October 24, 2025
CMS has instructed all Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with service dates of October 1, 2025, and later for certain services impacted by select expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025 (Pub. L. 119-4, Mar. 15, 2025). This includes:
Claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and Federally Qualified Health Center (FQHC) claims.
Telehealth claims that CMS can confirm are definitively for behavioral and mental health services. Please note that CMS has directed all MACs to continue to temporarily hold claims for other telehealth services (i.e., those that CMS cannot confirm are definitively for behavioral and mental health services) and for acute Hospital Care at Home claims. More information is available on the CMS website.
CMS also notes that the Bipartisan Budget Act of 2018 (Pub. L. 115-123, Feb. 9, 2018), which added section 1899(l) to the Social Security Act, allows clinicians in applicable Medicare Shared Savings Program Accountable Care Organizations (ACOs) to provide and receive payment for covered telehealth services to certain Medicare beneficiaries without geographic restrictions and in the beneficiary’s home.
Get more information, including details on which ACOs these flexibilities apply to.