Update on the Government Shutdown: Medicare Claims Hold
On October 15, 2025, the Centers for Medicare and Medicaid Services (CMS) issued a statement on the continued hold of all fee schedule claims. You may have heard that CMS decided to pause reimbursement for all Medicare claims until after the shutdown, but this decision was quickly reversed after much pushback. In this blog, we discuss the latest update and what it means for you.
Certain Medicare Claims Will Remain on Hold
While CMS initially instructed Medicare Administrative Contractors (MACs) to continue to hold all Medicare claims until further notice, this decision was quickly reversed after significant pushback.
Now, only Medicare claims impacted by expired provisions will remain on hold. While this is good news for claims outside of these provisions, there are still many types of claims that remain affected, including claims for telehealth other than behavioral and mental health services and claims for care delivered in low-cost geographic areas. In some cases, Medicare claims reimbursements across entire states are affected, as we discuss in the next section of this blog.
Note that the claims hold does not apply to Medicare Advantage or to Medicaid.
For more information on the types of claims affected by expired provisions and additional details on the shutdown, refer to our previous blog: What You Need to Know about the Government Shutdown.
You can also click on the dropdown below for a reminder on the telehealth flexibilities that expired on September 30, 2025. Claims for these services will not be reimbursed unless Congress acts to renew these flexibilities.
Impact on Medicare Reimbursement in Low-Cost Geographic Areas
On September 30, 2025, the 1.0 floor on the geographic practice cost index (GPCI) adjustment to the physician work component of Medicare reimbursements expired. As it is uncertain whether the floor will be reinstated by Congress when they pass the budget, CMS is holding all claims impacted by the expiration of the 1.0 work GPCI floor. This impacts 51 of the 109 Medicare localities, 30 of which encompass entire states and/or US territories.
Click on the dropdown below to see the 51 localities impacted by the expiration of the GPCI work floor. For these localities, payments will be held until the shutdown ends or until further CMS action.
To see the localities that were not impacted by the expiration of the GPCI work floor, click on the dropdown below. For these localities, payments will be processed normally.
Next Steps
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Written By: Jessica Peterson, MD, MPH & Sarrah Hakim, MHSA
About the Authors:
Jessica Peterson, MD, MPH is the Senior Director of Value-Based Care Policy at Anatomy IT.
Sarrah Hakim, MHSA is a Manager of Health Policy at Anatomy IT.
