CMS announces payments to physicians on hold as government shutdown continues

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.