A growing pattern of automated E/M reductions is appearing across multiple states, and most practices won’t see the losses until the month-end numbers don’t add up. Your E/M payments may already be shifting.
When Cigna Healthcare's R49 policy made headlines in October 2025, many assumed it was an isolated case. Cigna Healthcare then paused the policy due to regulatory pressure. The relief was short-lived. The trend didn't stop; it had already spread to nearly every major insurer in the country.
This article examines how Cigna Healthcare’s R49 policy and NBC News' recent investigation reveal a growing challenge for healthcare providers and how our Downcoding Defense Tools help practices stay compliant and protect their revenue.
Aetna’s CCRP quietly began downcoding high-level E/M claims in March 2025, joining Cigna’s R49 policy effective Oct 1. Providers face hidden revenue loss, delayed payments, and rising admin burden. Learn how Downcoding Defense™ tools protect your practice.
Starting October 1, 2025, Cigna Healthcare’s R49 downcoding policy is set to catch many practices off guard. These denials are not clerical mistakes; they’re part of a systemic tightening on higher-level E/M codes. Cigna Healthcare will not provide healthcare providers any notice; it happens automatically.
The Hidden Cost of DIY Medical Billing
Every denied claim, every delayed payment, every billing error costs your practice real money. While you're focused on patient care, critical revenue opportunities slip through the cracks.
Sep 193 min read
In fact, one healthcare provider we worked with achieved 132% of monthly collection goals.
⚠️ Is Your Practice at Risk?
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I'll help you identify:
✓ Hidden revenue leaks in your payer contracts
✓ Downcoding exposure you might not see
✓ Early warning signs of contract breakdown
