On October 15, the Centers for Medicare & Medicaid Services (CMS) issued initial guidance suggesting that all Medicare claims for services rendered after October 1 might be held because certain legislative authorizations had lapsed. The agency later revised that guidance, explaining that only select claims tied to expired provisions — such as some telehealth and rural-care programs — are being temporarily held pending congressional renewal.
In its updated statement, CMS said that “to date, no payments have been delayed,” noting that all Medicare Administrative Contractors are still operating under the statutory 14-day “payment floor” for processing electronic claims. Under federal law, contractors must hold claims for at least 14 days before release, which the agency emphasized is standard procedure.
Medical groups including the American Medical Association and the Texas Medical Association said they are monitoring for any payment problems and have circulated CMS updates to members.
Specialty-society advisories add that limited holds are a routine safeguard when congressional “extender” programs expire, preventing large-scale reprocessing if lawmakers later reauthorize them. Current categories affected include select Physician Fee Schedule claims impacted by expired provisions, ground ambulance services, and federally qualified health center claims. Providers may continue submitting claims, with payment for held categories to resume once funding authority is restored.
Industry analysts note that even short administrative holds can strain smaller medical practices that depend on steady reimbursements, but no system-wide interruption in Medicare payments has been reported as of Thursday.
