Cigna modified MM 0528 for laser interstitial thermal therapy (MRgLITT), effective September 26, 2025. Here's what billing teams need to do.
Cigna Healthcare updated its coverage policy for brain laser interstitial thermal therapy under policy code MM 0528, with an effective date of September 26, 2025. This change covers CPT codes 61736 and 61737—the two intracranial LITT codes billed by neurosurgery programs. If your practice or facility bills either of these codes to Cigna, you need to review the updated medical necessity criteria before your next claim goes out.
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 (editorial assessment) |
| Specialties Affected | Neurosurgery |
| Key Action | Audit CPT 61736 and 61737 claims against updated medical necessity criteria before 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 addresses one specific application: intracranial MRgLITT, also called magnetic resonance-guided laser interstitial thermal therapy. This is brain surgery performed with real-time MRI guidance and laser ablation. Cigna is not addressing prostate LITT here—that lives under CP 0159, which covers benign prostatic hyperplasia treatments.
Both CPT 61736 and CPT 61737 are designated as medically necessary when the criteria in the applicable coverage position are met. The distinction between CPT 61736 and CPT 61737 is defined in the CPT codebook; confirm the correct code against operative documentation. Your charge capture team needs to apply the right code to the right case—mismatches between the procedure documentation and the billed code are a direct path to claim denial.
The real issue with this coverage policy is what Cigna doesn't spell out publicly in the abbreviated summary: the "applicable coverage position" language means medical necessity is gated on criteria that go beyond simply performing the procedure. Prior authorization requirements are not specified in the MM 0528 policy summary. Verify requirements directly with Cigna before scheduling.
For any high-cost neurosurgical procedure billed to Cigna, reimbursement depends on documentation that mirrors the specific language in the coverage criteria. Your operative notes, imaging reports, and clinical rationale need to directly address why MRgLITT was chosen over alternative approaches. Talk to your compliance officer about how your documentation templates align with the updated MM 0528 criteria before the September 26, 2025 effective date.
Cigna Laser Interstitial Thermal Therapy Exclusions and Non-Covered Indications
The policy draws a hard line between intracranial LITT and prostate LITT. If your team receives any Cigna claims for laser interstitial thermal coagulation of the prostate billed under the assumption that MM 0528 applies, stop. Prostate applications fall under CP 0159. Mixing these up at submission wastes time and triggers denials.
Beyond the prostate distinction, Cigna's "medically necessary when criteria are met" framing implies that any case that fails to satisfy the coverage position criteria will be treated as not covered—or potentially experimental. LITT applications outside of the established intracranial indications that Cigna recognizes would fall into that bucket. Document the specific clinical rationale for each case. Don't assume that because the procedure was appropriate clinically, Cigna will cover it without documentation that checks every box in the coverage policy.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Intracranial lesion, LITT with MRI guidance | Covered (when criteria met) | CPT 61736 | Medical necessity criteria must be met; verify prior authorization requirements directly with Cigna |
| Intracranial lesion, LITT with MRI guidance and frameless stereotactic guidance | Covered (when criteria met) | CPT 61737 | Medical necessity criteria must be met; verify prior authorization requirements directly with Cigna |
| Prostate laser interstitial thermal coagulation | Not covered under MM 0528 | N/A | Refer to CP 0159 for BPH treatment coverage |
| Intracranial LITT outside recognized criteria | Not covered / potentially experimental | CPT 61736, 61737 | Fails medical necessity threshold under MM 0528 |
Cigna Laser Interstitial Thermal Therapy Billing Guidelines and Action Items 2025
The following steps apply to any billing team that submits CPT 61736 or 61737 to Cigna Healthcare. Act on these before September 26, 2025.
| # | Action Item |
|---|---|
| 1 | Verify prior authorization requirements for every Cigna LITT case now. Prior authorization requirements are not specified in the MM 0528 policy summary. Call Cigna or check the provider portal directly to confirm whether prior auth is required for CPT 61736 and 61737 under the updated policy. For a procedure with reimbursement at this level, a missing prior auth means a denied claim that may not be recoverable. |
| 2 | Update your charge capture to enforce the 61736 vs. 61737 distinction. These are not interchangeable. The distinction between the two codes is defined in the CPT codebook—confirm the correct code against your operative documentation. Run a quick audit of recent claims to confirm your coders are applying these correctly. |
| 3 | Separate MM 0528 from CP 0159 in your workflow. If your practice bills both neurosurgical LITT and urological LITT, make sure your billing guidelines route prostate cases to CP 0159 and brain cases to MM 0528. A single payer, two different policies, two different sets of criteria. Commingling them generates denials on both sides. |
| 4 | Pull the full MM 0528 policy text and compare it to your operative documentation templates. The policy summary references "criteria in the applicable coverage position"—that language points to specific clinical requirements. Get the full policy from the Cigna provider portal or the PayerPolicy source link. Map your documentation templates to those criteria line by line. Any gaps in your templates are gaps in your medical necessity support. |
| 5 | Review the full MM 0528 policy text to understand what changed. The September 26, 2025 update is classified as a modification, but the published summary does not specify what was altered. Pull the full policy from the Cigna provider portal and review it against your current workflows. If you have access to a prior version, compare them directly to identify any changes to coverage criteria, covered indications, or documentation requirements. |
| 6 | Loop in your compliance officer if you're unsure about the updated criteria. LITT is a high-cost, low-volume procedure. The financial exposure on a single denied case is significant. If your team isn't certain how the updated MM 0528 criteria apply to your specific case mix, get your compliance officer or a billing consultant involved before the effective date. |
| 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 (full description per AMA CPT codebook; MM 0528 policy data is truncated) |
| 61737 | CPT | Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance and frameless stereotactic guidance (full description per AMA CPT codebook; MM 0528 policy data is truncated) |
These are the only two codes addressed by MM 0528 in Cigna's system. No HCPCS or ICD-10 codes are listed in the current policy data for this coverage policy. That doesn't mean diagnosis codes are irrelevant—it means Cigna isn't specifying code-level diagnosis requirements in the published policy. Your clinical documentation still needs to establish the diagnosis and medical necessity clearly. Work with your coders to confirm that the ICD-10 codes you pair with 61736 and 61737 are consistent with the intracranial indications Cigna recognizes.
One practical note on LITT billing: these procedures are typically performed at hospital outpatient departments or inpatient settings. Your facility billing team and your professional billing team both need to be working from the same understanding of the MM 0528 criteria. A mismatch between the facility claim and the professional claim is a red flag for payers reviewing high-cost neurosurgical cases.
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