CMS Issues Update on Medicare Claims Hold Amid Federal Government Shutdown

As the federal government shutdown continues, the Centers for Medicare & Medicaid Services (CMS) has issued updated guidance directing all Medicare Administrative Contractors (MACs) to continue temporarily holding claims with dates of service of October 1, 2025, and later. This includes all claims paid under the Medicare Physician Fee Schedule, as well as ground ambulance and Federally Qualified Health Center (FQHC) claims.

Physicians and other health care providers may continue to submit claims; however, payment will not be released until CMS lifts the hold. The agency’s directive anticipates possible Congressional action related to the expired Medicare legislative payment provisions under the Full-Year Continuing Appropriations and Extensions Act, 2025.

Telehealth Flexibilities and GPCI Floor Expired

CMS also confirmed that several temporary Medicare flexibilities expired on October 1, 2025:

• Telehealth flexibilities have lapsed for care provided to all patients except those being treated for mental health or substance use disorders.
• The 1.0 work Geographic Practice Cost Index (GPCI) floor has expired, which may affect payment rates in certain regions.

In the absence of Congressional action, Medicare has reverted to pre-pandemic telehealth limitations for non-behavioral health services. These include restrictions on:

• Telehealth visits provided to beneficiaries in their homes or outside of rural areas; and
• Hospice recertifications that require a face-to-face encounter.

Practitioners who choose to furnish telehealth services not payable by Medicare on or after October 1, 2025, are advised to consider using an Advance Beneficiary Notice of Noncoverage (ABN). Guidance and forms for ABNs are available on the CMS Beneficiary Notices Initiative webpage

Special Telehealth Flexibilities for ACOs

CMS also emphasized that under the Bipartisan Budget Act of 2018, clinicians participating in Medicare Shared Savings Program Accountable Care Organizations (ACOs) retain certain telehealth flexibilities. These clinicians may continue to provide and receive payment for covered telehealth services without geographic restrictions and to patients in their homes. No special application or approval process is required for eligible ACOs. For more details, see CMS’s Shared Savings Program Telehealth Fact Sheet (PDF)

The American Medical Association (AMA) encourages physicians to monitor their MAC websites and the CMS Medicare Claims Processing page for the latest updates regarding claim holds and payment processing during the federal shutdown.

For additional information on Medicare Telehealth coverage, visit CMS Telehealth Coverage