Cigna has announced a new reimbursement policy, “Evaluation & Management Coding and Accuracy (R49),” which will take effect for services provided on or after October 1, 2025. The policy addresses coding practices for evaluation and management services.
According to representatives from Cigna, only a small number of physicians are expected to be impacted by the new policy. The company acknowledged that the initial press release may have caused confusion among physicians about the scope of the changes. “Cigna representatives met with the FMA and informed us that very few physicians will be affected, and that the initial press release led many physicians to erroneously believe they would be affected when, in reality, the vast majority of practices will never be subject to the policy. Cigna described this as a miscommunication on the company’s part.”
The Florida Medical Association (FMA) stated its intention to closely monitor the implementation of the policy and assess whether further advocacy is necessary. “However, the FMA is interested in monitoring the situation to determine if additional advocacy is needed. We strongly oppose all inappropriate downcoding initiatives.”
The FMA is encouraging its members who believe they have received inappropriate downcoding adjustments from Cigna to contact the association by email. The organization is also inviting members affected by other downcoding initiatives to reach out. This information will help the FMA evaluate the effects of Cigna’s policy and decide if further action is needed. The FMA also indicated it will offer direct assistance to members who are affected.
More information from Cigna is available here.
