Attention SNFs and Medical Billers: Significant Changes Ahead!
If you’re an Skilled Nursing Facility (SNF), Medicare is once again altering the rules. There’s a huge July 2025 HCPCS update you can’t afford to miss.
Why is this significant?
- Apply the wrong code? Your application will be DENIED.
- Utilizing an outdated code? You lose money.
- Miss a new code? You may miss THOUSANDS in reimbursements.
What is the HCPCS Update effective July 2025?
The July 2025 HCPCS update is a significant update introduced by CMS (Centers for Medicare & Medicaid Services). The updates alter the way SNFs like yours bill for:
- Drugs
- Imaging procedures
- Cancer therapies
- Prosthetics
- And more…
CMS adds new codes, supplants some current codes, and removes others.
Effective Date: July 1, 2025
Implementation begins: July 7, 2025.
Real Talk: What Happens If You Ignore This?
| What You Do | What Happens |
|---|---|
| Use a discontinued code | Claim is denied |
| Use an old description | Compliance issue |
| Don’t train your team | Lost revenue |
| Use new codes correctly | Maximum reimbursement |
NEW Codes = NEW MONEY
Let’s look at the shiny new codes from the July 2025 HCPCS update.
Category: Imaging & Cancer Planning
| Code | What It Means | Why It Matters |
|---|---|---|
| C8004 | Angiogram simulation for tumor planning | Big for cancer surgery prep |
Category: Chemotherapy
| Code | What It Means | Why It Matters |
|---|---|---|
| J9161 | Denileukin Diftitox-CXDL (new immunotherapy drug) | High reimbursement |
Category: Diagnostic Imaging
| Code | What It Means | Why It Matters |
|---|---|---|
| A9611 | Flurpiridaz F18 for PET scans | For heart disease imaging |
Category: Blood Disorders
| Code | What It Means | Why It Matters |
|---|---|---|
| C9304 | Marstacimab for Hemophilia | Important for clotting factor billing |
Category: Custom Prosthetics
| Code | Description |
|---|---|
| L5827 | Knee-shin system with electromechanical control |
| L6028–L6037 | Modular partial hand prosthetics |
| L6700 | Myoelectric-controlled upper prosthetics |
Why it matters: These codes now allow for SNFs that provide rehab services to bill for advanced devices.
Discontinued Codes = Do NOT Use
You’ll get denied for using these after July 1.
| Code | Description |
|---|---|
| Q5139 | Eculizumab-AEEB (10 mg) |
| J9247 | Melphalan Flufenamide |
| L8010 | Breast prosthesis, mastectomy sleeve |
Replace these NOW! Don’t say we didn’t warn you.
Revised Codes = Be Extra Careful
Some codes got updated descriptions or changed dosages.
| Old Code | New Code | Key Change |
|---|---|---|
| Q5139 | Q5152 | Dosage changed to 2 mg |
| J9247 | Terminated | No replacement yet |
How to Prepare for the July 2025 HCPCS Update
1. Verify Your Claims Immediately
Verify whether you are still using them:
- Q5139
- J9247
- L8010
If so, correct them right away.
2. Update Your Billing Software & EHR
Call your supplier and ask:
“Do we possess the new codes from the July 2025 HCPCS update within our system?”
3. Train Your Employees
Schedule a 30-minute meeting with your employees prior to July 1.
Use flashcards, in-class demonstrations
4. Look for Crosswalks
Some deleted codes have direct replacements.
Common Errors That Can Cost You a Fortune
- Not updating the software
- Without new code descriptions.
- Filing claims with July 2024 codes
- Trusting memory rather than referencing the list
FAQ: You Ask, We Answer
Yes! If you are charging Medicare for any service, these codes are for you.
Claim will be denied. You can reprocess, but that postpones payment weeks later.
Every three months. July is the largest update of the year.
Final Thoughts: Be Prepared and Not Surprised
The July 2025 HCPCS update is the year’s largest billing revision.
If you do nothing, you’ll have denied claims, lost business, and a whole lot of stress.
But what if you take action now?
- You stay compliant
- You charge correctly.
- You get paid fast
One More Time - Here's What You Need to Do:
- Read the update
- Train your team
- Double-check every code
- Bookmark this blog
- Take a help from experts like Human Medical Billing
