CommercialAdministrativeHigh impact
Clinical, reimbursement, and administrative policy updates
Cigna·Claims & Billing
Effective date
Aug 17, 2024
We identified it
Jun 19, 2026
Summary
Cigna Healthcare has implemented multiple administrative claim denial policies affecting billing procedures, code editing, and diagnosis requirements. Key changes include denying certain revenue codes on professional claims, adding bundling restrictions for specific CPT codes, and requiring more specific diagnosis coding to prevent automatic denials.
Action Required
Immediately: Update billing software to prevent administrative denials by implementing the following rules: 1) Deny revenue codes 960-989 on UB-04 forms for professional services - use CMS-1500 instead, 2) Flag CPT codes 76376 and 76377 as incidental when billed by facilities, 3) Add bundling edits for CPT codes 38204, 92921, 92925, 92929, 92934, 92938, 92944, 97602 and HCPCS A4262, A4263, 4) Require specific laterality diagnosis codes - reject claims with only unspecified laterality codes, 5) Block listed Z-codes as sole diagnosis codes, 6) Prevent modifier 50 billing with unilateral procedures, 7) Add frequency limits for behavioral health and lab codes per CMS guidelines. Train billing staff on new denial patterns and update claim scrubbing rules to catch errors before submission.