Recent CMS Updates: Claims Hold and Vaccine Administration Edit
CMS recently released several important billing and claims updates that may impact provider payments and telehealth services beginning October 2025.
Temporary Claims Hold
CMS has instructed Medicare Administrative Contractors (MACs) to temporarily hold certain Medicare claims dated October 1, 2025, and later.
This includes:
- Claims paid under the Medicare Physician Fee Schedule
- Ground ambulance transport claims
- Federally Qualified Health Center (FQHC) claims
Providers can still submit claims, but payments will be paused until further notice while CMS awaits possible Congressional action related to expired Medicare payment provisions.
Telehealth Service Updates
Unless Congress acts, many of the temporary telehealth flexibilities that were introduced during the COVID-19 Public Health Emergency have expired as of October 1, 2025.
Key changes include:
- Some non-behavioral health telehealth services are no longer covered for patients outside of rural areas or in their homes.
- Hospice recertifications now again require an in-person visit.
Clinicians providing telehealth services that may not be covered by Medicare should consider using an Advance Beneficiary Notice of Noncoverage (ABN) to inform patients of possible out-of-pocket costs.
Providers in certain Medicare Shared Savings Program ACOs may continue to use telehealth flexibilities without geographic restrictions.
Vaccine Administration Edit Correction
CMS also identified and corrected an edit affecting some COVID-19 vaccine administration claims.
Claims for 90480 that were denied when billed with G0008, G0009, or G0010 were impacted by a recent NCCI Procedure-to-Procedure edit.
As of October 14, 2025, CMS has issued corrected files, and MACs will automatically reprocess affected claims from July 1–October 15, 2025—no provider action is needed.
Resource: Special Edition: Claims Hold Update | Vaccine Administration Edit