By CMS’ notice, it appears that the reticence on lifting the temporary hold for nonbehavioral health telehealth claims is in response to the resurgence of pre-pandemic telehealth coverage restrictions.

Claims Payment Hold

Due to the U.S. government shutdown, the Centers for Medicare and Medicaid Services (CMS) have paused reimbursement payments for nonbehavioral health telehealth Medicare claims, pending congressional action. This pause has been in effect for nonbehavioral health telehealth claims and acute hospital care at home claims since October 1, 2025. Last month, CMS issued a claims hold update for the Medicare fee schedule, ground ambulance transport and federally qualified health center claims. CMS instructed Medicare administrative contractors (MACs) to continue temporarily holding claims with dates of service of October 1, 2025, and later. This directive was a response to expired Medicare legislative payment provisions that were part of the Full-Year Continuing Appropriations and Extensions Act 2025.

However, on October 21, 2025, CMS issued a new claims hold update, directing MACs to lift the claims hold for Medicare physician fee schedule, ground ambulance transport and federally qualified health center claims, including telehealth claims that “CMS can confirm are definitively for behavioral and mental health services.”

Of note, CMS directed MACs to continue to temporarily hold claims for nonbehavioral and mental health services telehealth claims and for acute hospital care at home claims. By CMS’ notice, it appears that the reticence on lifting the temporary hold for nonbehavioral health telehealth claims is in response to the resurgence of pre-pandemic telehealth coverage restrictions.

Telehealth Statutory Flexibilities

A new congressional bill, Section 207 of the Continuing Appropriations Act 2026 (H.R. 5371), if passed, would have statutorily extended certain telehealth flexibilities, mainly for nonbehavioral healthcare services. 

Given the bill’s failure in the Senate, pre-COVID-19 restrictions for Medicare telehealth coverage will continue to be in effect until congressional action further extends the telehealth flexibilities. Until the bill or other legislation is passed (and perhaps through an end to the U.S. government shutdown), the following coverage restrictions will be in place: 

1. Provider limitations so that physical therapists, occupational therapists, speech-language pathologists and audiologists are no longer permitted to provide Medicare covered telehealth services;
2. Geographic restrictions and originating site restrictions, such as that beneficiaries should be located in a rural area and in a medical facility to receive covered telehealth services;
3. Audio-only telehealth services for nonbehavioral health may not be covered;
4. Hospice recertifications require a face-to-face encounter; and
5. Aside from rural health clinics and federally qualified health centers, an in-person visit within six months of an initial Medicare behavioral/mental telehealth service will not be covered, under 42 C.F.R. § 405.2463(b)(3).

CMS released an October 1, 2025, frequently asked questions (FAQ) further explaining the above-listed telehealth coverage restrictions. For example, the FAQ clarifies that telehealth services using audio-only communication may be covered so long as the beneficiary is not capable of using or does not consent to using audio-video technology. Additionally, per the FAQ, CMS will not require a six-month in-person visit for beneficiaries that received mental health treatment in their home prior to October 1, 2025. CMS stated:

[If] a beneficiary began receiving mental health services on or before September 30, 2025, then they would not be required to have an in-person visit within 6 months; rather, they will be considered established and will instead be required to have at least one in-person visit every 12 months.

Additionally, the FAQ made clear that audio-only technology is permitted for behavioral health telehealth services and that there are no geographic and place of service restrictions for coverage of behavioral health telehealth services.

The FAQ lastly provides medical coding guidance for affected providers. CMS, for example, stated that through December 31, 2025, rural health clinics and federally qualified health centers may continue to bill for nonbehavioral telehealth services by using the HCPCS code G2025 on a claim.

Takeaways for Providers

Affected providers may consider structuring ongoing telehealth services to adhere to telehealth coverage restrictions and issuing beneficiaries advance notices of coverage to increase the likelihood of payment for rendered services.

Duane Morris will be monitoring further congressional action in this area.

For More Information

If you have any questions about this Alert, please contact Erin M. Duffy, Neville M. Bilimoria, Victoria (Tori) Hawekotte, any of the attorneys in our Health Law Practice Group or the attorney in the firm with whom you are regularly in contact. 

Disclaimer: This Alert has been prepared and published for informational purposes only and is not offered, nor should be construed, as legal advice. For more information, please see the firm's full disclaimer.