CommercialReimbursementHigh impact
2025 Clinical, reimbursement, and administrative policy updates
Cigna·Claims & Billing
Effective date
Mar 15, 2025
We identified it
Jun 18, 2026
Summary
Cigna Healthcare is implementing multiple billing policy changes with staggered effective dates through October 2025, including bilateral procedure modifier requirements, preventive care criteria, E/M code restrictions, hospital readmission bundling, and ambulance service billing guidelines. These changes will affect reimbursement rates, claim denials, and require specific modifier usage and documentation.
Action Required
By March 15, 2025: Update billing system to require modifier 50 for bilateral procedures instead of LT/RT modifiers, as claims with LT/RT will be denied. By March 17, 2025: Review preventive care billing to ensure appropriate age, frequency, and diagnosis codes are used. By June 1, 2025: Stop billing CPT 99459 with non-preventive E/M codes or claims will be denied. By July 1, 2025: Adjust hospital readmission expectations within 30 days for same/similar diagnoses. By October 1, 2025: Review high-level E/M codes (99204-99205, 99214-99215, 99244-99245) for AMA guideline compliance as inappropriate levels will be adjusted down. By October 11, 2025: Update ambulance billing to use proper origin/destination modifiers and separate mileage lines, as related services will be bundled.