On October 21, the Centers for Medicare & Medicaid Services (CMS) released updated guidance to Medicare Administrative Contractors (MACs) regarding the processing of Medicare claims during the ongoing federal government shutdown. The American Medical Association (AMA) has been in active communication with CMS to help clarify previous instructions, as significant confusion had developed among providers about which claims were being processed and paid.
According to the latest directive, CMS has instructed all MACs to lift the claims hold and process claims with dates of service on or after October 1, 2025, for certain services impacted by the expired Medicare legislative payment provisions (Full-Year Continuing Appropriations and Extensions Act, 2025 (Pub. L. 119-4, Mar. 15, 2025). This applies to claims paid under the Medicare Physician Fee Schedule, ground ambulance transports, and Federally Qualified Health Center (FQHC) claims. Importantly, this also includes telehealth claims that CMS can verify as definitively behavioral or mental health services.
However, CMS has directed MACs to continue holding all other telehealth claims, specifically those the agency cannot confirm as behavioral or mental health services, as well as claims related to the Acute Hospital Care at Home program. These services remain on hold pending further Congressional action to address the expired provisions.