SHUTDOWN NEWS: CMS says payment issues won't bite yet; give telehealth patients ABNs

by: Roy Edroso Oct 1, 2025

Members of Congress did not come to a budget agreement before the Oct. 1 start of the fiscal year, and a government shutdown of all but "essential" spending is now in effect. CMS has issued some advice to providers.

In a Medicare Learning Network email, CMS tells subscribers "certain legislative payment provisions (‘extenders') are scheduled to expire," and that it has told the Medicare administrative contractors (MAC) to "implement a temporary claims hold." But, the agency adds, this should have no immediate effect on payments:

This standard practice is typically up to 10 business days and ensures that Medicare payments are accurate and consistent with statutory requirements. The hold prevents the need for reprocessing large volumes of claims should Congress act after the statutory expiration date and should have a minimal impact on providers due to the 14-day payment floor. Providers may continue to submit claims during this period, but payment will not be released until the hold is lifted.

However, one of the unresolved issues in the budget is the status of the telehealth flexibilities that were set to expire on Oct. 1. CMS hints that Congress may eventually issue a retroactive fix that will allow practices to get paid on those claims if filed at a later date. In the meantime, have your advance beneficiary notices of noncoverage (ABN) handy:

In the absence of Congressional action, practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage. 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. Additionally, Medicare would not be able to pay some kinds of practitioners for telehealth services. For further information: https://www.cms.gov/medicare/coverage/telehealth.

CMS has also posted shutdown contingency plans for the Center for Clinical Standards and Quality for various audit, survey and certification activities. Part B News will keep tabs on shutdown actions that affect Medicare providers and keep you posted.

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Blog Tags: CMS, Legislation, telehealth

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