Payer Intelligence

Cigna, Aetna, Anthem, Humana, Molina, UnitedHealth, and regional Blue Cross Blue Shield plans are all automatically downcoding E/M claims in 2026. Maryland has fined Cigna, Indiana has passed a law, and a physician coalition says the practice repeats a scheme a 2004 court settlement was meant to end.

Seventy two of the hundred sacroiliac joint injection claims federal auditors reviewed did not survive the review. A failure rate that high on a routine interventional procedure is not a coding problem. It is what happens when a national billing…

Referral denials and authorization denials are different failures with different fixes. Here is what each CARC code means and how to stop both before submission.

CMS proposed cutting same day E/M payment by 50 percent in the CY 2027 Physician Fee Schedule. The justification contradicts CMS's own position on practice expense data in the same rule.

S9083 is a single flat fee that replaces the visit’s E/M code entirely. S9088 is an add-on code billed alongside a standard E/M code to reflect the extra overhead of an urgent care setting. Some payers mandate S9083 and will…

When a well child visit turns up a real problem, a rash a parent already tried two creams on, an ear pulled at for two days, wheezing that was not there at the last checkup, that visit is worth two…

CPT 90460 pays for the first component of a vaccine. Add on code 90461 pays for every component after that, and most pediatric practices never bill past the first one.

CMS proposed paying 50 percent for the lesser service when an E/M visit and a global procedure occur on the same day. See the mechanic, the specialties exposed, and what to do before September 14, 2026.