CMS Claims Hold Update: October 2025

CMS has lifted the claims hold for certain Medicare services with dates of service October 1, 2025, and later. This includes claims under the Medicare Physician Fee Schedule, ground ambulance, and Federally Qualified Health Centers (FQHCs). In addition, CMS is now processing telehealth claims clearly identified as behavioral and mental health services. However, claims for other telehealth services and acute Hospital Care at Home remain on hold for now.

What Changed on October 1, 2025?

Many temporary telehealth payment flexibilities introduced during the COVID-19 pandemic expired. As a result:

• Medicare no longer pays for many telehealth services provided in the patient’s home or outside rural areas.

• Hospice recertifications again require face-to-face encounters.

• Providers may need to use an Advance Beneficiary Notice of Noncoverage (ABN) if they offer telehealth services no longer covered by Medicare.

For ABN forms and instructions, visit:
CMS Beneficiary Notices Initiative

Tips for Providers

• Continue submitting eligible Medicare claims, especially for behavioral health telehealth and applicable ACO telehealth services.

• Monitor legislation closely, as Congress may modify telehealth payment rules.

• Consider holding non-payable telehealth claims temporarily until policies update.

Learn more here:
CMS Telehealth Coverage

Special Telehealth Flexibilities for ACOs

The Bipartisan Budget Act of 2018 allows clinicians in certain Medicare Shared Savings Program ACOs to provide telehealth without geographic restrictions. This includes care in the beneficiary’s home. Clinicians in these ACOs can bill Medicare for covered telehealth services as usual.

For details about applicable ACOs:
Shared Savings Program Telehealth Fact Sheet (PDF)

What to Do Next

• Use ABNs for telehealth services that Medicare will not cover.

• Educate patients about changes to telehealth coverage and potential costs.

• Stay updated with CMS announcements and Congressional actions.