99401-99404 with Cigna: what the policy says
By Javier Alvarez · Updated · 2 min read
1 row: Cigna. Public policy, not the member's benefits.
Cigna
Commercial · All states
| 97802 | Listed [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Not named (not on A004's preventive list; may pay under the medical benefit) [1] |
| G0271 | Not named (not on A004's preventive list; may pay under the medical benefit) [1] |
| Diagnoses | A wellness code from Code Group 1 (includes Z71.3) for the preventive rows: adults with cardiovascular risk factors, adults and children 6 and older with obesity, and midlife women. An illness or injury diagnosis goes to the medical benefit. 97802 to 97804 and S9470 are also preventive with a maternity diagnosis code for pregnant members. [1] |
| Other codes | 97804 and S9470; 99401 to 99404, 99411 and 99412 allowed with any diagnosis. [1] |
| Telehealth POS | POS 02. Cigna's system accepts POS 10 but asks providers not to bill it "until further notice". [2] |
| Telehealth modifier | 95, GT or GQ. Paid at 100% of face-to-face rates when the requirements are met. [2] |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
- Cigna: Administrative Policy A004, Preventive Care Services (effective 10/1/2026), checked October 30, 2026
- Cigna: Virtual care billing guidance for commercial plans (updated 08/23/2022), checked October 22, 2026
What Cigna's policy says about 99401-99404
99401-99404 is the CPT code for preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15, 30, 45 and 60 minutes. At Cigna it is listed: named in the payer's public policy. Each line below is from Cigna's own text:
- Where it is listed. The wellness examination frequency table lists 99401 to 99404 and 99411, 99412 for ages 0 to 5 and for ages 5 and above. (Cigna, checked October 30, 2026)
- When it pays. On the nutrition and physical activity counseling row, 99401 to 99404 are allowed with any diagnosis, while 97802 to 97804 need a Group 1 wellness code. (Cigna, checked October 30, 2026)
- Units. The code table describes each as preventive counseling to an individual, approximately 15, 30, 45 and 60 minutes. (Cigna, checked October 30, 2026)
- Also. Also listed for breast-feeding support and counseling during pregnancy and after birth, with S9443. (Cigna, checked October 30, 2026)
99401-99404 at other payers
- 99401-99404 with BCBS of IL, TX, OK and NM (HCSC): limited.
- 99401-99404 with Blue Cross NC: listed.
- 99401-99404 with Blue Cross Blue Shield of Massachusetts: limited.
- 99401-99404 with UnitedHealthcare: listed.
- 99401-99404 with Anthem Blue Cross and Blue Shield: listed.
The rest of Cigna's MNT rules
The Cigna row has its codes, telehealth rule, limits and referrals, each with its source. Other codes we checked at Cigna: Z71.3 and G0447. What 99401-99404 means at any payer is on the 99401-99404 code page. Before the claim goes out, compare it with the row in the table above, then download the PDF of what you see.