Government shutdown impacts Medicare claims hold

CMS 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.

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.”