Effective October 1, 2025, The Centers for Medicare & Medicaid Services (CMS) has released an update on Medicare operations during the current government shutdown. Two key areas affect providers:
Temporary Claims Hold
CMS has directed all Medicare Administrative Contractors (MACs) to implement a temporary hold on claims for up to 10 business days. This is a standard practice when legislative payment provisions are set to expire. Providers may continue to submit claims during this period, but payments will not be released until the hold is lifted. Because Medicare already has a 14-day payment floor, CMS expects the impact on providers to be minimal.
Reversion of Telehealth Coverage Rules
Unless Congress acts, beginning October 1, 2025, Medicare telehealth coverage will revert to the limitations in place before the COVID-19 Public Health Emergency. This means most telehealth services provided to patients in their homes or outside of rural areas will no longer be covered. Some services, like hospice recertification visits, will again require in-person encounters. Importantly, behavioral and mental health telehealth services remain covered, and clinicians in certain Medicare Shared Savings Program ACOs may continue to provide covered telehealth regardless of geographic location or patient site.
What This Means for You
Claims may be delayed, but you should continue to submit as usual. Payments will resume once the hold is lifted.
For telehealth visits, carefully review coverage requirements. If you provide services that Medicare may not cover after October 1, consider issuing an Advance Beneficiary Notice of Noncoverage (ABN) so patients are aware of potential financial responsibility.
Practices participating in Medicare Shared Savings Program ACOs may continue providing and billing for covered telehealth services under current ACO rules.
Behavioral and mental health telehealth visits remain protected.
We will continue to monitor CMS updates closely and share new guidance as it becomes available. For further details, visit CMS’s telehealth resources: https://www.cms.gov/medicare/coverage/telehealth.
