In the Administrative Policy Updates email that was sent to providers and dated July 11, 2025, there is a policy name Evaluation and Management Coding Accuracy R49.
Cigna will review professional claims billed with the following CPT E/M codes for billing and coding accuracy in alignment with American Medical Association (AMA) E/M services guidelines:
99204-99205
99214-99215
99244-99245
Services must be adjusted by one level to reflect the appropriate reimbursement when the AMA guidelines are not met.
The WCA Help Desk is not sure exactly what that means as far as claims processing so we will have to see how claims process for dates of service October 1, 2025, and after. These denials should be appealed, and documentation should be submitted.
View Cigna's Evaluation and Management Coding and Accuracy Policy