BLOGS

Modifier denials in healthcare are rising across every specialty in 2025. Most of the patterns trace back to a small group of high-risk billing modifiers — including Modifier 25, Modifier 59, Modifier 24, and the X-modifiers — that payers now flag more aggressively. These denial trends reveal workflow gaps long before aging A/R exposes the problem. If your practice is seeing more claim denial patterns tied to modifiers, the data is signaling a revenue cycle issue worth paying

On October 1, Cigna Healthcare implemented its new R49 policy, introducing more stringent medical complexity criteria for Evaluation and Management (E/M) code reimbursement. For most practices, it may seem like business as usual. Claims are still going out the door. Documentation is still being entered, and nothing unusual has appeared on your remittance reports. But here's the catch: downcoding has already started.