When Medicare beneficiaries are in a skilled nursing facility (SNF) receiving Part A coverage for their stay, the SNF is required to pay for every service the resident needs, as a result of the principle of “consolidated billing.” However, CMS specifically excludes certain “high cost, low probability” services from consolidated billing. The exclusion of a service means that the providers of the excluded service can separately bill the Medicare program. Exclusions from consolidated billing are critical for chemotherapy, as discussed in “Getting Chemotherapy While in a Nursing Home” (CMA Alert, Dec. 11, 2025).
CMS has just released its “2026 Annual SNF Consolidated Billing HCPCS Update,” which is reached through a Download link at CMS, 2026 Part A MAC Update. This excel worksheet identifies every HCPCS code, with a brief description, for every excluded item or service, by category.
CMS also provides a General Explanation of the Major Categories for Skilled Nursing Facility (SNF) Consolidated Billing (CB)
December 17, 2025 – T. Edelman