UPDATE: CMS now says most payments to physicians will be paid 'in a timely manner' as government shutdown continues

UPDATE:

Late on October 15, The U.S. Centers for Medicare and Medicaid Services (CMS) reversed course and said in an updated notice that payment on claims will not be on hold, with the exception of claims related to telehealth flexibilities and other expired programs.

The revised notice reads:

"Effective October 1, 2025, CMS instructed all Medicare Administrative Contractors (MACs) to hold claims with dates of service of October 1, 2025, and later for services impacted by the expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025. In light of the continuing government shutdown, CMS will continue to process and pay held claims in a timely manner with the exception of select claims for services impacted by the expired provisions. To date, no payments have been delayed as statute already requires all claims to be held for a minimum of fourteen days, and this recent hold is consistent with that statutory requirement. Providers may continue to submit claims accordingly."

ORIGINAL ARTICLE:

The U.S. Centers for Medicare and Medicaid Services (CMS) announced Oct. 15 that all Medicare Physician Fee Schedule (PFS) payments and some other payment programs are now on hold as the government shutdown lingers on.

Previous instructions from CMS to Medicare Administrative Contractors were to hold claims for 10 days, according to Anders Gilberg, Senior Vice President, Government Affairs at Medical Group Management Association, in a LinkedIn post.

The hold applies to claims with date of service on or after October 1, 2025. In addition to PFS payments, the hold applies to claims for ground ambulance transports and Federally Qualified Health Centers.

“Providers may continue to submit these claims, but payment will not be released until the hold is lifted,” the notice reads.

The notice also addresses the Oct. 1 expiration of Medicare telehealth flexibilities, which were created during the COVID-19 pandemic and had been extended in the years since. It was not extended this time.

“These include prohibition of many services provided to beneficiaries in their homes and outside of rural areas, and hospice recertifications that require a face-to-face encounter,” the notice reads. “In the absence of Congressional action, practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage.”

The most recent government shutdown began on October 1, with health care as a major cause of the stalement between the political parties. Democrats are refusing to back a short-term spending bill unless it extends the enhanced Affordable Care Act (ACA) subsidies that were expanded during COVID-19 and set to expire at the end of the year. Without those subsidies, millions of people who buy coverage through the ACA marketplace could see their premiums rise sharply in January.

President Donald Trump and the Republicans, by contrast, are insisting on a “clean” continuing resolution that keeps funding at current levels through mid-November while leaving health policy fights for later.