Becker's Healthcare December 9, 2025
Insurers are updating reimbursement policies that include new rules surrounding remote monitoring and inpatient reimbursement. Here’s a look at some of the most recent notable updates.
- BCBS North Carolina will no longer approve inpatient status in advance for elective procedures under its Medicare Advantage and D-SNP plans, starting in February 2026. Instead, the level of care will be determined based on the member’s clinical condition after the procedure.
- Cigna launched its downcoding policy on Oct. 1, which allows the insurer to adjust higher-level evaluation and management (E/M) codes for certain visits if they don’t meet complexity standards. This policy affects codes 99204-99205, 99214-99215, and 99244-99245. Cigna temporarily paused its implementation for California HMO plans while the California Department of...
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