Starting October 1st, Cigna is rolling out a controversial “R49” policy that automatically down-codes higher-level E/M visits—cutting physician reimbursement even when documentation fully supports the billed level. In this episode of the NatRevMD Podcast, Dr. Heather Signorelli, DO, breaks down what this means for your practice, how ICD-10 codes and E/M guidelines intersect, and why the California Medical Association is fighting back. You’ll learn: • What R49 really does and which CPT codes are being targetedredacted, 99205, 99214, 99215, 99244, 99245). • How to protect your practice with rock-solid level 4 and 5 documentation and accurate ICD-10 coding. • What legal and advocacy efforts are underway to stop algorithmic down-coding. • Practical steps for appeal and audits so you can recover revenue and stay compliant. By the end of this episode, you’ll have actionable strategies to strengthen your documentation, safeguard reimbursement, and navigate payer policy changes with confidence.