Post by Lighthouse Lab Services

Heads up: CMS issued an update on October 15 clarifying how claims are being processed amid the U.S. government shutdown. Here’s what labs and providers need to know, and what you should be watching for if you see delays. 🧩 What the MLN clarification says CMS directed all MACs to temporarily hold certain claims with dates of service on or after October 1, 2025. However, the hold only affects services billed under the Medicare Physician Fee Schedule (MPFS), not services billed under the Clinical Laboratory Fee Schedule (CLFS). Even within MPFS, the hold is limited: it only applies to claims tied to expired legislative payment provisions (i.e. “extender” provisions) that lapsed October 1. These include: -Telehealth flexibilities and geographic waivers -Some hospice face-to-face encounter waivers -Other “extender” rules that have not been renewed In short: if your lab is seeing payment delays for services under CLFS, it’s not due to this CMS hold; something else is likely at play! 🔍 What this means in practice: -Labs billing under CLFS should continue to see normal processing (unless there are unrelated adjudication issues). -Providers billing MPFS services should flag any claims tied to lapsed rules and monitor those specifically for delays. -If you're encountering delays beyond what this hold would predict, it may indicate other issues (e.g. coding, documentation, or adjudicator workflows) that warrant closer review. -The hold is not blanket; CMS emphasized that the scope is narrower than the agency's initial notices suggested. If you’re worried about claim lag, need a second look at your adjudication flow, or just want to validate whether a delay is “expected or not,” feel free to follow up with us directly. Our team is here to help you navigate this period of uncertainty.