CommercialReimbursementHigh impact
Professional claims for evaluation and management services
Cigna·Coding
Effective date
Oct 1, 2025
We identified it
Jun 18, 2026
Summary
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.
Action Required
Immediately: Review all level 4 and 5 E/M coding patterns to ensure alignment with AMA guidelines and diagnosis complexity. Monitor EOPs starting November 21, 2025 for adjusted claims through CignaforHCP.com portal. Prepare to submit clinical documentation for reconsideration requests via secure fax 833.392.2092 or online portal. Ensure providers document medical necessity thoroughly for complex cases to support high-level E/M codes.