Elation is Ready to Support Your Practice with Cigna’s New Downcoding Policy
Starting October 1, 2025, Cigna will implement a new Evaluation and Management (E/M) Coding Accuracy policy (R49) that will automatically downcode certain high-level E/M claims. For many practices, this policy is expected to increase administrative burden and reduce reimbursement.
At Elation, we believe your time should be spent caring for patients—not chasing down lost revenue. That’s why we’re ready with tools and workflows that will help protect your practice from day one.
What’s Changing with Cigna’s Policy
Cigna’s new policy applies to services provided on or after October 1, 2025. It specifically targets higher-level E/M CPT codes, including:
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New patient visits: 99204, 99205
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Established patient visits: 99214, 99215
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Consultations: 99244, 99245
Here’s how it works:
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Cigna’s automated system will flag claims when the submitted diagnosis does not appear to support the complexity of the billed visit.
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If flagged, Cigna will automatically reduce payment by one level (e.g., 99215 to 99214).
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This will happen without manual review of your medical records.
For practices, that means potential delays in payment and reduced reimbursement—along with the additional work of identifying issues and filing appeals.
Elation’s Solution: Built-In Protection for Practices
Elation is building solutions right into Elation Billing so you’ll be ready on October 1. Our tools will help you:
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Identify downgraded claims through auditing and reporting
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Highlight reimbursement discrepancies so practices can take action quickly.
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Take action immediately with a built-in appeals process, including:
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Appeals initiation
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Appeal letter creation
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Appeal submission
Our Commitment
Insurer policy changes like this can create real challenges for independent practices. But Elation is here to help you stay ahead, protect your revenue, and keep your focus where it matters most—on your patients.
We’ll continue sharing updates as this policy takes effect. In the meantime, Elation customers can feel confident that we’re ready for October—and ready to stand with you across policy changes.
Protect your practice’s revenue and stay ahead of changes—contact us today to learn how Elation can help.