Sep '25 • General Practice Questions
🚨 Big Reimbursement Changes Coming Oct 1 🚨
1️⃣ Cigna Downcoding
Cigna is rolling out a new downcoding policy. Their system may automatically reduce your E/M level (for example, billing a 99215 but being paid for a 99213) if they don’t think your diagnoses support the higher level. While other payers have been doing this, very low volume of these denials seen so far.
What do you do?
⚠️ This isn’t about your documentation quality — it’s payer-driven.
👉 Track your Cigna claims closely.
👉 Watch for CARC code C150 (downcoded payment).
👉 Be ready to appeal with documentation.
👉 Consider emailing provider rep saying you want OUT of auto downcoding.
2️⃣ Medicare Telehealth
Starting Oct 1, 2025:
Non-behavioral telehealth: Geographic + originating site restrictions return. ESRD-related monthly assessments allowed.
Behavioral / mental health telehealth: Patients can continue visits from home for:
• Mental health disorders
• Substance use disorder
What do you do?
👉 Collect ABNs when coverage is uncertain.
👉 Commercial payers may not follow Medicare’s lead — stay alert.
Bottom line: Don’t let these changes catch you off guard. Protect your revenue by monitoring claims and updating your telehealth workflows.
#cigna #Medicare #Telehealth #MedicalBilling #RevenueCycle #PhysicianPractice #NatRevMD
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🚨 Big Reimbursement Changes Coming Oct 1 🚨
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