Deep Dive: 2026 Medicare Prior Auth Changes
Cigna & Aetna 2025 E/M Downcoding Policy Update
Starting October 1, 2025, both Cigna and Aetna will begin downcoding certain Level 4 & 5 E/M visits if documentation doesn’t meet their criteria.
That means:
- Higher-level visits may be reimbursed at a lower level
- Payments could be delayed or denied
- More appeals and record requests are likely
We’ve put together a full breakdown of these changes and how Peregrine helps protect your revenue.
At Peregrine Healthcare, we fight for every dollar you’ve already earned. Staying ahead of these payer tactics is critical and we’re here to make sure your practice gets paid what it deserves.