UPDATE: Providers – Hurtling Through the Telehealth Abyss During the Federal Government Shutdown

As the U.S. federal government shutdown continues into its third week, telehealth service providers have now been hurled off the telehealth cliff and into the abyss created by the September 30, 2025, expiration of Medicare’s telemedicine flexibilities.

As Bradley previously reported, telehealth services provided under the COVID-19 statutory waivers on or after October 1, 2025, are not currently payable by Medicare due to the shutdown. Absent any congressional action, telehealth within the Medicare program is now subject to pre-pandemic restrictions, which — in light of the ongoing government shutdown — may continue into the holiday season.

As a result of the expiration of telemedicine flexibilities, telehealth services (excluding those for behavioral or substance use disorder treatment) previously provided to Medicare beneficiaries in their homes via telehealth are now subject to statutory prohibitions that require a face-to-face encounter to be payable under traditional Medicare (the Medicare fee-for-service (FFS) model).

Initially, CMS recommended that Medicare hold all claims during the shutdown. However, CMS walked back that recommendation, stating in subsequent guidance published on October 15 that Medicare continue paying all claims except for those services provided under statutory waivers, including telehealth. CMS further recommended that telehealth providers send their Medicare patients an Advance Beneficiary Notice of Noncoverage (ABN), which would allow the provider to directly bill their patients for telehealth visits if Medicare ultimately denies those claims.

Further muddying the waters, CMS guidance regarding statutory restrictions on “Medicare telehealth services” does not distinguish between the Medicare FFS model and Medicare Advantage (MA) plans; as a result, it is unclear whether CMS’ guidance also applies to MA plans, which roughly half of all Medicare beneficiaries are enrolled in. As previously mentioned, private payors are generally reimbursing for telehealth services during this time, but since they often follow CMS policies, they may be hesitant to continue doing so, especially if the shutdown continues for an unprecedented length of time.

Providers should continue to monitor congressional action related to Medicare telehealth, but in the meantime, should evaluate transferring telehealth services impacted by the current statutory limitations to face-to-face encounters or rescheduling them – neither of which may be palatable to patients with acute or chronic issues or living in rural areas with no care alternatives. Providers may need to consider providing Medicare patients with ABNs to ensure they receive payment for impacted telehealth services, regardless of whether Congress elects to take future action as Medicare may not retrospectively reimburse telehealth services provided during the shutdown, particularly those provided pursuant to the COVID-19-created flexibilities.

Should you have any questions regarding how this impacts your telehealth practice, please contact Evie Lalangas or Carly Kirkland.

Bradley continues to monitor developments related to the Medicare telehealth coverage restrictions and reimbursement issues.