The recent government shutdown caused multiple Medicare statutory payment provisions to lapse on October 1, 2025, due to the absence of Congressional action. With the passage of the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026 (Pub. L. 119-37), (discussed here), Congress has retroactively restored many of these provisions. The looming question at the time of the passage was whether there would be retroactive payments. 

On November 21, 2025, Centers for Medicare and Medicaid Services (CMS) issued a Special Edition to clarify retroactive processing of claims.

Telehealth and Acute Hospital Care at Home Claims

• On November 6, 2025, CMS instructed Medicare Administrative Contractors (MACs) to return certain telehealth claims submitted on or before November 10, 2025, that were previously non-payable after the lapse of statutory provisions. These claims are now payable if they meet all Medicare requirements.
• Practitioners should resubmit returned claims and any held telehealth claims. Refund any beneficiary payments for services now retroactively covered. The prior instructions to append the “GY “modifier are rescinded.
• Similarly, beginning November 10, 2025, MACs returned claims for the Acute Hospital Care at Home initiative for dates of service on or after October 1, 2025. Hospitals may resubmit these claims.

Next Steps for Providers
Facilities, practitioners, and suppliers should expect a return to normal processing operations soon.