Covered CPT Codes Under MM 0276
| 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 MUA |
| 26989 | CPT | Unlisted procedure, hands or fingers | Considered not medically necessary when used to report MUA |
| 28899 | CPT | Unlisted procedure, foot or toes | Considered not medically necessary when used to report MUA |
No ICD-10-CM diagnosis codes are listed in the MM 0276 policy data.
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