CommercialReimbursementMedium impact
New Reimbursement Policy for Professional Evaluation and Management Services Claims effective October 1, 2025
Cigna·Coding
Effective date
Oct 1, 2025
We identified it
Jun 18, 2026
Summary
Cigna Healthcare implemented a new Evaluation and Management Coding Accuracy (R49) policy effective October 1, 2025, that reviews high-level E/M claims (levels 4 and 5) for billing accuracy. The policy affects only 3% of providers who consistently code at higher levels compared to peers, with claims automatically adjusted down one level if documentation doesn't support the billed service level.
Action Required
Immediately: Review E/M coding patterns for levels 4 and 5 visits to ensure documentation supports billed service levels. Monitor EOPs for claim adjustments indicating downcoding. If claims are adjusted, submit full encounter records via CignaforHCP.com or secure fax 833.392.2092 for reconsideration. Providers with 5+ adjustments can request policy bypass by emailing EMCodingAccuracy@CignaHealthcare.com with supporting documentation showing 80% appropriate billing compliance.