TL;DR: Cigna Healthcare modified MM 0528 for laser interstitial thermal therapy (LITT) of the brain, with an effective date of September 26, 2025. If your team bills CPT 61736 or CPT 61737, check your criteria documentation now.
Cigna Healthcare updated its coverage policy MM 0528 governing magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for intracranial lesions. The two affected codes — CPT 61736 and CPT 61737 — cover LITT procedures performed with MRI guidance through burr holes. This is a modification, not a new policy, so the real question for your billing team is what changed between versions and whether your current documentation still supports medical necessity.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Laser Interstitial Thermal Therapy (MM 0528) |
| Policy Code | MM 0528 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Neurosurgery, Neurology, Interventional Radiology |
| Key Action | Audit CPT 61736 and 61737 claims against updated medical necessity criteria before billing on or after September 26, 2025 |
Cigna Laser Interstitial Thermal Therapy Coverage Criteria and Medical Necessity Requirements 2025
The Cigna laser interstitial thermal therapy coverage policy under MM 0528 covers brain LITT — specifically magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) — when criteria are met. The two covered codes are CPT 61736 and CPT 61737. Both describe LITT of an intracranial lesion, performed through burr holes, with MRI guidance.
This is a high-dollar neurosurgical procedure. Claim denial rates on LITT procedures are elevated across payers because the documentation burden is substantial and the technology is still relatively new in widespread clinical use. Cigna's coverage position treats CPT 61736 and 61737 as medically necessary when selection criteria are satisfied — but "when criteria are met" is doing a lot of work in that sentence.
Cigna's MM 0528 coverage policy sits in the same category as other technology-specific policies where payers have narrowed coverage over time. The Cigna LITT coverage policy specifically addresses brain applications. If your facility also treats benign prostatic hyperplasia with interstitial laser coagulation, that falls under a completely different policy — CP 0159 for BPH Treatments. Don't let your billing team conflate those two.
Prior authorization is almost certainly required for CPT 61736 and 61737 under Cigna plans, given the procedure cost and the medical necessity threshold. Verify prior auth requirements for each specific Cigna plan before scheduling. Missing a prior authorization on a neurosurgical procedure at this reimbursement level is an expensive mistake.
Cigna LITT Exclusions and Non-Covered Indications
The MM 0528 policy explicitly limits coverage to brain LITT procedures. Prostate applications are excluded from this policy entirely and redirected to CP 0159.
That's a meaningful boundary to document in your charge capture workflow. If a coder sees "laser interstitial thermal therapy" on an operative note without reading the anatomic site, they could misroute the claim. Brain LITT bills under CPT 61736 or 61737 — period. Any other anatomic site lands under a different policy or potentially no Cigna coverage at all under MM 0528.
Cigna also does not cover LITT under MM 0528 when the applicable medical necessity criteria are not met. The policy is structured as a conditional coverage position: medically necessary when criteria are satisfied, not covered when they aren't. That means a claim for CPT 61736 without documentation supporting those criteria is heading toward denial.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Brain LITT (MRgLITT) — intracranial lesion, with MRI guidance | Covered when criteria met | CPT 61736, CPT 61737 | Medical necessity documentation required; prior authorization likely required |
| Prostate interstitial laser coagulation | Not covered under MM 0528 | See CP 0159 | Refer to Cigna BPH Treatments policy |
| LITT at anatomic sites other than brain | Not addressed under MM 0528 | N/A | No coverage position in this policy for non-intracranial applications |
Cigna Laser Interstitial Thermal Therapy Billing Guidelines and Action Items 2025
The effective date of September 26, 2025 has already passed. If you're reading this after that date, you need to act now — not before the deadline, but immediately to catch any claims that went out under old criteria.
| # | Action Item |
|---|---|
| 1 | Pull all CPT 61736 and 61737 claims billed on or after September 26, 2025. Review them against the updated MM 0528 criteria. If your team was using pre-modification criteria to support medical necessity, some of those claims may be at risk. |
| 2 | Update your charge capture and clinical documentation templates. Make sure the operative note and clinical documentation your physicians produce explicitly maps to Cigna's current MM 0528 medical necessity criteria. Generic neurosurgical documentation doesn't cut it on technology-specific policies like this one. |
| 3 | Verify prior authorization requirements for each Cigna plan type before scheduling. Cigna commercial, Cigna Medicare Advantage, and employer self-funded plans can have different prior auth rules. Don't assume one plan's requirements apply to all. A missing prior auth on CPT 61736 or 61737 is a full claim denial — and this procedure doesn't have a cheap fallback code. |
| 4 | Confirm your coding team knows that MM 0528 only covers brain LITT. The distinction between intracranial LITT (CPT 61736, 61737 under MM 0528) and prostatic laser coagulation (CP 0159) must be built into your workflow. Route operative notes by anatomic site before coding. |
| 5 | Document the specific lesion type and clinical rationale in every case. Cigna's coverage position is conditional. "Medically necessary when criteria are met" means your documentation has to name the indication, the failed or contraindicated alternatives, and the clinical basis for choosing MRgLITT. Thin documentation equals denied claims. |
| 6 | If your facility has high LITT volume, talk to your compliance officer now. This is a modified policy, which means Cigna changed something. Without the line-by-line diff, you don't know exactly what shifted. If LITT billing is a material revenue line for your practice or facility, get your compliance officer and billing consultant to review the full policy text before your next case bills out. |
The real issue with modified policies like this one is that "modified" could mean a minor wording change or a meaningful criteria shift. Cigna doesn't broadcast what changed — you have to find it. Until your team knows what specifically changed in MM 0528, treat any claim for CPT 61736 or 61737 as requiring extra documentation scrutiny.
| 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 Laser Interstitial Thermal Therapy Under MM 0528
Covered CPT Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 61736 | CPT | Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance |
| 61737 | CPT | Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance |
Both CPT 61736 and CPT 61737 describe intracranial LITT with MRI guidance. The distinction between the two codes exists in the specifics of the lesion or approach — verify with your neurosurgery team which code applies to each case. Miscoding between 61736 and 61737 is an audit risk.
The MM 0528 Cigna system policy data does not list specific ICD-10-CM diagnosis codes or HCPCS codes within the policy. Diagnosis code selection should reflect the documented intracranial lesion and must support medical necessity under MM 0528 criteria. Work with your physicians to make sure the diagnosis code on the claim matches the lesion type documented in the operative and clinical notes.
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