STAT September 29, 2025
Complexity in medicine cannot be reduced to a billing code
Insurance companies continue to innovate.
On Oct. 1, Cigna will roll out a policy that tracks how physicians bill. It will flag those who submit a higher proportion of level four or level five visits — which get reimbursed at a higher rate — than their peers. For doctors placed under this extra scrutiny, certain claims at those higher levels may be adjusted down by one level if the billing details do not appear to justify the service. The affected codes include 99204–99205 (new patient, office/outpatient), 99214–99215 (established patient, office/outpatient), and 99244–99245 (consultations).
Cigna says the goal is to fight upcoding and billing abuse, arguing that some physicians bill for...
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