The Centers for Medicare & Medicaid Services (CMS) has released the July 2026 quarterly update to the Healthcare Common Procedure Coding System (HCPCS) codes used to enforce the Skilled Nursing Facility (SNF) Consolidated Billing (CB) provision. The update is outlined in Change Request (CR) 14427, with an effective date of July 1, 2026, and an implementation date of July 6, 2026.
CMS uses these quarterly updates to align HCPCS and CPT coding changes, as well as Medicare Physician Fee Schedule designations, with SNF consolidated billing policy. These updates revise edits in the Common Working File (CWF), allowing Medicare Administrative Contractors (MACs) to apply correct payment rules in accordance with the Medicare Claims Processing Manual. As with prior updates, these changes reflect routine coding maintenance and do not expand the scope of services subject to consolidated billing.
The July 2026 update includes coding changes affecting the Angiography, Lymphatic, Venous, & Related Procedures category, as well as the Chemotherapy category. CMS has added new codes in both categories and removed a previously active chemotherapy-related code, reflecting ongoing updates to drug and procedure classifications.
CMS has also updated both the Part A and Part B HCPCS files to reflect these changes. The updates include new additions to each file, as well as the removal of a discontinued code. Providers should ensure that claims submitted on or after the applicable effective dates reflect the updated coding, as terminated codes will no longer be accepted for payment.
Under SNF consolidated billing, Medicare generally pays the SNF for all services furnished to a resident during a covered Part A stay, except for services specifically excluded from consolidated billing. Excluded services may be paid directly to non-SNF providers, while non-excluded services remain the SNF’s responsibility. For non-therapy services, consolidated billing applies only during a covered Part A stay. Therapy services, including physical therapy, occupational therapy, and speech-language pathology, are always subject to consolidated billing, regardless of whether the stay is covered under Part A. CMS systems are updated to edit claims for both included and excluded services in all care settings to ensure proper payment.
As with previous updates, MACs will not automatically review previously paid claims for the affected HCPCS codes. Providers may request that MACs reopen and reprocess claims impacted by these updates. CMS has issued CR 14427 as the official guidance for implementation, and updated HCPCS code files for institutional and professional billing are available on MAC websites. Billing staff should be informed of these updates and incorporate the changes into workflows ahead of the July 2026 implementation date.
The quarterly update is available here.
Compliance Perspective
Issue
CMS has released the July 2026 quarterly update to HCPCS codes used to enforce Skilled Nursing Facility (SNF) Consolidated Billing (CB), with changes effective July 1, 2026. These updates include code additions and terminations that impact how services are billed under Medicare. Failure to incorporate these updates into billing practices may result in claim denials, payment errors, or compliance risk. Facilities should ensure that internal processes reflect current requirements and that staff are aware of the latest changes.
Discussion Points
- Review and update policies and procedures related to consolidated billing to ensure they reflect the July 2026 HCPCS updates. This includes incorporating any code additions and deletions and confirming that billing processes clearly distinguish between services included in and excluded from SNF consolidated billing. Facilities may also consider working with a consultant to review existing workflows and identify potential gaps or areas of risk.
- Educate billing and administrative staff on the most recent consolidated billing updates. Training should reinforce the importance of using current HCPCS codes, understanding billing responsibilities during a covered Part A stay, and recognizing how coding updates may impact claim submission and reimbursement. Med-Net Academy offers the course Understanding and Using the Medicare Triple Check Process, which reinforces billing accuracy for skilled services, including the prevention of claim errors and denials, and emphasizes the importance of ensuring that clinical documentation supports billed services.
- Conduct routine audits to confirm that billing practices align with the updated requirements. Audits should include a review of claims, supporting documentation, and the use of current codes to identify discrepancies or errors. In some cases, facilities may benefit from periodic independent or consultant-supported reviews to provide additional oversight and help validate compliance with consolidated billing requirements. Contact Med-Net Healthcare Consulting or info@mednetconcepts.com for more information.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*