The Centers for Medicare and Medicaid Services (CMS) has directed all Medicare Administrative Contractors (MACs) to temporarily hold Medicare claims for services provided on or after October 1, 2025, that are affected by the expired legislative payment provisions. This includes most telehealth services, excluding behavioral or mental health care, and services in areas with a work geographic practice cost index (GPCI) below the 1.0 floor. All other Medicare claims will continue to be processed and paid in a timely manner.
Several COVID-era Medicare telehealth flexibilities expired on September 30. With the exception of behavioral health services, telehealth is once again limited to rural areas, patients can no longer receive telehealth services in their homes, and audio-only services are no longer permitted. (See the updated CMS Telehealth FAQs for details.)
KMA, in partnership with national organizations, is closely monitoring these developments and their potential impact on claims processing and physician payment. We will continue to provide updates as more information becomes available.
More details on the limited Medicare claims hold are available here.