Medicare Claims Update: CMS Limits Claims Hold Amid Federal Shutdown
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As the federal government shutdown continues, CMS has issued new instructions to all Medicare Administrative Contractors (MACs) to temporarily hold claims dated October 1, 2025 and later for services affected by expired legislative payment provisions under the Full-Year Continuing Appropriations and Extensions Act, 2025. This includes all claims paid under the Medicare Physician Fee Schedule, ground ambulance and Federally Qualified Health Center (FQHC) claims. Physicians may continue submitting claims; however, payments will remain on hold until further notice.
CMS clarified that these holds aim to prevent payment errors while Congress deliberates on extending the expired provisions. For all other services, claims continue to be processed normally, and no delays have yet occurred beyond the routine 14-day statutory hold.
Additionally, CMS confirmed that the temporary telehealth flexibilities enacted during the COVID-19 Public Health Emergency have now lapsed for most non-behavioral services. Only mental-health and substance-use disorder care delivered via telehealth remains eligible for reimbursement. Physicians delivering telehealth outside these parameters should review the CMS Telehealth Coverage page and consider providing patients with an Advance Beneficiary Notice (ABN)—see ABN Forms and Instructions—to clarify financial responsibility if Medicare denies payment.
CMS also notes that clinicians participating in Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program may continue to furnish telehealth services without geographic limitations under special flexibilities established by the Bipartisan Budget Act of 2018. For further detail, review the Shared Savings Program Telehealth Fact Sheet (PDF).
MSSNY urges all New York physicians to stay informed through official CMS resources, including the MLN Connects Newsletter – October 15, 2025, and Medicare Fee-for-Service Provider Information, and to remain alert for Congressional action that may lift the claim holds.
