Beginning October 1, Cigna will enforce a new Evaluation and Management (E/M) Coding Accuracy policy. The policy targets CPT codes 99204–99205, 99214–99215, and 99244–99245, reviewing claims for documentation accuracy. If supporting documentation does not meet AMA guidelines, services may be downgraded by one level.
The move has faced opposition from Sen. Richard Blumenthal and the California and Texas medical associations, who have called on Cigna to reverse the policy.
According to a Cigna spokesperson, the policy is designed to align with American Medical Association E/M guidelines and will apply to roughly 3% of in-network physicians who consistently code at higher levels than their peers. Claims will be reviewed individually, and payments may be adjusted accordingly. Providers retain the right to request reconsideration or appeal if they believe a higher level of reimbursement is justified.