Cigna physical therapy coverage: codes, telehealth and limits
The short answerCigna covers medically necessary PT under the member's rehabilitation benefit. Policy CPG 135 caps a visit at 4 timed codes (one hour), and policy 0600 limits hospital outpatient PT to a short list of reasons.
By Javier Alvarez · Updated · 1 min read
1 row: Cigna. Public policy, not the member's benefits.
Cigna
Cigna / ASH Medical Coverage Policy CPG 135 and Cigna policy 0600 · All states
| 97110 | Listed (medically necessary when the policy criteria are met) [1] |
|---|---|
| 97112 | Listed (medically necessary when the policy criteria are met) [1] |
| 97140 | Listed (medically necessary when the policy criteria are met) [1] |
| 97161 | Listed (medically necessary when the policy criteria are met) [1] |
| 97530 | Listed (medically necessary when the policy criteria are met) [1] |
| Where it applies | Policy CPG 135 is a Cigna / ASH Medical Coverage Policy effective 12/15/2025. Under many Cigna plans, outpatient PT falls under the plan's Short-Term Rehabilitative Therapy benefit and its limits, and the plan document overrides the policy. Habilitative PT may or may not be covered. [1] |
| Telehealth POS | Site of care: PT in an outpatient hospital (POS 19 off-campus or POS 22 on-campus) is medically necessary only when specialized equipment or personnel, coordinated multidisciplinary expertise, no freestanding PT/OT facility within reasonable distance, or an equity barrier applies. Any other indication is not medically necessary (policy 0600, effective 8/15/2026). [2] |
| Visit limits | Outpatient PT is limited to a maximum of 4 timed codes (about one hour) per date of service per provider; time beyond that is not covered or reimbursable. Visit maximums come from the member's benefit plan, not from the policy. [1] |
| Also | When a patient gets manual therapy from a PT and chiropractic or osteopathic manipulation, the services must be documented as separate and distinct, on different body parts, and justified and non-duplicative. More than two passive modalities on a visit date should be justified in the documentation. [1] |
What Cigna's documents say
The table above has every field we found for Cigna, with numbered sources. In short:
- Visit limits. Outpatient PT is limited to a maximum of 4 timed codes (about one hour) per date of service per provider; time beyond that is not covered or reimbursable. Visit maximums come from the member's benefit plan, not from the policy.
- Telehealth POS. Site of care: PT in an outpatient hospital (POS 19 off-campus or POS 22 on-campus) is medically necessary only when specialized equipment or personnel, coordinated multidisciplinary expertise, no freestanding PT/OT facility within reasonable distance, or an equity barrier applies. Any other indication is not medically necessary (policy 0600, effective 8/15/2026).
- Where it applies. Policy CPG 135 is a Cigna / ASH Medical Coverage Policy effective 12/15/2025. Under many Cigna plans, outpatient PT falls under the plan's Short-Term Rehabilitative Therapy benefit and its limits, and the plan document overrides the policy. Habilitative PT may or may not be covered.
- Codes. 97110, 97112, 97140, 97161 and 97530 are listed.
Physical therapy coverage at other national payers
Medicare, UnitedHealthcare Medicare Advantage, UnitedHealthcare Commercial, Aetna, Humana and TRICARE.
Check Cigna's claim against the row
Before the claim goes out, compare it with the row above: the evaluation code matches the complexity you documented, the timed codes fit the minutes, any prior authorization covers the visit, and the plan of care is signed when the payer asks for it. The physical therapy table compares Cigna with every other payer we checked.