Billing for Skilled Nursing Facilities (SNFs) is one of the most complex areas of medical reimbursement, requiring precision, compliance, and a thorough understanding of SNF CPT codes. According to the Centers for Medicare & Medicaid Services (CMS), there are over 15,000 certified SNFs in the U.S., providing post-acute care to nearly 1.5 million patients annually.
Because of the volume and complexity of services provided, from therapy to lab testing, accurate coding with the right skilled nursing billing codes directly impacts revenue, compliance, and patient care outcomes.
In particular, the correct application of skilled nursing facility CPT codes, including the widely used 99309 CPT code, ensures that providers capture every billable service without triggering denials or audits.
A clear understanding of the 99309 CPT code description, along with other essential nursing home visit CPT codes, helps providers select the right CPT code for skilled nursing facility encounters.
By mastering these skilled nursing CPT codes, practices can reduce errors, improve reimbursement, and streamline claims processing.
This blog will break down the most important skilled nursing facility CPT codes, explain documentation requirements, and highlight the latest SNF billing codes and guidelines for 2025.
What is Skilled Nursing Facility (SNF) Billing and How Are Skilled Nursing CPT Codes Used?
A Skilled Nursing Facility (SNF) provides specialized medical care, rehabilitation, and daily assistance for patients recovering from illness, surgery, or injury. Unlike hospitals, SNFs focus on post-acute care, long-term rehabilitation, and ongoing clinical support.
Skilled nursing facility billing is governed by Medicare Part A (for facility stays) and Part B (for ancillary services), requiring accurate skilled nursing facility CPT codes, skilled nursing CPT codes, and HCPCS Level II codes for proper reimbursement. The complexity lies in the overlap of medical, nursing, and therapy services, where errors in SNF CPT codes or skilled nursing billing codes can quickly result in denied claims, revenue loss, and compliance risks.
Why Accurate Coding in SNF Billing Matters
The Centers for Medicare & Medicaid Services (CMS) reports that improper coding and documentation remain among the top causes of SNF claim denials, contributing to billions of dollars in improper payments each year. With increased payer scrutiny, understanding the skilled nursing billing codes is more than administrative; it directly impacts reimbursement and compliance.
For providers, accurate use of SNF CPT codes ensures they are fairly compensated for medically necessary services, while facilities can avoid revenue cycle delays caused by denials or audits.
Key Categories of CPT Codes Used in Skilled Nursing Facility Billing
1. Evaluation & Management (E/M) Codes
Evaluation and management services form the foundation of skilled nursing facility billing. Physicians and non-physician practitioners rely on the following nursing home visit CPT codes to capture initial and ongoing patient care:
- 99304–99310: Initial and subsequent SNF care
- 99315–99316: Discharge day management
- 99318: Annual patient assessment
These skilled nursing facility CPT codes cover the critical physician oversight that ensures patients receive high-quality care. For example, a provider conducting an initial patient evaluation in an SNF would bill 99304–99306, depending on the complexity of the case. Proper documentation here is vital because these visits often drive medical necessity for additional services.
2. Therapy and Rehabilitation Codes
Rehabilitation is a cornerstone of SNF services, and the correct application of skilled nursing billing codes for therapy ensures providers are reimbursed for specialized care. Common therapy-related SNF CPT codes include:
- 97161–97164: Physical therapy evaluations
- 97165–97168: Occupational therapy evaluations
- 92521–92526: Speech-language pathology services
These skilled nursing CPT codes not only document the type of therapy provided but also capture intensity and duration, which can affect reimbursement rates. Using the correct SNF CPT codes is critical in aligning therapy services with patient recovery goals and payer guidelines.
3. Laboratory & Diagnostic Codes
Laboratory testing and diagnostic services are common in SNFs to monitor patient conditions and guide treatment plans. Typical skilled nursing facility billing codes include:
- 80053: Comprehensive metabolic panel
- 85025: Complete blood count with differential
- 81001: Urinalysis with microscopy
Correctly pairing these skilled nursing facility CPT codes with ICD-10 diagnosis codes prevents claim denials and ensures compliance with CMS and commercial payers. These services play a key role in chronic disease management, which is a major focus area for SNFs.
4. Procedural & Minor Surgery Codes
Although major surgeries are not performed in SNFs, minor procedures and treatments require precise coding to secure reimbursement. Common CPT codes for skilled nursing facility use include:
- 11042–11047: Wound debridement
- 29580: Strapping (ankle/foot)
- 20552–20553: Trigger point injections
These skilled nursing CPT codes reflect essential bedside procedures frequently provided in nursing home settings. Accuracy in coding these services helps facilities demonstrate medical necessity and avoid compliance risks.
5. Telehealth and Remote Care Codes
The expansion of telehealth has significantly changed the landscape of skilled nursing facility CPT codes. CMS continues to cover many telehealth-related CPT codes for SNFs, such as:
- 99212–99215: Telehealth office visits
- 99441–99443: Telephone evaluation and management (E/M) by a physician
- G2252: Brief communication technology-based service
These SNF CPT codes enable providers to deliver high-quality care remotely, especially for specialists who may not be on-site. Telehealth services have become particularly valuable in managing chronic conditions, reducing unnecessary hospital readmissions, and maintaining compliance under evolving Medicare rules.
Also Read: Anesthesia Coding Cheat Sheet
Documentation Requirements for SNF CPT Codes
Accurate documentation is the foundation of skilled nursing facility billing and directly impacts reimbursement for SNF CPT codes. Payers, including Medicare and commercial insurers, require detailed records to validate that services billed under skilled nursing facility CPT codes and skilled nursing billing codes are medically necessary and properly delivered. Incomplete or vague documentation is one of the leading causes of claim denials and compliance audits.
To support claims for skilled nursing CPT codes, providers must include:
- Patient demographics and reason for SNF admission: Establishing medical necessity is essential when reporting nursing home visit CPT codes or the CPT code for skilled nursing facility services.
- Detailed physician or therapist notes: Notes must align with the service billed, such as the 99309 CPT code description for a subsequent nursing facility visit.
- Therapy minutes and treatment logs: Accurate tracking ensures proper use of therapy-related SNF CPT codes like physical, occupational, or speech therapy.
- Diagnostic test results: Laboratory and imaging results should link directly to the skilled nursing facility CPT codes billed, reducing payer scrutiny.
- Provider signatures: All services billed under skilled nursing billing codes must be signed by a qualified provider for compliance.
Check For: Pain Management Cpt Codes Cheat Sheet
Common Errors in Skilled Nursing Billing Codes
According to the Healthcare Financial Management Association (HFMA), the most frequent issues in SNF billing include:
- Underdocumentation: Providers bill 99309 CPT code without supporting interval history or exam findings.
- Overcoding: Selecting 99310 when only moderate complexity MDM is documented.
- Missing discharge codes: Facilities sometimes fail to bill 99315 or 99316, resulting in lost revenue.
- Improper use of initial codes: 99305 and 99306 were billed for established patients instead of new admissions.
Even small errors in choosing the correct skilled nursing billing codes can lead to compliance red flags or RAC audits.
Challenges in SNF CPT Code Billing
SNF billing presents several challenges:
- Complex Coverage Rules: Differentiating Medicare Part A vs. Part B services.
- High Denial Rates: Often caused by incorrect use of SNF CPT codes or insufficient documentation.
- Bundling Issues: Certain procedures are bundled under per-diem payments, complicating billing.
- Frequent Updates: Annual changes to CPT codes for skilled nursing facilities require ongoing staff training.
Skilled Nursing Facility Billing Guidelines 2025
Recent updates impacting skilled nursing facility billing codes include:
- 2025 CMS Rule Updates: More emphasis on prior authorization for therapy services under Part B.
- Telehealth Extensions: Many telehealth CPT codes remain reimbursable under SNF billing.
- Value-Based Care Models: Facilities are incentivized to track outcomes alongside service volume.
Staying current with these SNF billing guidelines ensures both compliance and optimized reimbursement.
Why Choose AffinityCore for Skilled Nursing Facility CPT Code Accuracy?
At AffinityCore, we specialize in simplifying the complexities of SNF CPT codes, nursing home visit CPT codes, and skilled nursing billing codes. Our certified coders ensure that every service, from initial assessments (99304–99306) to subsequent visits, such as the 99309 CPT code, is billed accurately, modifiers are correctly applied, and compliance standards are met.
With advanced skilled nursing facility billing solutions, denial prevention strategies, and technology-driven workflows, we help SNFs reduce claim rejections, strengthen compliance, and accelerate reimbursement.
Ready to streamline your SNF billing? Partner with AffinityCore today!
FAQs
Q1. What are the most common CPT codes for skilled nursing facilities?
Ans. The most frequently used SNF CPT codes include 99304–99310 for evaluation and management (E/M) services, therapy codes (97161–97168), and diagnostic codes like 80053. These skilled nursing billing codes ensure providers capture the full scope of services delivered in SNFs.
Q2. How are CPT codes different from HCPCS codes in SNF billing?
Ans. Skilled nursing facility CPT codes represent medical and clinical services, while HCPCS Level II codes describe equipment, supplies, and non-physician services. Together, they form the backbone of skilled nursing billing codes required for accurate reimbursement.
Q3. Do SNFs use modifiers in billing?
Ans. Yes. Modifiers such as 25, 59, RT, LT, and 50 are often applied to skilled nursing facility CPT codes to provide context about the service (e.g., right carpal tunnel release vs. left). Proper use of modifiers helps avoid denials and ensures accurate reporting under skilled nursing CPT codes.
Q4. How often are SNF CPT codes updated?
Ans. Skilled nursing facility CPT codes are updated annually by the AMA, while CMS issues yearly revisions to skilled nursing billing guidelines. For example, updates to the 99309 CPT code description directly affect how providers report ongoing patient care in SNFs.
Q5. What is the biggest challenge in SNF billing?
Ans. The biggest hurdles include documentation errors, misuse of skilled nursing CPT codes, and confusion when selecting the right CPT code for skilled nursing facility billing under Medicare Part A vs. Part B. These challenges can lead to increased denials and revenue loss if not managed properly.
