The Centers for & Medicaid Services (CMS) on Tuesday revised its guidance on a temporary hold on claims payments as the government shutdown enters its fourth week.
CMS has instructed Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service of October 1, 2025 and later for “services impacted by select expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025.”
When lawmakers could not agree on a spending measure for fiscal year 2026 and the government shut down on October 1, it also impacted telehealth flexibilities that have been in place since the pandemic. Extension of telehealth flexibilities expired on September 30 and were tied to the House-passed continuing resolution to fund the government through November 21.
After the shutdown, payment for telehealth services returned to pre-pandemic restrictions and CMS told MACs to place a temporary hold on claims payments for up to 10 business days. Providers could continue to submit claims, but payments will be delayed until the hold is lifted.
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In the revised guidance issued Tuesday, CMS told MACs they could process claims paid under the Medicare Physician Fee Schedule and ground ambulance transport and Federally Qualified Health Center claims.
What this means for telehealth claims
The claims hold is also lifted for telehealth services that CMS can confirm are for behavioral and mental health services and for acute-hospital care at home claims.
The temporary hold is still in effect for other telehealth services—claims that CMS can’t confirm are definitely for behavioral and mental health services.
CMS suggests that providers who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025 may want to give Medicare beneficiaries an Advanced Beneficiary Notice of Noncoverage and choose to hold claims associated with telehealth services that are currently not payable by Medicare in the absence of Congressional action,