The Pulse by Peregrine
September 2026 Revenue & Compliance Update
You’ve Earned the Revenue. Let’s Make Sure You Keep It.
Here are the key updates physician practices should be watching this month.
Payer Watch: Cigna E/M Downcoding
Cigna’s E/M Coding Accuracy policy allows certain higher-level E/M claims to be automatically paid one level lower based on claim data, without reviewing the medical record first. Other payers have adopted similar policies.
Practice action: Compare codes billed vs. paid and appeal downcoded claims with supporting medical records. If you’re seeing a pattern with Cigna, involve your payer representative.
Coding & Reimbursement Watch
Pain Practices: New Medicare Revenue Opportunity
Medicare’s Chronic Pain Management (CPM) code G3002 reimburses approximately $84.55 per patient, per month for qualifying services.
For practices already providing chronic pain management, care coordination, and patient follow-up, this may be revenue you’re not currently capturing.
50 eligible Medicare patients = ~$4,227/month
100 eligible Medicare patients = ~$8,455/month
Download our Chronic Pain Management Billing Guide »
560 New ASC Procedures. Is Your Facility Ready?
560 New ASC Procedures. Is Your Facility Ready?CMS added 560 procedures to the ASC Covered Procedures List for 2026, creating potential new opportunities for surgery centers.
But new coverage doesn’t automatically mean new revenue. See which specialties may benefit and what your ASC should review before adding cases.
Laboratory Billing Under the Microscope
CMS recently announced it prevented more than $1.6 billion in potentially improper Medicare laboratory payments, highlighting its growing use of advanced analytics and AI to identify unusual billing patterns.
For laboratories, the message is clear: documentation, medical necessity and billing accuracy matter more than ever.
Read the CMS Announcement »
Peregrine Breakroom
Quick Quiz: True or False: If an insurance claim is paid, it was paid correctly.
Answer: False. Downcoding and payment edits can result in a paid claim that is still underpaid.
Spot the Revenue Leak: A claim is billed as 99214 but the payer processes it as 99213. Denial or revenue leak? Answer: Revenue leak. Because the claim was paid, it may never appear on a denial report.
Did You Know? Some of the easiest revenue to lose is revenue you never realize is missing. Comparing what was billed vs. paid can uncover reimbursement issues that ordinary denial reports may miss.
Peregrine Resource Center
Peregrine tracks payer, Medicare, and compliance changes, so your team stays informed without the overwhelm. Each month, we highlight what matters most.
For official source updates, we recommend subscribing directly to:
Centers for Medicare & Medicaid
American Academy of Professional Coders
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Between Issues…
The Pulse delivers the highlights each month, but we share important payer, compliance, credentialing, and reimbursement updates all month long. Follow Peregrine Healthcare on Facebook, LinkedIn, and Instagram to stay informed.