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Summary of Provider Newsroom U.S. commercial medical articles
Act
by Jun 1, 2025
Effective date
Jun 1, 2025
Identified
Jun 18, 2026
Summary
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.
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What to do
by Jun 1, 2025 · 3 steps
01Billing team must stop submitting claims for advanced primary care management services to Cigna Healthcare Medicare Advantage plans as these will not be reimbursed.
02Update billing system to flag these services.
03For specialty medical injectables, verify that all injectable claims are submitted through Cigna-contracted specialty pharmacies or obtain prior authorization before dispensing.
Original notice
Summary of Provider Newsroom U.S. commercial medical articles
providernewsroom.com · Always check the source before changing claims.
Related changes
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