Transvaginal Ultrasound, Non-Obstetrical - (0398) — MM 0398 | CIGNA Coverage Update

TL;DR: Cigna Healthcare modified MM 0398 for non-obstetrical transvaginal ultrasound, effective February 22, 2026. If your practice bills CPT 76830, your ICD-10 pairings and medical necessity documentation need a hard look before claims go out the door.

Cigna Healthcare updated its transvaginal ultrasound coverage policy under policy code MM 0398, with an effective date of February 22, 2026. This policy governs CPT 76830 — the transvaginal ultrasound code your gynecology, women's health, and OB/GYN billing teams use for non-obstetrical evaluations. Cigna modified MM 0398 effective February 22, 2026. Review the full policy diff for details on what changed.

Quick-Reference Table

Cigna Transvaginal Ultrasound Coverage Criteria and Medical Necessity Requirements 2026

The Cigna transvaginal ultrasound coverage policy under MM 0398 covers CPT 76830 when the procedure is medically necessary for the evaluation of gynecologic disorders and cancer screening. That phrase — medically necessary — is doing a lot of work here.

For transvaginal ultrasound billing to clear Cigna's bar, the clinical indication must align with the approved ICD-10 list. This list runs 148 codes.

The policy covers TVUS for gynecologic disorder evaluation and cancer screening. Codes like N95.1 (menopausal and female climacteric states), N95.8, and N95.9 are included in the policy code list. So are hematuria codes — R31.1, R31.21, R31.29, and R31.9 — which matters for urogynecology practices that bill TVUS in the workup of urinary symptoms alongside N39.0 (urinary tract infection) and R30.9 (painful micturition).

Medical necessity is the threshold question on every CPT 76830 claim. Cigna will scrutinize whether the documented clinical picture supports the study. The ICD-10 code has to match the documented clinical scenario.

The source policy data does not include prior authorization language. Verify prior authorization requirements directly with Cigna for each plan product — especially for high-volume practices where a blanket assumption can generate a wave of denials.

Cigna Transvaginal Ultrasound Exclusions and Non-Covered Indications

The policy title specifies non-obstetrical use. Based on that title, obstetrical transvaginal ultrasound appears to fall outside MM 0398's scope. If your practice bills TVUS for pregnancy-related evaluations, those claims likely fall under different policy coverage criteria. Confirm with Cigna directly before using MM 0398 as your policy reference for those claims.

The policy includes a broad ICD-10 list — 148 codes in total. Several codes in the set, like D64.9 (anemia, unspecified), M81.0 (age-related osteoporosis without current pathological fracture), and a range of breast disorder codes from N60 through N64, appear alongside the core gynecologic indications. The policy lists these codes without qualification.

The source policy does not assign reduced coverage likelihood to any specific codes in the list. All 148 codes appear as part of the policy code set. Document your clinical rationale for CPT 76830 clearly regardless of which diagnosis code you're billing — that's good billing practice for any Cigna claim.

Coverage Indications at a Glance

Cigna Transvaginal Ultrasound Billing Guidelines and Action Items 2026

Here's what your billing team needs to do before and after the February 22, 2026 effective date.

CPT, HCPCS, and ICD-10 Codes for Transvaginal Ultrasound Under MM 0398

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Key ICD-10-CM Diagnosis Codes

The full policy includes 148 ICD-10-CM codes. The table above reflects the complete set provided in the policy data. Access the full code list and line-by-line policy diff at app.payerpolicy.org.