October 2026 SNF CB update: therapy codes stay on File #4

CMS issued Change Request 14561 on August 21, 2026, as Transmittal 13881 to the Medicare Claims Processing Manual. MM14561 is the provider education (PDF last-modified August 26, 2026, 3:27 p.m. ET).

This is the October 2026 quarterly update to the HCPCS lists used for SNF consolidated billing (CB) enforcement. Effective date is October 1, 2026 (date of service). Implementation date is October 5, 2026.

It is not Wednesday's October 2026 CLFS/CLIA update. That CR is the lab fee schedule. This CR is the SNF CB enforcement file.

Therapy codes stay on File #4

CMS says certain therapy HCPCS codes "were inadvertently included in both Part B SNF CB File #1 and Part B SNF CB File #4." The CR is the correction: "The affected HCPCS codes will be removed from File #1 and will remain assigned to File #4."

MM14561 Table 8 is that list. Independently counted, Table 8 has 45 codes. Examples only: 90901, 97129, and 97550. This page does not reprint Table 8. Load the official files.

MM prints October 5, 2026 on every Table 8 row. The CR administrative note says the File #1 removals are effective with this quarterly implementation: "the codes identified as erroneously added to File #1 will be removed and will remain on File #4." Keep the CR header pair: effective October 1, 2026 (date of service); implementation October 5, 2026. Do not date the File #1 removals as October 1 DOS.

Part A exclusion adds and Part B file updates

The Part A file is MM Tables 1-4. Part B File #1 is MM Table 5. The same seven ADDs appear on both, dated July 1, 2026 in the MM tables: 1027T, C1609, 1050T, 1051T, 90616, 90639, and 1036T. 98978 is File #1 only, dated January 1, 2026.

The CR Part A narrative heading says "Effective July 01, 2025." Business requirements 14561.1 through 14561.4 and MM Tables 1-4 date those same seven ADDs July 1, 2026. This page uses the MM/BR 2026 dates.

The CR points billers to the CMS SNF CB file hub. That hub page last-modified March 3, 2026. It does not yet post October 2026 quarterly lists. Until CMS posts those files, use the CR and MM tables.

This is also not Tuesday's October 2026 HCPCS file / G0685. That ZIP is the Level II file-load. This CR is the SNF CB edit list.

When SNF CB applies to therapy vs other services

The CR background is the same rule the SNF desk already works from. For non-therapy services, "SNF CB applies only when the services are furnished to a SNF resident during a covered Part A stay." Therapy is the exception: "SNF CB applies to physical and occupational therapies and speech-language pathology services whenever they are furnished to a SNF resident, regardless of whether Part A covers the stay."

That is why a therapy HCPCS sitting on the wrong Part B file is not a trivia item. File #4 is where those codes belong for CB enforcement. File #1 is the one they come off.

What MACs will and will not reopen

MM14561 says MACs "won't search their files for incorrectly paid claims for HCPCS codes listed in Business Requirements 1-12 of this CR." They "will reopen and reprocess claims you bring to their attention."

If a claim paid against the old dual listing, bring that claim to the MAC. Do not wait for a sweep. The CR does not tell contractors to hunt the files.

What this is not

It is not a CMS-HCC or V28 mapping change. These are HCPCS used for SNF CB edits. They do not assign an HCC. If the question is risk adjustment, use the model year you are actually coding in ICD-10 to HCC.

It is not the FY 2027 ICD-10-CM Coding Guidelines. That PDF is still marked not yet available on the CMS ICD-10 page.

Look up a long descriptor in the encoder or the code book after you load the file. Do not rebuild the edit list from a 45-code blog dump.