CMS Clarifies Telehealth Coverage and Claims Adjustments Following Government Shutdown
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- What’s Happening: CMS has issued an update clarifying that Medicare telehealth services remain payable through January 30, 2026, with retroactive coverage for services provided during the federal government shutdown
- Why It Matters for New York Physicians: Physicians may resubmit telehealth claims impacted by the lapse in payment authorization from October 1–November 10, 2025.
- Impact on You and Your Practice: Claims returned with FISS reason codes WW120 and WW121 are now being processed normally by NGS; providers should review and resubmit any affected claims.
- MSSNY Action: MSSNY continues to monitor Medicare policy updates and advocate for clear, consistent payment processes to protect physician practices.
For New York physicians navigating Medicare billing amid ongoing federal changes, CMS has issued updated guidance on processing telehealth claims affected by the government shutdown. The update clarifies that all Medicare telehealth flexibilities have been retroactively restored through January 30, 2026, ensuring continuity of payment and coverage for services rendered to patients during the lapse.
According to communications received by MSSNY from CMS and National Government Services (NGS), physicians can now resubmit telehealth claims that were previously returned or denied between October 1 and November 10, 2025. These claims, once rejected due to the temporary expiration of telehealth provisions, are now payable under reinstated statutory authority. Practitioners should identify affected claims—particularly those marked with FISS Reason Codes WW120 and WW121, and resubmit them to ensure full reimbursement.
CMS has also updated its Telehealth Frequently Asked Questions to reflect these changes. Of particular note, FAQ #16 confirms that telehealth services provided during the shutdown will be paid as if the lapse never occurred, protecting both physicians and patients from financial disruption.
MSSNY recognizes that administrative changes like these add significant pressure to already overextended practices. As New York physicians continue providing high-quality care amid shifting federal timelines, MSSNY remains a partner and advocate, ensuring members receive timely updates and support in navigating Medicare compliance.
