We track 50 documented policy changes from Cigna across AL, AR, AZ, CA, CO and 5 more states. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Cigna notice. Use the related links below to narrow results by specialty or state, or create a free alert to get new Cigna updates by email (daily or weekly, your choice, on every plan).
Cigna Healthcare is joining other health plans to standardize electronic prior authorization submission requirements and reduce the number of services requiring prior authorization. By end of 2026, standardized electronic prior auth will apply to medical services representing more than 70% of Cigna's prior authorization volume, with additional reductions and improvements rolling out through 2027.
This is historical material (published August 24, 2026; updated October 15, 2026; discovered October 16, 2026) outlining Cigna Healthcare's conditional approach to maternity coding changes pending a final CMS rule. Cigna will adopt either 15 new HCPCS G-codes (if CMS approves them) or the AMA maternity coding framework on January 1, 2027. Current 2026 billing guidance remains unchanged; providers should continue existing maternity billing practices through December 31, 2026.
Cigna Healthcare is discontinuing all medical Individual & Family Plans (IFPs) effective January 1, 2027. Affected patients currently enrolled in these plans will lose coverage on December 31, 2026 and must select new coverage for 2027. Claims submitted within the required filing timeframe for services incurred during active coverage will still be processed.
Cigna Healthcare is discontinuing all medical Individual & Family Plans (IFPs) effective January 1, 2027. Affected patients will lose coverage on December 31, 2026, and must select new insurance for 2027. Cigna commercial group plans and dental IFPs are unaffected. Claims submitted within required timelines for services incurred during active coverage will still be processed.
Starting with dates of service on or after January 1, 2027, claim payments, remittance advices (835s), and 1099s for Priority Health plan members will come from Optum Financial in partnership with ECHO Health, Inc. instead of Priority Health's current system; claims with dates of service on or before December 31, 2026 continue to be paid by the current system, so payments may come from both systems during the transition. The practice's billing team should update its payment posting, EFT/remittance setup, and reconciliation processes for these claims.
Effective January 1, 2027, Cigna Healthcare will cover at-home, self-collected cervical cancer screening tests at no cost to customers, with follow-up testing for positive results also covered. This policy aims to remove screening barriers and improve compliance with cervical cancer prevention guidelines.
Cigna Healthcare is implementing a new 2027 Care Designation (CCD) and Tier 1 provider evaluation program that separates primary care providers (PCPs) from specialty care providers (SCPs) for assessment. Tier 1 designation will display in Cigna directories starting October 2026 (preview) and become effective January 1, 2027, potentially affecting patient copayments and coinsurance based on provider tier status. Practices must submit reconsideration requests by August 17, 2026 if they want changes reflected in the October preview.
Cigna is updating medical record review indicators effective 2027 to require documentation of early mental health and substance use screening. New standards align with AAP and USPSTF guidelines: tobacco, alcohol, and depression screening for youth age 11+, adults, and pregnant/postpartum women; anxiety screening for youth age 8+, adults, and pregnant/postpartum women. Providers should begin implementing these screenings during wellness visits prior to the 2026-2027 school year to ensure compliant documentation.
Cigna Healthcare's October 2026 Provider Newsroom recap lists several U.S. commercial items, most notably a prior authorization portal change: effective October 31, 2026, EviCore by Evernorth will move prior authorization requests for certain Cigna Healthcare services from the MedSolutions portal to the CareCore portal on EviCore.com. Other items cover drug list updates for Cigna Specialty Care Options and Cigna Pathwell Specialty, a Specialty Medical Injectables reimbursement restriction requiring dispensing and claim submission through a Cigna-contracted specialty pharmacy, and a 270/271 eligibility transaction enhancement.
Effective October 31, 2026, EviCore is transitioning prior authorization requests for Cardiology, Radiology (High Tech Imaging), Joint Surgery, and Pain Management from the MedSolutions portal to the CareCore portal on EviCore.com. Providers must submit all new prior authorization cases through CareCore after this date, though existing MedSolutions cases can still be viewed. No changes to clinical criteria, covered services, or review processes.
The AMA released new maternity coding guidelines effective January 1, 2027, replacing the global maternity package with detailed CPT codes. However, Cigna Healthcare is NOT implementing these changes and will maintain current maternity billing guidance. For patients with initial prenatal visits on or after September 1, 2026, providers must continue using existing maternity billing processes and NOT submit the new AMA-recommended prenatal E/M CPT codes to avoid payment delays.
Effective July 1, 2026, Cigna Healthcare will implement real-time validation of primary diagnosis codes at EDI claim submission. Claims with unacceptable primary diagnoses (manifestations, external causes, sequelae, or 'code first' conditions per ICD-10-CM guidelines) will be rejected at submission with rejection codes A7 or 255, allowing immediate correction rather than post-adjudication denial. This is not a new policy, but a timing shift of an existing edit to reduce downstream denials and rework.
Cigna Healthcare is implementing real-time claim rejection for EDI submissions with unacceptable primary diagnosis codes starting July 1, 2026. Claims with invalid primary diagnoses will be rejected at submission (not after processing) and returned with specific error codes A7 and 255 for immediate correction.
Beginning March 26, 2026, all electronic eligibility inquiries (270 transactions) submitted to Cigna Healthcare must include the National Provider Identifier (NPI) in the correct data segment. Transactions without NPI will be rejected with a 999 error response.
Cigna Pathwell Specialty has expanded their drug list with 25 new specialty medications (most recently added February 9, 2026) and removed 4 drugs. Patients must receive these specialty drugs from Cigna Pathwell Specialty Network providers for coverage, with no out-of-network benefits except rare case-by-case exceptions.
Effective January 1, 2026, HealthSpring will take over prior authorization management for Post Acute Care services (Skilled Nursing, Inpatient Rehab, Long Term Acute Care, and Home Health) from EviCore for Cigna Healthcare Medicare Advantage patients. Providers must submit authorization requests through the Availity Provider Portal to HealthSpring instead of EviCore starting December 29, 2025.
Cigna Healthcare has launched an enhanced online precertification portal on CignaforHCP.com where providers can now submit, draft, save, and upload documentation for prior authorization requests directly online. This streamlines the precertification process by eliminating the need for phone, fax, and manual submissions.
Cigna Healthcare has released the 2025 fourth quarter National Injectable and Immunization Fee Schedule (NIIFS) update, which affects reimbursement rates for injectable drugs and immunizations. This quarterly update contains new payment amounts that billing teams must implement for proper claims processing.
Cigna Healthcare will implement a new reimbursement policy (R49) on October 1, 2025, to review high-level E/M office visit claims for billing and coding accuracy. Claims with CPT codes 99204-99205, 99214-99215, and 99244-99245 will be subject to enhanced scrutiny to ensure compliance with AMA E/M guidelines.
Effective October 1, 2025, Cigna Healthcare will require medical necessity review through American Specialty Health (ASH) for physical therapy and occupational therapy services provided in outpatient hospital settings. Providers must submit review requests after initial assessment if continued PT/OT treatment in hospital setting is needed, with approval decisions made within one business day.
Cigna Healthcare implemented a new reimbursement policy (R49) that automatically adjusts high-level E/M codes to lower levels for providers identified as having coding patterns inconsistent with diagnosis complexity. Claims are paid at the adjusted level but providers can request reconsideration with clinical documentation.
This is a monthly summary of all Cigna Healthcare policy updates published in November 2025, including a new E/M reimbursement policy (R49) that reviews high-level evaluation and management codes for accuracy, effective October 1, 2025. The summary also covers changes to prior authorization processes, portal enhancements, and various administrative updates.
Cigna Healthcare is emphasizing the need for complete clinical documentation for all pre-service, concurrent, and post-service reviews to prevent claim denials and care delays. Incomplete documentation will result in denials, approval delays, and payment issues.
Cigna Healthcare has successfully reconnected with Change Healthcare for electronic claim submissions (837 transactions) as of July 15, 2025, for Commercial and Individual Family Plans. All major electronic services including ERAs, eligibility verification, and claim status inquiries are now restored after the February 2024 cyber incident.
Cigna Healthcare is adding 9 new oncology drugs to their dose rounding program effective July 7, 2025. The program rounds drug doses down to the nearest vial size when within 5-10% of prescribed dose, and all prior authorizations are managed through EviCore.
Cigna Healthcare now covers alternative pain management services and medications for Massachusetts patients under House Bill 5143, including non-medication treatments like acupuncture, chiropractic care, physical therapy, and non-opioid medications. Coverage varies by individual benefit plan and requires verification for each patient.
Effective July 1, 2025, Cigna Healthcare Garden State plan members must use only in-network providers located within New Jersey. Care provided outside New Jersey (except emergencies) will not be covered and claims will be denied, leaving patients responsible for full payment.
Effective July 1, 2025, Cigna Healthcare Garden State plan customers must use in-network providers located only in New Jersey through the new Open Access Plus (OAP) NJ Network. Services provided outside New Jersey (except emergencies) will not be covered and claims will be denied, leaving patients responsible for full payment.
Cigna Healthcare will no longer reimburse advanced primary care management services effective June 1, 2025, as defined by CMS. Additionally, nine new specialty medical injectables have been added to the reimbursement restriction list requiring dispensing through Cigna-contracted specialty pharmacies.
Cigna Healthcare is removing 96 codes from prior authorization requirements effective May 31, 2025, including commonly requested cardiology, ENT, and other routine services. This means providers will no longer need to obtain prior authorization for these services, reducing administrative burden and allowing faster patient access to care.
Cigna Healthcare removed 96 codes from prior authorization requirements effective immediately, including commonly requested cardiology, ENT, and other routine services. This reduces administrative burden for providers and eliminates the need to obtain prior auth for these previously restricted procedures.
Cigna Healthcare has expanded its Specialty Medical Injectables with Reimbursement Restriction list, requiring that certain injectables be dispensed and claims submitted through a Cigna-contracted specialty pharmacy when administered in outpatient hospital settings. One drug (Zanvastro) is already restricted as of September 28, 2026, and 11 additional drugs become restricted effective January 1, 2027. The restriction does not apply to injectables administered in provider offices, non-hospital ambulatory infusion suites, or home settings.
Cigna Healthcare has expanded coverage for breast cancer screening services to include MRIs, ultrasounds, biopsies, and pathology procedures at no cost when needed to complete screening or address initial findings. This policy emphasizes continued screening during pregnancy and postpartum periods and references the updated Preventive Care Services (A004) administrative policy for specific CPT codes.
Change Healthcare is reconnecting with Cigna Medicare Advantage for electronic transactions after their February cyberattack. Eligibility checks and claim status requests are now working, but ERAs require providers to contact Zelis before reconnecting. Claim submissions (837s) will be restored over the next month.
Cigna expanded their Specialty Care Options (SCO) and SCO+ programs to include additional specialty injectable medications that require site-of-care review and prior authorization. The programs aim to redirect patients from higher-intensity settings like outpatient hospitals to less intensive sites when clinically appropriate.
Cigna Healthcare removed prior authorization requirements for 345 tests, procedures, and services (15% decrease) and enhanced their provider web portal to allow online PA submission, status checking, and documentation upload. They also expanded post-care claims advocacy support for complex situations.
Cigna Healthcare has updated the National Injectable and Immunization Fee Schedule (NIIFS) for the fourth quarter of 2026. The updated fee schedule became effective on November 1, 2026, and your practice should verify reimbursement rates for injectable drugs and immunizations against the new schedule to ensure accurate billing.
Cigna Healthcare added Isembyld (effective October 5, 2026) to the Specialty Medical Injectables with Reimbursement Restriction list. When this injectable is administered in an outpatient hospital setting, it must be dispensed and billed through a Cigna-contracted specialty pharmacy; the restriction does not apply to provider offices, non-hospital ambulatory infusion suites, or home settings.
Cigna Healthcare completed Phase 3 of 270/271 eligibility and benefits transaction enhancements on October 5, 2026, enabling providers to submit procedure codes (CPT, HCPCS, ADA CDT) with 270 requests and receive procedure-specific benefit details in 271 responses. This enhancement applies to medical, dental, and behavioral health providers and supports CAQH CORE1 compliance. No mandatory action is required unless your EDI vendor instructs you to update systems or complete testing.
Cigna Healthcare completed Phase 3 of 270/271 eligibility and benefits transaction enhancements on October 5, 2026. Providers can now submit procedure codes (CPT, HCPCS, ADA CDT) on 270 requests to receive procedure-specific benefit details in 271 responses, reducing follow-ups and supporting CAQH CORE1 compliance. No mandatory action is required unless your EDI vendor instructs system updates or testing.
Cigna has enhanced the CignaforHCP.com portal to streamline the submission and tracking of pended claim attachments. Effective September 12, 2026, users can now upload unlimited files up to 500 MB total (previously 6 files, 384 MB max), view individual file upload status, and resubmit only failed files instead of entire submissions.
Evernorth Provider portal now allows unlimited file uploads (up to 500 MB total) with no page limits for pended claim attachments, replacing the previous 6-file, 384 MB, 999-page restrictions. The system now displays individual file upload status, allowing providers to resubmit only failed files instead of entire submissions.
Cigna has expanded its Specialty Care Options (SCO) and SCO+ programs to include two additional drugs—Armlupeg® (pegfilgrastim-unne) and PasatruTM (garetosmab-grts)—on both drug lists effective September 1, 2026. These programs conduct medical necessity site-of-care reviews to redirect patients to lower-intensity care settings when clinically appropriate. Billing teams should verify whether these drugs are used in practice and ensure prior authorization workflows account for the expanded drug list.
Cigna is expanding its Specialty Care Options (SCO and SCO+) programs to include additional specialty medications effective September 1, 2026, and January 1, 2027. These drugs will now require site-of-care review to determine if administration can occur in a less-intensive setting (office, home infusion, or ambulatory center) rather than hospital outpatient settings. Billing teams must identify claims for these medications and ensure prior authorization includes site-of-care medical necessity documentation.
This is a newsroom summary page recapping behavioral health articles from August 2026, including three actionable policy updates: LOCUS/CALOCUS-CASII criteria adoption in Illinois, Maryland, and Oregon (effective August 29, 2026); maternity coding updates using new AMA CPT framework; and California HMO access standards. The page itself is informational and does not constitute a direct policy change.
Effective August 29, 2026, Evernorth Behavioral Health will adopt LOCUS (Level of Care Utilization System) for adults aged 19+ and CALOCUS-CASII for youth aged 6-18 in Illinois, Maryland, and Oregon to determine mental health level-of-care medical necessity. This replaces previous criteria sources for these three states only. The medical necessity review process itself remains unchanged.
This is a newsroom summary document aggregating July 2026 policy updates from Cigna Healthcare, including several items requiring billing team attention: discontinuation of Individual & Family Plans (IFPs) effective January 1, 2027, updates to the National Injectable and Immunization Fee Schedule (NIIFS) effective August 1, 2026, changes to specialty medical injectables with reimbursement restrictions, and acceptance of Kyxata as an alternative to Carboplatin for existing prior authorizations. The document is informational and links to detailed policy articles rather than providing specific billing code changes.
Cigna Healthcare's National Injectable and Immunization Fee Schedule (NIIFS) has been updated for the third quarter of 2026 and will become effective August 1, 2026. The billing team must obtain the updated fee schedule to ensure accurate reimbursement for injectable drugs and immunization administration services.
Cigna Healthcare has added three new specialty medical injectables to their reimbursement restriction list, effective on staggered dates between April and July 2026. When these injectables are administered in outpatient hospital settings and covered under the medical benefit, claims must be submitted by a Cigna Healthcare–contracted specialty pharmacy. The restriction does not apply to provider offices, non-hospital ambulatory infusion suites, or home settings.
Cigna Healthcare will accept Kyxata as an alternative medication for patients with existing approved prior authorizations for Carboplatin due to a temporary manufacturing shortage. This eliminates the need for new prior authorization requests when substituting Kyxata for already-approved Carboplatin prescriptions covered under medical benefits. New Kyxata starts and other alternative medications still require standard prior authorization.
Network, contract and program news from the payers we track.
Published October 6, 2026: Cigna Healthcare announced Health Sense, a connected patient experience and clinical support model built on existing myCigna, customer service, care management and clinical support services.
Cigna Healthcare is introducing Health Sense™, a connected patient experience and clinical support model that integrates health guidance, benefits, and support through the myCigna platform and care management programs.
Cigna Healthcare announced Health Sense, a connected patient support model that shares context across myCigna, customer service, care management and clinical support.
The Cigna Group Foundation announced $3 million in grants to 22 nonprofits working on youth mental health, part of a three-year, $9 million commitment.
This is a Cigna Group community health initiative announcement about the Safe Swimming with Sickle Cell (SSwSC) program, which provides free swim lessons and water safety education for children with sickle cell disease.
Cigna Healthcare is expanding its care management programs to proactively identify and engage more customers (20% increase) earlier in their health journeys using AI-enabled predictive analytics.
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