Written by Jeremy Carter.
Navigating the world of medical billing can feel overwhelming, especially when it comes to understanding CPT (Current Procedural Terminology) codes. For nursing homes and skilled nursing facilities, these codes are vital. They ensure correct billing for services provided and help maintain compliance with both Medicaid and Medicare regulations.
This guide will simplify things by focusing on the most common nursing home CPT codes for 2025. Whether you’re a healthcare professional, billing specialist, or just looking to better understand medical billing processes, we’ve got you covered.
What Are CPT Codes and Why Are They Important?
CPT codes are standardized five-digit codes used by healthcare providers to document and bill for medical services and procedures. Maintained by the American Medical Association (AMA), these codes ensure uniformity and accuracy in healthcare billing across the United States.
For nursing homes, CPT codes play a major role in capturing the variety of services provided to their residents. From routine checkups to physical therapy, these codes itemize every service delivered, ensuring proper reimbursement under systems like Medicaid, Medicare, and private insurers.
The Difference Between CPT and HCPCS Codes
Before we jump into the codes themselves, it’s important to clarify how CPT codes differ from HCPCS (Healthcare Common Procedure Coding System) codes. While CPT codes cover most medical services, HCPCS codes were created by CMS (Centers for Medicare & Medicaid Services) to capture services not included in the CPT code set—like durable medical equipment or consumable supplies.
For nursing facilities, it’s common to use a combination of both CPT and HCPCS codes daily to experience nursing home billing services that are seamless and efficient.
Benefits of Accurate Coding in Nursing Homes
Accurate coding does more than secure timely payments; it impacts every aspect of an organization, including financial health, compliance, and quality of care delivery.
Here are some benefits of using correct CPT codes:
- Timely Reimbursement: Avoid delays in payments by accurately documenting services.
- Regulatory Compliance: Ensure all billing complies with Medicaid and Medicare standards.
- Enhanced Patient Care: Transparency in services fosters trust among patients and families while optimizing workflows.
- Reduced Errors and Audits: Having a strong coding process minimizes billing errors, preventing potential audits or penalties.
The Most Common Nursing Home CPT Codes in 2025
Below is a list of the most frequently used CPT codes for nursing facilities in 2025, categorized by key services.
-
Evaluation and Management (E&M) Services
Evaluation and management services comprise a large portion of nursing home practices. They cover everything from routine evaluations to more detailed reviews of a patient’s ongoing care.
- 99304 – Initial nursing facility care for a new or established patient (comprehensive).
- 99305 – Initial nursing facility care requiring moderate medical decision-making.
- 99306 – Initial nursing facility care requiring high medical decision complexity.
- 99307 – Subsequent nursing facility care (straightforward/simpler).
- 99308 – Subsequent care requiring low complexity.
- 99309 – Subsequent nursing care requiring moderate complexity.
- 99310 – Subsequent care requiring high complexity decisions.
These codes track caregiver-patient interactions, ensuring appropriate care levels are recorded and billed accurately.
-
Therapeutic and Rehabilitative Services
Rehabilitation services are integral to nursing facilities, as many residents require physical, occupational, or speech therapy. Some common procedures include:
- 97110 – Therapeutic exercises to develop strength and endurance.
- 97112 – Neuromuscular re-education interventions.
- 97530 – Therapeutic activities aimed at functional use enhancement.
- 92507 – Speech therapy (individual sessions).
- 92526 – Evaluation or treatment for swallowing and related disorders.
These codes allow facilities to capture their work assisting residents with mobility, coordination, and communication challenges.
-
Lab and Diagnostic Services
Routine lab work and diagnostic procedures are essential for monitoring a resident’s condition. Key codes for 2025 include:
- 81001 – Urinalysis with microscopy.
- 85610 – Prothrombin time testing (used for anticoagulation therapy management).
- 80048 – Basic metabolic panel (routine lab tests).
- 93010 – Electrocardiogram, interpretation and report only.
- 36415 – Routine venipuncture.
Accurate coding for diagnostic services ensures proper monitoring of chronic conditions often associated with aging, such as diabetes or heart disease.
-
Preventive Care Services
Preventive care plays an essential role in improving residents’ long-term health. These services are commonly coded as follows:
- 99381 – Initial comprehensive preventive service evaluation (new patients).
- 99391 – Periodic comprehensive re-evaluation for established patients.
- 90732 – Pneumococcal vaccine administration.
- 90658 – Annual influenza vaccine (seasonal).
Using codes for routine vaccinations and wellness checkups also demonstrates your facility’s proactive approach to resident health.
-
Mental Health and Behavioral Services
Mental health services are equally vital, given the common prevalence of mood disorders, dementia, or anxiety among nursing home residents.
- 90832 – Individual psychotherapy, 30 minutes.
- 90834 – Individual psychotherapy, 45 minutes.
- 90853 – Group psychotherapy sessions.
- 96127 – Brief emotional/behavioral assessments (such as anxiety or depression scales).
By coding these services accurately, nursing homes can better illustrate the importance of mental wellness for their residents.
-
Palliative and End-of-Life Care
End-of-life care becomes a sensitive yet critical area of service in skilled nursing facilities. Common codes include:
- 99377 – Hospice care planning services requiring extensive decision-making.
- 99397 – Routine final-stage follow-ups for long-term residents.
These codes acknowledge the compassionate and personalized care residents and their families receive during this time.
How Artificial Intelligence Supports Better Coding
With the growing complexity of medical billing, artificial intelligence and augmentative data analysis tools are changing the game for skilled nursing facilities.
AI-powered platforms help reduce time spent on manual coding, identify missed billing opportunities, and flag discrepancies to prevent errors or rejections. Tools like these can quickly identify usage trends in CPT and HCPCS codes, ensuring billing departments stay accurate and efficient.
By leveraging AI, facilities can improve their overall workflow while focusing more resources on providing care, not chasing down denied claims.
Next Steps for Your Facility
Understanding and implementing the correct CPT codes doesn’t have to be daunting. By keeping updated with industry changes and incorporating tools like AI-driven solutions, your facility can stay ahead of regulatory requirements while delivering excellent service.
Curious about how to streamline your coding workflows further? Explore our guide to AI-driven billing systems, or reach out to us directly. Improved accuracy and efficiency could be just one tool away.
Please also review AIHCP’s Health Care Ethics Consultant Certification program and see if it meets your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification