In anticipation of possible congressional action, the Centers for Medicare & Medicaid Services has instructed Medicare administrative contractors to limit the Medicare claims hold for services provided on or after Oct. 1, 2025, that are impacted by expired Medicare legislative payment provisions.
This includes telehealth services other than for behavioral or mental health care, as well as services provided in locations with a work geographic practice cost index (GPCI) below the 1.0 floor. Providers may continue to submit these claims, but payment will not be released until the hold is lifted.
According to CMS, all other Medicare claims will be processed and paid in a timely manner, and no payments have been delayed, as statute already requires all claims to be held for a minimum of 14 days.
Questions about Medicare claims processing may be directed to coding@aasm.org.
