CMS Clarifies Claims Hold And COVID-19 Vaccine Administration Edit

As the federal government shutdown continues, CMS has released clarification about a temporary hold on certain claims. According to CMS, Medicare Administrative Contractors have been instructed to temporarily hold claims with dates of service of Oct. 1 and later for services affected by the expired Medicare legislative payment provisions passed under the full-year Continuing Appropriations Act of 2025. Specifically, the claims hold will apply to claims tied to lapsed legislative provisions such as nonbehavioral telehealth visits, hospital-at-home care and hospice face-to-face recertifications.

CMS also released updates to COVID-19 vaccine administration edits. CMS previously denied claims with 90480 CPT codes that were billed in conjunction with G0008, G0009 or G0010. CMS issued on Oct. 14 replacement NCCI files to remove this edit. The MACs will reprocess claims with dates of service between July 1 and Oct. 15 within the next 30 business days.