{"id":2602,"date":"2025-10-22T18:41:31","date_gmt":"2025-10-22T18:41:31","guid":{"rendered":"https:\/\/consulmed.com\/c\/?p=2602"},"modified":"2025-11-18T23:25:46","modified_gmt":"2025-11-18T23:25:46","slug":"cms-medicare-claims-hold-update-october-2025","status":"publish","type":"post","link":"https:\/\/consulmed.com\/c\/cms-medicare-claims-hold-update-october-2025\/","title":{"rendered":"Claims Hold Update"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><p>\u00a0<\/p>\n<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-blend:overlay;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-2\"><h2 class=\"mb-2 mt-4 font-display font-semimedium text-base first:mt-0\"><span style=\"color: #ffffff;\">CMS Claims Hold Update: October 2025<\/span><\/h2>\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">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.<\/p>\n<h3 class=\"mb-2 mt-4 font-display font-semimedium text-base first:mt-0\"><span style=\"color: var(--awb-color3);\">What Changed on<\/span> <a href=\"https:\/\/consulmed.com\/c\/government-shutdown-2025\/\" style=\"color: var(--awb-color1);\"><u>October 1, 2025<\/u><\/a><span style=\"color: var(--awb-color3);\">?<\/span><\/h3>\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Many temporary telehealth payment flexibilities introduced during the COVID-19 pandemic expired. As a result:<\/p>\n<ul class=\"marker:text-quiet list-disc\">\n<li class=\"py-0 my-0 prose-p:pt-0 prose-p:mb-2 prose-p:my-0 &#091;&amp;&gt;p&#093;:pt-0 &#091;&amp;&gt;p&#093;:mb-2 &#091;&amp;&gt;p&#093;:my-0\">\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Medicare no longer pays for many telehealth services provided in the patient&#8217;s home or outside rural areas.<\/p>\n<\/li>\n<li class=\"py-0 my-0 prose-p:pt-0 prose-p:mb-2 prose-p:my-0 &#091;&amp;&gt;p&#093;:pt-0 &#091;&amp;&gt;p&#093;:mb-2 &#091;&amp;&gt;p&#093;:my-0\">\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Hospice recertifications again require face-to-face encounters.<\/p>\n<\/li>\n<li class=\"py-0 my-0 prose-p:pt-0 prose-p:mb-2 prose-p:my-0 &#091;&amp;&gt;p&#093;:pt-0 &#091;&amp;&gt;p&#093;:mb-2 &#091;&amp;&gt;p&#093;:my-0\">\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Providers may need to use an Advance Beneficiary Notice of Noncoverage (ABN) if they offer telehealth services no longer covered by Medicare.<\/p>\n<\/li>\n<\/ul>\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">For ABN forms and instructions, visit:<br \/><a class=\"reset interactable cursor-pointer decoration-1 underline-offset-1 text-super hover:underline font-semibold\" href=\"https:\/\/www.cms.gov\/medicare\/forms-notices\/beneficiary-notices-initiative\/ffs-abn\" target=\"_blank\" rel=\"nofollow noopener\">CMS Beneficiary Notices Initiative<\/a><\/p>\n<h3 class=\"mb-2 mt-4 font-display font-semimedium text-base first:mt-0\" style=\"color: var(--awb-color3);\">Tips for Providers<\/h3>\n<ul class=\"marker:text-quiet list-disc\">\n<li class=\"py-0 my-0 prose-p:pt-0 prose-p:mb-2 prose-p:my-0 &#091;&amp;&gt;p&#093;:pt-0 &#091;&amp;&gt;p&#093;:mb-2 &#091;&amp;&gt;p&#093;:my-0\">\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Continue submitting eligible Medicare claims, especially for behavioral health telehealth and applicable ACO telehealth services.<\/p>\n<\/li>\n<li class=\"py-0 my-0 prose-p:pt-0 prose-p:mb-2 prose-p:my-0 &#091;&amp;&gt;p&#093;:pt-0 &#091;&amp;&gt;p&#093;:mb-2 &#091;&amp;&gt;p&#093;:my-0\">\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Monitor legislation closely, as Congress may modify telehealth payment rules.<\/p>\n<\/li>\n<li class=\"py-0 my-0 prose-p:pt-0 prose-p:mb-2 prose-p:my-0 &#091;&amp;&gt;p&#093;:pt-0 &#091;&amp;&gt;p&#093;:mb-2 &#091;&amp;&gt;p&#093;:my-0\">\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Consider holding non-payable telehealth claims temporarily until policies update.<\/p>\n<\/li>\n<\/ul>\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Learn more here:<br \/><a class=\"reset interactable cursor-pointer decoration-1 underline-offset-1 text-super hover:underline font-semibold\" href=\"https:\/\/www.cms.gov\/medicare\/coverage\/telehealth\" target=\"_blank\" rel=\"nofollow noopener\">CMS Telehealth Coverage<\/a><\/p>\n<h3 class=\"mb-2 mt-4 font-display font-semimedium text-base first:mt-0\" style=\"color: var(--awb-color3);\">Special Telehealth Flexibilities for ACOs<\/h3>\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">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\u2019s home. Clinicians in these ACOs can bill Medicare for covered telehealth services as usual.<\/p>\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">For details about applicable ACOs:<br \/><a class=\"reset interactable cursor-pointer decoration-1 underline-offset-1 text-super hover:underline font-semibold\" href=\"https:\/\/www.cms.gov\/files\/document\/shared-savings-program-telehealth-fact-sheet.pdf\" target=\"_blank\" rel=\"nofollow noopener\">Shared Savings Program Telehealth Fact Sheet (PDF)<\/a><\/p>\n<h3 class=\"mb-2 mt-4 font-display font-semimedium text-base first:mt-0\" style=\"color: var(--awb-color3);\">What to Do Next<\/h3>\n<ul class=\"marker:text-quiet list-disc\">\n<li class=\"py-0 my-0 prose-p:pt-0 prose-p:mb-2 prose-p:my-0 &#091;&amp;&gt;p&#093;:pt-0 &#091;&amp;&gt;p&#093;:mb-2 &#091;&amp;&gt;p&#093;:my-0\">\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Use ABNs for telehealth services that Medicare will not cover.<\/p>\n<\/li>\n<li class=\"py-0 my-0 prose-p:pt-0 prose-p:mb-2 prose-p:my-0 &#091;&amp;&gt;p&#093;:pt-0 &#091;&amp;&gt;p&#093;:mb-2 &#091;&amp;&gt;p&#093;:my-0\">\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Educate patients about changes to telehealth coverage and potential costs.<\/p>\n<\/li>\n<li class=\"py-0 my-0 prose-p:pt-0 prose-p:mb-2 prose-p:my-0 &#091;&amp;&gt;p&#093;:pt-0 &#091;&amp;&gt;p&#093;:mb-2 &#091;&amp;&gt;p&#093;:my-0\">\n<p class=\"my-2 &#091;&amp;+p&#093;:mt-4 &#091;&amp;_strong:has(+br)&#093;:inline-block &#091;&amp;_strong:has(+br)&#093;:pb-2\">Stay updated with CMS announcements and Congressional actions.<\/p>\n<\/li>\n<\/ul>\n<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-3\"><p>\u00a0<\/p><\/p>\n<\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":2558,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[23],"tags":[],"class_list":["post-2602","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-government"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\r\n<title>Claims Hold Update - Consulmed<\/title>\r\n<meta name=\"description\" content=\"CMS lifts Medicare claims hold for select services starting Oct 1, 2025. 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