Medicare to Continue to Hold Claims

Due to the continued government shutdown, CMS has instructed all Medicare Administrative Contractors to continue to hold claims for all services reimbursed under the Medicare Physician Fee Schedule.

Update from CMS:

In light of the continuing government shutdown, CMS will continue to process and pay held claims in a timely manner with the exception of select claims for services impacted by the expired provisions. 

Claims impacted by the expired provisions include outpatient therapy delivered via telehealth. In addition, several localities are impacted by the geographic price cost index (GPCI) minimum work floor of 1.0. On October 1, 2025, that legislation expired and many localities will now have a work GPCI of less than 1.0. Those localities may have payments withheld as well.

Stay tuned!