Health Law Alert by Lamb McErlane attorneys Vasilios J. Kalogredis, Esq. and Sonal Parekh, Esq.

As of October 1, 2025, many of the Medicare telehealth flexibilities introduced during the COVID-19 public health emergency have officially lapsed. This shift marks a return to pre-pandemic statutory limitations and raises new compliance and operational concerns for providers. The ongoing federal government shutdown has further complicated the situation, delaying potential Congressional action that could otherwise extend or modify these policies.

In connection with the expiration of key statutory “extenders,” CMS has directed all Medicare Administrative Contractors (MACs) to impose a temporary claims hold—a standard measure that typically lasts up to 10 business days. Normally, such a hold minimizes administrative burden in case Congress acts after the deadline. However, with the shutdown stalling legislative negotiations, providers face added uncertainty about how long payments may be delayed. While claims may still be submitted, reimbursement will not be released until the hold is lifted. The standard 14-day payment floor should limit disruption, but providers should prepare for possible short-term cash flow impacts.

 With the expiration of statutory extensions:

• Most non-mental health telehealth services delivered to patients at home or in non-rural areas are no longer covered by Medicare.
• Hospice recertifications again require in-person assessments.
• Certain practitioners are now ineligible for telehealth reimbursement under Medicare.

Providers continuing to offer non-covered telehealth services should consider using an Advance Beneficiary Notice of Noncoverage (ABN) to clarify patient financial responsibility. Providers may also consider delaying claims for these services until Congress acts.

 Clinicians in applicable Medicare Shared Savings Program Accountable Care Organizations (ACOs) remain an exception. Under the Bipartisan Budget Act of 2018, these clinicians may continue offering and billing for permitted telehealth services without geographic restriction and regardless of location to their assigned beneficiaries. No additional approval is required for this authority.

 What Providers Should Do Now

1. 1. Closely Monitor Legislative Developments — The shutdown increases uncertainty around whether and when telehealth extensions may be re-enacted. Congress may re-enact or modify telehealth flexibilities.
   2. Evaluate Your Telehealth Services — Determine which services are still Medicare-payable.
   3. Use ABNs Prudently — For services no longer covered, clearly inform patients of their financial liability.
   4. Hold Claims, Where Appropriate and Plan for Delays — Consider retaining claims for potentially non-payable services until the temporary hold is lifted. Anticipate disruptions caused by both the claims hold and ongoing shutdown.
2. Communicate Internally and With Patients — Update compliance policies, contracts, and patient notices to reflect the new restrictions.

The expiration of pandemic-era flexibilities and the government shutdown have converged to create a period of heightened operational risk for providers. While ACO participants retain some telehealth authority, most practitioners must now navigate narrower coverage rules, delayed payments, and legislative uncertainty. For the moment, careful compliance planning and proactive communication remain the best tools for providers to manage this evolving landscape.

If you have any questions or if we may be of further assistance regarding compliance or other health law matters, please feel free to contact Bill Kalogredis, Esq. or Sonal Parekh, Esq.

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Vasilios J. (Bill) Kalogredis, Esq. has been advising physicians, dentists, and other healthcare professionals and their businesses as to contractual, regulatory and transactional matters for over 50 years. He is Chairman of Lamb McErlane PC’s Health Law Department. Bill can be reached by email at bkalogredis@lambmcerlane.com or by phone at 610-701-4402.

Sonal Parekh, Esq., is an associate at Lamb McErlane PC who focuses on healthcare transactional matters and a broad range of healthcare regulatory-related issues on behalf of healthcare systems, physicians, dentists, and other healthcare providers, and is a pharmacist by education and training. Sonal can be reached by email at sparekh@lambmcerlane.com or by phone at 610-701-4416.

*This alert is for educational purposes only and is not intended to be legal advice. Should you require legal advice on this topic, any health care matter, or have any questions or concerns, please contact Vasilios J. (Bill) Kalogredis, Esq. or Sonal Parekh, Esq.