CommercialReimbursementHigh impact
Summary of Provider Newsroom U.S. commercial medical articles
Cigna·General
Effective date
Oct 1, 2025
We identified it
Jun 18, 2026
Summary
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.
Action Required
Before October 1, 2025: Billing team must review and update documentation requirements for high-level E/M visits (99204-99205, 99214-99215, 99244-99245). Providers must ensure documentation meets AMA E/M guidelines for medical decision making, history, and exam components. Update encounter forms and EMR templates to include E/M documentation reminders. Train staff on proper E/M coding criteria to avoid claim denials and potential audits.