As the federal government shutdown continues, the Centers for Medicare & Medicaid Services (CMS) has issued updated guidance to Medicare Administrative Contractors (MACs) regarding payment processing and telehealth coverage.
Key Takeaways for Physicians:
-
CMS Confirms Payments Continue: Most Medicare claims are being processed and paid on schedule despite the federal shutdown.
-
Limited Hold Applies: Only claims affected by expired legislative provisions are temporarily held.
-
Telehealth Flexibilities Reduced: As of October 1, 2025, most pandemic-era telehealth waivers have expired, except those for mental health and substance use disorder care.
-
Stay Informed: Monitor your MAC’s website, CMS payment updates, and PAMED’s Government Shutdown Resource Page for the latest guidance.
Medicare Claims Processing
On October 15, CMS announced that most Medicare claims will continue to be processed and paid on schedule, despite the shutdown. Only claims tied to expired Medicare legislative provisions—including certain telehealth services and services in areas affected by the expired 1.0 work geographic practice cost index (GPCI) floor—are temporarily impacted.
-
Physicians may continue to submit all claims as usual.
-
CMS emphasized that, to date, no payments have been delayed beyond the standard 14-day statutory hold period required for all claims.
-
Claims unrelated to the expired provisions will be processed and paid in a timely manner.
Telehealth Flexibilities
As of October 1, 2025, many COVID-19-era telehealth flexibilities expired for services other than those related to mental health and substance use disorders.
-
Most telehealth services provided to beneficiaries in their homes or outside of rural areas are no longer reimbursable under Medicare.
-
Physicians providing non-covered telehealth services should consider issuing an Advance Beneficiary Notice of Noncoverage (ABN) to patients.
-
Clinicians participating in Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program may continue to bill for covered telehealth services without geographic restrictions.
Next Steps for Physicians
CMS and the American Medical Association (AMA) continue to monitor the situation closely. Physicians are encouraged to:
-
Check the CMS Medicare Claims Processing page and their MAC websites for updates.
-
Review the CMS Telehealth Coverage page and updated Telehealth FAQs.
-
Report any payment delays to AMA Advocacy at [email protected] with the subject line “Medicare Payment Delay.”
-
For the latest information, physicians should monitor their MAC’s website and this CMS webpage.
ACMS will continue to share updates as new information becomes available.
PAMED has also created a Government Shutdown Resource Page (member login required).
Last updated: October 16, 2025 10:00 AM EST