Resources
Consolidated Billing
SNF Consolidated Billing Training Module
CMS 2025 Part A MAC Update & HCPCS File
👉 Instructions to access the relevant file:
1-Navigate to the CMS page using the link above.
2-Scroll to the bottom of the page.
3-Download the ZIP file titled: "2025 Annual SNF Consolidated Billing HCPCS Update (ZIP)."
4-Within the extracted ZIP folder, open the Excel spreadsheet.
5-In the spreadsheet, search for the specific CPT or HCPCS code in question.
6-Refer to Column D for that code. If "inclusion" is not stated, the service can typically be billed separately to the Medicare Administrative Contractor (MAC).
Critical Element Pathways
CMS-20066 Activities of Daily Living
CMS-20067 Behavioral and Emotional Status
CMS-20052 Beneficiary Notification
CMS-20125 Bladder and Bowel Incontinence
CMS-20069 Communication and Sensory Problems
CMS-20073 Hospice and End of Life
CMS-20054 Infection Prevention Control and Immunization
CMS-20055 Kitchen/Food Service Observation
CMS-20056 Medication Administration Observation
CMS-20076 Pain Recognition and Management
CMS-20120 Positioning, Mobility, ROM
CMS-20080 Rehab and Restorative
CMS-20057 Resident Council Interview
CMS-20062 Sufficient and Competent Nurse Staffing Review