What’s New in Coding | July 2025 CMS Updates

Each quarter, the Centers for Medicare & Medicaid Services (CMS) updates coding systems critical to effective patient care, research, reimbursement, and reporting. The July 2025 changes to the Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) include several notable changes. They affect not just how services are coded, but how care is documented and reimbursed, making it essential to plan and prepare.

Key Updates to Know

• New HCPCS Codes for Drugs and Biologics: CMS added HCPCS Level II codes for newly approved therapies, particularly high-cost and specialty medications.
• PLA Codes Priced by Contractors: Proprietary Laboratory Analyses (PLA) codes are priced at the discretion of the individual Medicare Administrative Contractors until national pricing is established. This shift adds complexity to reimbursement workflows, making payer-specific strategy and coordination more critical than ever.
• Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement Revisions: New and revised codes for angiography and chemotherapy administration aim to improve coding specificity, but may require retraining for revenue cycle staff.
• Updates to Blood Clotting Factor and Prosthetic Codes: These changes reflect evolving treatment options and product use, and accurate documentation is essential to ensure appropriate reimbursement.

Why It Matters

HCPCS/ CPT and ICD-10-CM codes must work together. ICD-10-CM explains the why (e.g., hemophilia A), while HCPCS/CPT codes explain the what (e.g., clotting factor used). Incomplete or inaccurate coding, especially when specificity is lacking, can lead to claim denials, payment delays, and data quality issues that compromise both compliance and care.

How to Prepare

1. Update Systems: Ensure revenue cycle platforms, electronic health records, and code libraries reflect all changes by July 1
2. Train Your Teams: Offer focused sessions for revenue cycle teams, especially in high-impact areas like SNFs and specialty medications
3. Review Workflows: Audit charge capture for drug administration, lab services, and prosthetics to confirm code accuracy
4. Monitor Claims: Track early trends in rejections or denials tied to new codes to address issues quickly

Turning Compliance into Competitive Advantage

Accurate coding is not simply the domain of revenue cycle teams; it requires cross-functional alignment. Clinical staff, coders, and other revenue cycle professionals must collaborate to ensure that documentation supports compliance and accurately represents the care provided, while ensuring that operational processes can adapt to regulatory changes.

The July 2025 updates may appear technical, but they reflect broader trends in care delivery, regulatory oversight, and healthcare innovation. Staying informed and agile positions your organization not only to remain compliant but to lead in an increasingly data-driven and precise healthcare environment.

Learn how Nym's autonomous medical coding solution helps revenue cycle and health information management teams stay ahead of complex coding guideline updates.