10/15/2025
Government Shutdown & Medicare Claims
Important Notice from AMA's Federal Relations:
As the federal government shutdown continues, the AMA continues to monitor the impact of the government shutdown, and any impacted physicians are encouraged to email AMA advocacy staff at ama.advocacy@ama-assn.org and include the subject heading “Medicare Payment Delay.”
Please NOTE:
CMS just issued updated guidance to Medicare Administrative Contractors (MACs) instructing them to limit the Medicare claims hold for services provided on or after October 1, 2025, that are impacted by the expired Medicare legislative payment provisions, including telehealth services other than for behavioral or mental health care, and services provided in locations with a work geographic practice cost index (GPCI) below the 1.0 floor. For all other services, Medicare claims will continue to be processed and paid in a timely manner. To date, no payments have been delayed as statute already requires all claims to be held for a minimum of 14 days.
CMS just issued updated guidance to Medicare Administrative Contractors (MACs) instructing them to limit the Medicare claims hold for services provided on or after October 1, 2025, that are impacted by the expired Medicare legislative payment provisions, including telehealth services other than for behavioral or mental health care, and services provided in locations with a work geographic practice cost index (GPCI) below the 1.0 floor. For all other services, Medicare claims will continue to be processed and paid in a timely manner. To date, no payments have been delayed as statute already requires all claims to be held for a minimum of 14 days.
CMS has also updated its telehealth FAQs.
Further information on use of the ABN, including ABN forms and form instructions: https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn.
Practitioners should monitor Congressional action and may choose to hold claims associated with telehealth services that are not payable by Medicare in the absence of Congressional action.
Learn More at:
https://www.cms.gov/medicare/coverage/telehealth.
https://www.cms.gov/medicare/coverage/telehealth.