CMS Restores Medicare Telehealth Reimbursement Flexibilities Through Early 2026

The Centers for Medicare and Medicaid Services (CMS) has resolved the uncertainty around Medicare telehealth claims affected by the recent federal government shutdown. Through updated guidance issued in late November, CMS confirmed the retroactive reimbursement of telehealth services provided during the shutdown period, ensuring providers and patients are not financially penalized. The updated guidance, including a November 20 telehealth FAQ and a November 21 MLN Connects Special Edition, reinstates all Medicare telehealth flexibilities for services furnished between October 1, 2025, and January 30, 2026, with claims processed as if the shutdown had not occurred. During the federal government shutdown, telehealth waivers that allowed Medicare beneficiaries to receive services regardless of geography or originating site temporarily lapsed, resulting in Medicare Administrative Contractors returning or withholding numerous claims due to noncompliance with pre-waiver regulations. CMS has now directed contractors to process claims from this period under the restored telehealth authorities following Congress's retroactive extension of telehealth provisions. The reinstated policy permits Medicare beneficiaries to continue receiving telehealth services from any location, including their homes, through January 30, 2026, contingent upon meeting all standard Medicare billing and coverage requirements. CMS clarified that services rendered during the shutdown in non-rural areas or patient homes are now payable, and contractors are instructed to process resubmitted claims accordingly. CMS also addressed the treatment of claims previously returned or denied during the shutdown, indicating that these claims are now eligible for payment upon resubmission. Providers are encouraged to identify patients who made out-of-pocket payments for telehealth services during the shutdown, as they should receive refunds once Medicare processes the eligible claims. This clarification helps stabilize telehealth reimbursement processes, minimizing financial disruption for providers and beneficiaries caused by the temporary lapse in telehealth flexibilities. The CMS guidance underscores the agency's commitment to supporting continuity of care via telehealth, particularly amid fluctuating federal administrative conditions. Insurance professionals and healthcare providers should ensure claims resubmission aligns with the updated CMS directives to avoid claim denials and ensure proper reimbursement.