Update on Medicare telehealth claims processing

After more than a month of confusion, Medicare payment is starting to return to normal. The Centers for Medicare & Medicaid Services (CMS) announced that the "Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026" (H.R. 5371) retroactively restores many of the expired payment provisions, effective Oct. 1, 2025, through Jan. 30, 2026. This includes the flexibilities that allowed Medicare beneficiaries to receive telehealth services regardless of their location.

Practices should submit any telehealth claims held during the shutdown. If you charged beneficiaries for telehealth services with dates of service between Oct. 1, 2025, and Nov. 10, 2025, you should submit applicable claims to Medicare and issue refunds to beneficiaries for any overpayments. Claims returned to practices because Medicare could not identify them as payable during the lapse can be resubmitted. These claims were returned with the CARC 16 and RARC M77 codes.

Medicare Administrative Contractors (MACs) have been instructed to perform mass adjustments to any paid claims that are inconsistent with the reinstated policies.

Additional information can be found in Medicare's updated Telehealth FAQ.

— Erin Solis, Manager, Practice & Payment at the American Academy of Family Physicians

Posted on Nov. 24, 2025