In response to advocacy by the American Academy of Sleep Medicine and other medical organizations, Cigna has agreed to pause its automatic downcoding policy — Evaluation and Management (E/M) Coding and Accuracy Policy (R49) — effective Oct. 1, 2025.
In the AASM’s letter to Cigna, we highlighted that the policy was particularly problematic for patients with sleep disorders, as it would limit access to comprehensive evaluation and management, disrupt care pathways, and cause confusion and financial harm. We also highlighted implications for sleep medicine professionals, which include administrative burden, undervaluation of clinical work, and a negative impact on workforce sustainability. Cigna also had not specified the algorithms that would potentially trigger downcoding.
While Cigna has agreed to a temporary pause, we encourage members to continue reaching out to Cigna by downloading the template letter and by contacting Cigna through the provider portal to express concerns about the policy and to encourage the payer to completely eliminate this policy.
The AASM will continue to monitor and report updates on this issue. Please send any questions to coding@aasm.org.
