Serum Folate and Red Blood Cell Folate Testing - (0567) — MM 0567 | CIGNA Coverage Update

Cigna modified MM 0567 for serum folate and RBC folate testing, effective December 16, 2025. Here's what billing teams need to know before that date.

Cigna Healthcare updated its coverage policy for CPT 82746 (serum folate) and CPT 82747 (RBC folate), two common lab tests used to diagnose folate deficiency and related conditions. The MM 0567 Cigna system policy governs medical necessity criteria across a wide range of hematologic, neurologic, and nutritional diagnoses. If your practice bills folate testing for any of 325 covered ICD-10 diagnoses, this update affects your claim submission workflow.

Quick-Reference Table

Cigna Folate Testing Coverage Criteria and Medical Necessity Requirements 2025

The Cigna Healthcare serum folate and RBC folate testing coverage policy covers CPT 82746 and CPT 82747 when specific medical necessity criteria are met. Cigna considers both tests medically necessary only when paired with an appropriate covered diagnosis code. This is not a blanket coverage approval — the diagnosis on your claim has to match the covered indication list.

CPT 82746 covers serum folate testing. CPT 82747 covers folate testing of red blood cells specifically. These two methods aren't interchangeable from a clinical standpoint, and Cigna's policy treats them as distinct tests with the same coverage framework. If your providers order both on the same date of service, document the clinical rationale for each separately.

The covered diagnosis list runs 325 ICD-10-CM codes deep. That's a broad list — it spans myeloid leukemias (C92.xx), myelodysplastic syndromes (D46.xx), folate deficiency anemias (D52.xx), vitamin B12 deficiency anemias (D51.xx), nutritional anemias (D53.xx), hemolytic anemias (D59.xx), and several hematologic conditions including thrombocytopenia (D69.xx) and neutropenia (D70.xx). It also extends into malnutrition codes like E40 (Kwashiorkor) and E43 (severe protein-calorie malnutrition).

Neurologic and cognitive indications are also covered. The list includes dementia in diseases classified elsewhere (F02.80). This matters for practices managing complex patients with overlapping diagnoses — folate deficiency has a real clinical relationship to cognitive decline, and Cigna's policy reflects that.

The depth of this ICD-10 list is the most operationally significant part of this policy. Claim denial risk is highest when your team uses an unspecified or vague diagnosis code when a more specific one exists. D52.9 (folate deficiency anemia, unspecified) is covered — but if your patient has D52.1 (drug-induced folate deficiency anemia), bill D52.1. Specificity protects your reimbursement.

The policy does not indicate prior authorization requirements for CPT 82746 or 82747 based on the available summary. But if your Cigna contract or plan type includes prior auth for outpatient lab — particularly for high-utilization testing — verify at the plan level before assuming you're clear. If you're unsure, talk to your compliance officer before December 16, 2025.

Coverage Indications at a Glance

Cigna Folate Testing Billing Guidelines and Action Items 2025

CPT, HCPCS, and ICD-10 Codes for Folate Testing Under MM 0567

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Key ICD-10-CM Diagnosis Codes

The full covered list includes 325 ICD-10-CM codes. Below is the complete set from the policy data. Pair CPT 82746 or 82747 with one of these codes to meet Cigna's medical necessity criteria.

The full policy includes 325 ICD-10-CM codes. The table above reflects all codes provided in the policy data. For the complete list, review the full policy at the Cigna source document.

The real issue with a policy this broad is exactly that — its breadth creates a false sense of security. "325 covered codes" sounds like almost anything goes. But Cigna's folate testing billing guidelines are still criteria-driven. The code has to match the clinical picture, and the documentation has to support it. A long covered list doesn't protect a poorly coded claim.

This update is a moderate-risk change for high-volume lab billers and practices in hematology or oncology. The diagnosis code list is detailed enough that a code selection error — even a minor one — can flip a covered claim to a denied one. The difference between D52.0 and D52.9 won't matter clinically, but it might matter to a Cigna edit.