We routinely review our coverage, reimbursement, and administrative policies for potential updates. During this review, we take into consideration one or more of the following: professional society recommendations, Centers for Medicare & Medicaid Services’ guidance, industry standards, and our other existing policies.

As a result of this review, effective January 1, 2026, Cigna Healthcare Medicare Advantage will:

• No longer deny facility claims billed with Healthcare Common Procedure Coding System (HCPCS) code G0463 (hospital outpatient clinic visit for assessment and management of a patient) and revenue code 0510 (hospital-based outpatient clinics) for participating and nonparticipating providers.
• Pay facility claims for both participating and nonparticipating providers when billed with any Current Procedural Terminology (CPT) and HCPC codes and revenue codes 0510–0519 or 0520–0529. A PCP or Specialist cost share will apply to these claims; the specific amount is based on the member’s benefit plan.
• Continue to pay professional claims billed with 99202–99215 and Place of Service (POS) 19 or 22. No member cost-share will be calculated when POS 19 or 22 is present.

Additional information

If you would like additional information, please contact your Provider Performance Enablement (PPE) representative.