The Centers for Medicare & Medicaid Services (CMS) has released the 2026 annual update to the Healthcare Common Procedure Coding System (HCPCS) used to enforce Skilled Nursing Facility (SNF) Consolidated Billing (CB). The updated codes apply to services provided on or after January 1, 2026, and will be used by Part A Medicare Administrative Contractors (MACs) when editing institutional claims.
CMS updates the SNF CB HCPCS files annually to reflect changes in CPT and HCPCS coding and Medicare payment policy. These updates support accurate claims processing under the SNF Prospective Payment System (PPS) and consolidated billing requirements and do not expand the scope of services subject to SNF CB.
Under consolidated billing, Medicare will pay providers other than the SNF only for services that appear on CMS exclusion lists when furnished to residents in a covered Part A stay. Services not listed remain the financial responsibility of the SNF. Effective January 1, 2026, CMS has added several HCPCS codes across multiple major categories.
New codes have been added to Major Category I.B (Cardiac Catheterization), which includes services that must be furnished in a hospital setting and are excluded from SNF PPS and consolidated billing. These additions reflect new add-on codes for coronary angiography and related interventional procedures, such as flow reserve measurement, intravascular imaging, three-dimensional mapping, and coronary lithotripsy.
CMS has added several new chemotherapy-related HCPCS codes that are excluded from SNF consolidated billing, including new injectable and intravesical chemotherapy agents, as well as a new radioisotope add-on code. Several HCPCS codes will also be deleted effective January 1, 2026, primarily affecting chemotherapy drugs and customized prosthetic devices. Claims submitted using terminated codes on or after the effective date will not be paid.
CMS also noted several structural changes reflected in the 2026 files:
- HCPCS codes for Major Category II.A dialysis-related services for ESRD beneficiaries will no longer appear in the Part A file beginning January 2026.
- HCPCS codes for Major Category IV.B vaccines will no longer appear in the Part A file, though these services remain Part B benefits.
- HCPCS codes for Major Category V therapy services will no longer be listed in the Part A file, despite therapy remaining subject to SNF PPS and consolidated billing.
Most non-therapy services are subject to consolidated billing only during a covered Part A stay, while physical therapy, occupational therapy, and speech-language pathology services remain subject to consolidated billing regardless of Part A coverage.
The 2026 Annual SNF Consolidated Billing HCPCS Update file and the General Explanation of the Major Categories are available for download on the CMS website here.
Compliance Perspective
Issue
CMS has released the 2026 annual update to HCPCS codes used to enforce SNF consolidated billing, with changes effective January 1, 2026. These updates include newly added and terminated codes, as well as structural changes to how certain categories appear in the Part A files. Failure to account for these changes when billing services furnished to SNF residents may result in improper billing, payment denials, or potential compliance risk. Facilities should take steps to ensure that billing practices, internal controls, and oversight processes reflect the updated consolidated billing requirements.
Discussion Points
- Review and update policies and procedures related to consolidated billing to ensure they reflect the 2026 HCPCS updates, including added and terminated codes and changes to the Part A files. Facilities may wish to work with their consultant to review current billing workflows, identify areas of risk, and confirm that responsibilities between the facility and outside providers are clearly defined and documented.
- Educate appropriate staff on the 2026 consolidated billing updates, including billing staff, therapy leadership, and others involved in ordering or coordinating services for residents. Training should reinforce which services remain the financial responsibility of the SNF during a covered Part A stay and emphasize the importance of using current, active HCPCS codes when submitting claims. Med-Net Academy offers the course Fraud Module 10 – Vendor Contracts, which reviews the company vendor contracting policy, discusses key aspects of Medicare Part B consolidated billing, and identifies required elements of federal government contracting.
- Conduct routine audits of claims and supporting documentation to ensure services are billed in accordance with the updated consolidated billing rules. Audits should include a review of high-risk services and terminated codes to identify errors before they result in denials or recoupments. Some facilities may benefit from periodic independent or consultant-led reviews or mock audits to provide additional assurance that billing practices remain compliant with current CMS guidance.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*