Update on Medicare Payments During the Government Shutdown
On October 20, 2025, the Centers for Medicare & Medicaid Services (CMS) gave new guidance to Medicare Administrative Contractors (MACs) about handling Medicare claims. This update was needed because many people were confused about which claims would be paid during the federal government shutdown.
Lifting of Claims Hold for Certain Services
CMS told all MACs to stop holding back claims and start processing them for some services provided on or after October 1, 2025. This change mainly affects services that lost special payment rules when a law expired but were covered again by a new law called the Full-Year Continuing Appropriations and Extensions Act, 2025. Some examples of services that will now be paid include those billed under the Medicare Physician Fee Schedule, ground ambulance rides, and services at Federally Qualified Health Centers (FQHCs).
Telehealth Claims Processing
CMS explained that telehealth claims (physician visits by phone or video) for behavioral and mental health services will be paid if they can be clearly identified. However, other telehealth claims—where it’s not clear if they are for behavioral or mental health—and claims for Hospital Care at Home will still be put on hold for now.
Changes to Telehealth Payment Rules
Starting October 1, 2025, for telehealth services not related to behavioral health, many of the special rules that allowed more telehealth visits during the COVID-19 pandemic have ended. Now, Medicare will not pay for some services if they are given to patients at home or outside of rural areas. Also, hospice recertifications must now include a face-to-face visit.
Advance Beneficiary Notice of Noncoverage (ABN)
If Congress doesn’t take further action, physicians who want to offer telehealth services that Medicare does not cover after October 1, 2025, should let their patients know ahead of time by giving them an Advance Beneficiary Notice of Noncoverage (ABN). You can find more information and the ABN forms at www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn. Physicians should keep watching for updates from Congress and may choose to wait before sending in claims for telehealth services that Medicare is not currently paying for. For more details, see www.cms.gov/medicare/coverage/telehealth.
Special Telehealth Rules for ACOs
A law from 2018 allows doctors in certain Medicare Shared Savings Program Accountable Care Organizations (ACOs) to provide and get paid for telehealth services without worrying about where the patient lives—even if the patient is at home. These doctors and their staff do not need to fill out any extra forms to get these special telehealth payments. CMS will pay for telehealth claims from ACO doctors for behavioral and mental health services, but some other telehealth claims will still be held. To see which ACOs this applies to, visit www.cms.gov/files/document/shared-savings-program-telehealth-fact-sheet.pdf.
Merit-based Incentive Payment System (MIPS) Payment Adjustment Information
The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) payment adjustment information for the 2024 performance period/2026 MIPS payment year. Physicians’ 2024 MIPS final score determines the MIPS payment adjustment physicians will receive in 2026. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2026. The AMA encourages physicians to review their final score as soon as possible as the deadline to file a Targeted Review is only open until November 14, 2025.
The AMA has sought clarification from CMS and they are still accepting and reviewing Targeted Reviews during the government shutdown. However, some decisions may be delayed due to the need for broader CMS staff review, and some staff are furloughed. There are no plans currently to extend the targeted review period.