Cigna modified MM 0315 for computerized gait analysis, effective September 26, 2025. Here's what changes for billing teams.
Cigna Healthcare updated its coverage policy for gait analysis under policy code MM 0315. This policy governs CPT codes 96000, 96001, 96002, 96003, and 96004 — the full suite of comprehensive computer-based motion analysis and dynamic electromyography codes. The update affects practices billing gait analysis for patients with cerebral palsy diagnoses, and your team needs to review documentation and charge capture before the September 26, 2025 effective date.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Gait Analysis – Coverage Position Criteria |
| Policy Code | MM 0315 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | Medium |
| Specialties Affected | Orthopedics, Physical Medicine & Rehabilitation, Pediatric Neurology, Pediatric Orthopedics |
| Key Action | Audit active gait analysis claims for ICD-10 alignment with G80.x cerebral palsy codes before September 26, 2025 |
Cigna Gait Analysis Coverage Criteria and Medical Necessity Requirements 2025
The Cigna gait analysis coverage policy under MM 0315 designates computerized gait analysis — also called motion analysis — as medically necessary when specific clinical criteria are met. All five CPT codes in this policy (96000, 96001, 96002, 96003, and 96004) carry the same coverage position: considered medically necessary when applicable criteria are satisfied.
The ICD-10 codes attached to this policy tell you exactly who qualifies. Cigna limits covered gait analysis to patients with cerebral palsy diagnoses. The covered diagnosis codes are G80.0 (spastic quadriplegic cerebral palsy), G80.1 (spastic diplegic cerebral palsy), G80.2 (spastic hemiplegic cerebral palsy), G80.4 (ataxic cerebral palsy), G80.8 (other cerebral palsy), and G80.9 (cerebral palsy, unspecified).
That's a narrow diagnostic window. If your practice bills gait analysis for other neurological or orthopedic conditions — stroke, traumatic brain injury, Parkinson's disease, idiopathic gait disorders — this Cigna coverage policy does not cover those indications. Document cerebral palsy as the driving diagnosis, or expect a claim denial.
Prior authorization requirements for gait analysis under MM 0315 are not explicitly detailed in the published policy summary. That doesn't mean prior auth isn't required for your specific Cigna plan contracts. Check individual plan benefits before scheduling, especially for comprehensive studies combining 96000 or 96001 with dynamic EMG codes 96002 or 96003.
Reimbursement for these services depends entirely on diagnosis alignment. A clean 96004 (physician review and interpretation) claim without a supported G80.x diagnosis code will not pass Cigna's medical necessity review.
Cigna Gait Analysis Exclusions and Non-Covered Indications
The structure of MM 0315 is worth understanding clearly. The policy lists only cerebral palsy ICD-10 codes (G80.0 through G80.9) as the supported diagnoses. No other diagnoses appear in the policy data.
This is a de facto exclusion list by omission. Gait analysis billing for patients without a G80.x diagnosis code is not supported under this coverage policy. That includes common gait analysis referrals for conditions like:
| # | Excluded Procedure |
|---|---|
| 1 | Post-stroke hemiplegia |
| 2 | Parkinson's disease |
| 3 | Muscular dystrophy |
| 4 | Developmental coordination disorder |
| 5 | Idiopathic toe-walking |
If your physiatrists or orthopedic surgeons order gait analysis for these patients and bill to Cigna, you're billing outside the covered indications in MM 0315. Those claims face denial. If you believe gait analysis is medically necessary for a patient outside the G80.x codes, talk to your compliance officer before billing — and document the clinical rationale thoroughly.
The real issue here is scope creep. Gait analysis labs often serve a broad patient mix. This policy draws a hard line around cerebral palsy. Know where that line is.
Coverage Indications at a Glance
| Indication | Status | Relevant CPT Codes | Relevant ICD-10 Codes | Notes |
|---|---|---|---|---|
| Spastic quadriplegic cerebral palsy | Covered (when criteria met) | 96000, 96001, 96002, 96003, 96004 | G80.0 | Document CP diagnosis as primary driver |
| Spastic diplegic cerebral palsy | Covered (when criteria met) | 96000, 96001, 96002, 96003, 96004 | G80.1 | Common pediatric orthopedic referral |
| Spastic hemiplegic cerebral palsy | Covered (when criteria met) | 96000, 96001, 96002, 96003, 96004 | G80.2 | Confirm laterality in documentation |
| Ataxic cerebral palsy | Covered (when criteria met) | 96000, 96001, 96002, 96003, 96004 | G80.4 | Less common; document clinical need |
| Other cerebral palsy | Covered (when criteria met) | 96000, 96001, 96002, 96003, 96004 | G80.8 | Use when specific type not classified |
| Cerebral palsy, unspecified | Covered (when criteria met) | 96000, 96001, 96002, 96003, 96004 | G80.9 | Use when type is not yet determined |
| Non-CP gait disorders | Not Covered under MM 0315 | 96000, 96001, 96002, 96003, 96004 | N/A | No supported ICD-10 codes outside G80.x |
Cigna Gait Analysis Billing Guidelines and Action Items 2025
Here's what your billing team needs to do before and after September 26, 2025.
| # | Action Item |
|---|---|
| 1 | Audit your active gait analysis referrals for Cigna patients now. Pull every open order for CPT 96000, 96001, 96002, 96003, and 96004 with a Cigna payer. Confirm each patient has a documented G80.x diagnosis. If the referral is for a non-CP diagnosis, flag it for clinical review before the service is rendered. |
| 2 | Update your charge capture to require a G80.x ICD-10 code for all Cigna gait analysis claims. Hard-code a diagnosis validation rule if your practice management system supports it. This prevents clean-looking claims from slipping through with unsupported diagnoses. |
| 3 | Verify prior authorization requirements with each Cigna plan contract separately. MM 0315 doesn't spell out prior auth requirements explicitly. Individual plan contracts may require it. Call or check the portal before September 26, 2025 — don't assume you're covered without confirming. |
| 4 | Review any pending Cigna gait analysis claims with non-G80.x diagnoses. If you have claims in flight for stroke, Parkinson's, or other gait disorders billed to Cigna, assess denial risk now. Resubmitting with corrected documentation is easier before a denial than after. |
| 5 | Educate your ordering physicians on the diagnosis specificity Cigna requires. Pediatric orthopedic surgeons and physiatrists often order gait analysis across a wide patient mix. They need to know that Cigna's MM 0315 coverage policy ties reimbursement to G80.x codes only. A verbal order with "gait abnormality" as the working diagnosis won't hold up. |
| 6 | Document clinical rationale in the procedure note for every study. Even with a G80.x code on the claim, Cigna may request records to confirm medical necessity. Your 96004 interpretation note (physician review and interpretation of the comprehensive motion analysis) should clearly reference the cerebral palsy diagnosis and explain how the gait data informs treatment decisions. |
| 7 | If you bill 96003 (dynamic fine wire electromyography), pay attention to the code descriptor. The policy data notes the code description is truncated — confirm you're billing the current active code and that your encoder is using the most recent descriptor. Fine wire EMG is an invasive procedure and Cigna may scrutinize it more closely than surface EMG (96002). |
If your practice runs a dedicated gait analysis lab and Cigna is a significant payer in your mix, loop in your billing consultant before September 26, 2025 to assess the full financial exposure.
| 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 Gait Analysis Under MM 0315
Covered CPT Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 96000 | CPT | Comprehensive computer-based motion analysis by video-taping and 3D kinematics |
| 96001 | CPT | Comprehensive computer-based motion analysis by video-taping and 3D kinematics; with dynamic plantar pressure measurements during walking |
| 96002 | CPT | Dynamic surface electromyography, during walking or other functional activities, 1–12 muscles |
| 96003 | CPT | Dynamic fine wire electromyography, during walking or other functional activities, 1 muscle |
| 96004 | CPT | Review and interpretation by physician or other qualified health care professional of comprehensive computer-based motion analysis |
All five codes share the same coverage position under MM 0315: considered medically necessary when applicable criteria are met. None are designated experimental or not covered — provided the G80.x diagnosis requirement is satisfied.
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| G80.0 | Spastic quadriplegic cerebral palsy |
| G80.1 | Spastic diplegic cerebral palsy |
| G80.2 | Spastic hemiplegic cerebral palsy |
| G80.4 | Ataxic cerebral palsy |
| G80.8 | Other cerebral palsy |
| G80.9 | Cerebral palsy, unspecified |
These six ICD-10-CM codes represent the full set of supported diagnoses under MM 0315. Every covered gait analysis claim billed to Cigna needs one of these codes on the claim. There is no G80.3 in the ICD-10-CM classification — that code doesn't exist — so the G80.x range covered here runs 0, 1, 2, 4, 8, and 9. Don't assume G80.3 is an oversight you can use.
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