After the government shutdown earlier this fall, several Medicare payment provisions expired on October 1, 2025. With the passage of the Continuing Appropriations and Extensions Act, 2026, Congress has now retroactively restored many of these policies through January 30, 2026—including key Medicare telehealth flexibilities that allow patients to receive telehealth services from home and in non-rural areas.
How Claims Were Affected
During the lapse, MACs processed claims based on the payment schedules available at the time. CMS has now instructed MACs to mass-adjust previously paid claims that are not consistent with the restored provisions, including updates for:
- Low-volume hospitals
- Medicare-dependent hospitals
- Certain telehealth claims
- Acute Hospital Care at Home services
Telehealth Claim Guidance
Some telehealth claims submitted before November 10 were returned when the statutory flexibilities temporarily expired. These services are now payable again, and providers may:
- Resubmit returned telehealth claims
- Submit claims previously held pending Congressional action
- Refund beneficiaries who were billed for dates of service now retroactively covered
- Note that the earlier guidance to append the GY modifier has been rescinded
Hospital at Home Claims
Claims for the Acute Hospital Care at Home initiative dated on or after October 1 may now also be resubmitted.
MAC Operations
Claims processing is expected to return to normal. CMS recommends contacting your MAC only if you see specific issues.
CY 2026 ESRD PPS Final Rule
CMS has finalized updates to the End-Stage Renal Disease (ESRD) Prospective Payment System for CY 2026, including:
- A new PPS base rate of $281.71
- An estimated 2.2% increase in total payments to ESRD facilities
- Updates to AKI dialysis payment rates
- Adjustments to the ESRD Quality Incentive Program
- A new non-labor cost adjustment for facilities in Alaska, Hawaii, and U.S. Pacific Territories
Resource: Update on Processing of Medicare Claims Impacted During the Government Shutdown