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Summary of Provider Newsroom U.S. commercial medical articles
Effective date
Oct 1, 2025
Identified
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.
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What to do
Action · 4 steps
01Before October 1, 2025: Billing team must review and update documentation requirements for high-level E/M visits (99204-99205, 99214-99215, 99244-99245).
02Providers must ensure documentation meets AMA E/M guidelines for medical decision making, history, and exam components.
03Update encounter forms and EMR templates to include E/M documentation reminders.
04Train staff on proper E/M coding criteria to avoid claim denials and potential audits.
Codes mentioned
992049920599214992159924499245
Original notice
Summary of Provider Newsroom U.S. commercial medical articles
providernewsroom.com · Always check the source before changing claims.
Related changes
See all Cigna changes →2025 Clinical, reimbursement, and administrative policy updatesHighEffective Mar 15, 2025 · Claims & BillingSummary of Provider Newsroom U.S. commercial medical articlesMediumEffective Oct 1, 2025 · GeneralProfessional claims for evaluation and management servicesHighEffective Oct 1, 2025 · CodingNew Reimbursement Policy for Professional Evaluation and Management Services Claims effective October 1, 2025MediumEffective Oct 1, 2025 · CodingBrowse every Cigna change in the policy list