All PlansAdministrativeMedium impact
Updates to the Code Editing Policy and Guidelines
Cigna·Psychiatry, Family Medicine, Pediatrics·Coding
Effective date
Jul 14, 2024
We identified it
Jun 19, 2026
Summary
Cigna Healthcare/Evernorth updated their Code Editing Policy to automatically deny claims when specific behavioral health codes are billed above CMS medically unlikely edit frequency limits by the same provider for the same patient on the same day. This affects 17 CPT codes and 3 HCPCS codes for behavioral health services.
Action Required
Immediately: Billing team must review frequency of behavioral health code submissions for the affected CPT and HCPCS codes to ensure they do not exceed CMS medically unlikely edit limits when billing multiple units for the same patient by the same provider on the same day. Update billing system alerts to flag potential over-frequency billing. Claims exceeding limits will be administratively denied at the line level.