{"id":2583,"date":"2025-10-15T16:15:34","date_gmt":"2025-10-15T16:15:34","guid":{"rendered":"https:\/\/consulmed.com\/c\/?p=2583"},"modified":"2025-10-22T20:34:49","modified_gmt":"2025-10-22T20:34:49","slug":"cigna-reimbursement-policy-oct-1-2025","status":"publish","type":"post","link":"https:\/\/consulmed.com\/c\/cigna-reimbursement-policy-oct-1-2025\/","title":{"rendered":"Cigna reimbursement policy Oct 1, 2025"},"content":{"rendered":"
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Cigna Reimbursement Policy \u2013 Effective October 1, 2025<\/h1>\n

Cigna Healthcare has introduced a new reimbursement policy for evaluation and management (E\/M) claims, focusing on coding accuracy and industry standards.<\/p>\n

Key Highlights<\/h2>\n

Effective Date:<\/strong> October 1, 2025
Applies To:<\/strong> CPT\u00ae E\/M codes 99204-99205, 99214-99215, and 99244-99245<\/p>\n

What\u2019s New<\/h2>\n
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    New Policy:<\/strong> \u201cCigna Healthcare Evaluation and Management Coding Accuracy (R49)\u201d aligns with American Medical Association (AMA) coding guidelines.<\/p>\n<\/li>\n

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    Provider Impact:<\/strong><\/p>\n

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      Only providers who consistently bill higher E\/M levels for routine services, compared to their peers, are affected.<\/p>\n<\/li>\n

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      About 99% of in-network providers are not<\/em> impacted, including 97% who bill level 4 and 5 E\/M codes.<\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

      How Claims Are Evaluated<\/h2>\n
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        Applies to level 4 and 5 E\/M claims from affected<\/em> providers when submitted documentation does not justify the level billed.<\/p>\n<\/li>\n

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        If claims are adjusted, Cigna issues prompt payment for lower-level<\/em> codes and notes adjustments on the Explanation of Payment (EOP).<\/p>\n<\/li>\n<\/ul>\n

        Reconsideration & Appeals Process<\/h2>\n
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          Providers may submit the full patient encounter record<\/em> for reconsideration:<\/p>\n

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            Submission via secure fax: 833.392.2092<\/strong><\/p>\n<\/li>\n

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            If the records support the original code, Cigna will reimburse at the original level.<\/p>\n<\/li>\n

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            If denied, providers can pursue an administrative appeal<\/em>.<\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

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            New Reimbursement Policy for Professional Evaluation and Management Services Claims effective October 1, 2025<\/a><\/p><\/blockquote>\n