CMS Announces Status on Processing Claims

The Centers for Medicare and Medicaid Services (CMS) recently provided guidance to Medicare Administrative Contractors (MACs) to process claims with dates of service of October 1, 2025, and later. Services impacted by the expired appropriations legislation had a claims hold, including those paid under the Medicare Physician Fee Schedule.

However, CMS has instructed MACs to continue to temporarily hold claims for telehealth other than for behavioral and mental health services. CMS has advised that practitioners who choose to perform telehealth services that are not currently payable by Medicare on or after October 1, 2025, can either hold claims associated with telehealth services or could consider providing beneficiaries with an Advance Beneficiary Notice of Noncoverage (ABN).