*Note to APMA members that received the October 21 Weekly Focus: Shortly after the Weekly Focus was finalized, CMS updated its guidance and lifted most claims holds. The text in Weekly Focus should be disregarded. The news article below has been updated with the latest CMS guidance.
In anticipation of possible Congressional action, CMS has instructed all Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service of October 1 and later for services impacted by the expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025.
The claims hold has now been lifted for claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and Federally Qualified Health Center (FQHC) claims.
Claims holds on behavioral and mental health services have also been lifted. CMS has directed all MACs to continue to temporarily hold claims for telehealth services that CMS cannot confirm are definitively for behavioral and mental health services.
CMS has also directed all MACs to continue to temporarily hold Hospital Care at Home claims.
Members can view all government shutdown resources at www.apma.org/shutdown. Please contact the APMA Advocacy Department with any questions or concerns.