UPDATE: Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service October 1, 2025, and later

This afternoon, CMS released the below updated guidance, directing all Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service October 1, 2025, and later for services affected by the expiration of temporary payment provisions under the Full-Year Continuing Appropriations and Extensions Act, 2025 (P.L. 119-4). This includes claims under the Medicare Physician Fee Schedule, ground ambulance services, and Federally Qualified Health Center (FQHC) claims. MACs will also process telehealth claims that can be confirmed as behavioral or mental health services, while continuing to hold other telehealth and Hospital Care at Home claims pending further guidance.

Practitioners providing services no longer payable by Medicare should consider issuing an Advance Beneficiary Notice of Noncoverage (ABN). Clinicians participating in eligible Medicare Shared Savings Program ACOs may continue furnishing covered telehealth services without geographic restrictions under section 1899(l) of the Social Security Act.