The Centers for Medicare and Medicaid Services (CMS)
has published the SNF consolidated billing Healthcare Common Procedure Coding System (HCPCS) code tables for calendar year (CY) 2025. HCPCS codes are ordinarily billed under Medicare Part B payment policies, but due to
SNF consolidated billing provisions, the codes on these tables represent services that cannot be billed by any provider other than a SNF during a beneficiary’s SNF stay. Additionally, during Part A covered stay, many of these services are bundled into the Part A SNF prospective payment system (PPS) pre-diem rate and cannot be unbundled and billed to Part B. These tables also list HCPCS codes that meet a limited number of statutory exclusions from the SNF Consolidated billing policy and can be billed separately under Part B.
A general explanation of the major categories of services excluded from SNF CB
can be found here. A listing of the HCPCS coded assed or deleted for CH 2025 is listed on the
CMS 2025 Part A MAC Update webpage. Below is a list of the major categories with code changes for CY 2025:
Added SNF CB Codes for CY 2025 (25 total added)
- Major Category III. A. – Chemotherapy (7 codes)
- Major Category III. D. - Customized Prosthetic Devices (4 codes)
- Major Category III. E. - Certain blood clotting factors (2 codes)
- Major Category IV. A. -Mammography Screening (1 code)
- Major Category IV. B. -Vaccines (Pneumococcal, Flu, Hepatitis B, or Covid-19) (3 codes)
- Major Category IV. D. -Screening Pap Smear and Pelvic Exams (2 codes)
- Major Category IV. E. -Colorectal Screening Services (2 codes)
- Major Category IV. H. -Diabetic Screening (1 code)
- Major Category V. A. - Therapies – INCLUSION (3 codes)
Terminated SNF CB Codes for CY 2025 (30 total removed)
- Major Category III. A. – Chemotherapy (2 codes)
- Major Category IV. B. - Vaccines (Pneumococcal, Flu, Hepatitis B, or Covid-19) (23 codes)
- Major Category IV. C. - Vaccine Administration (5 codes)