Medical coverage policy update: Physical therapy services billed with Current Procedural Terminology codes 97016 and 97026 effective February 12, 2022
For Health Care Professionals
November 2021

Dear Provider,

We routinely review our coverage, reimbursement, and administrative policies for potential updates. In that review, we take into consideration one or more of the following: evidence-based medicine, professional society recommendations, Centers for Medicare & Medicaid Services guidance, industry standards, and our other existing policies.

As a result of a recent review, we will update the way we process claims for physical therapy services billed with Current Procedural Terminology (CPT®) codes 97016 and 97026.

Effective for claims with dates of service on or after February 12, 2022, we will expand our existing policy to include all provider contract types, and continue to deny services billed with these codes as not medically necessary. Medical necessity appeal rights will be available.

Additional information

For more information about our coverage policies, log in to the Cigna for Health Care Professionals website ( > Review coverage policies).

To register, go to > Register. If you would like additional information, please call Cigna Customer Service at 800.88Cigna (882.4462).

Thank you for the care you provide to our customers.


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