Government Shutdown & Medicare: What Physical Therapy Clinics Need to Know
By Brianna Hall, Director of Development, Medical Billing Center
As of October 1, 2025, the U.S. federal government has officially entered a shutdown due to Congress’s failure to pass a continuing resolution. While this situation creates uncertainty across many sectors, Medical Billing Center (MBC) is here to provide clarity and guidance for physical therapy clinic owners navigating Medicare billing during this time.
How Government Shutdowns Work
A government shutdown occurs when Congress does not pass funding legislation for the upcoming fiscal year. This halts operations for many federal agencies and furloughs non-essential employees. However, mandatory programs like Medicare and Medicaid continue to operate, albeit with reduced staffing and potential delays in administrative processes. [www.kiplinger.com]
Will Medicare Payments Be Delayed?
Yes and no.
- Claims Processing Continues: Medicare Administrative Contractors (MACs) are still accepting and processing claims.
- Temporary Claims Hold: CMS has directed MACs to implement a temporary claims hold of up to 10 business days. This is a standard precaution to avoid reprocessing claims if Congress retroactively changes payment rules. [www.mgma.com]
- 14-Day Payment Floor: Medicare law requires a 14-day delay between claim submission and payment, so short-term holds typically do not disrupt cash flow for providers.
- Extended Shutdowns: If the shutdown lasts longer than 2–4 weeks, payment delays may increase, especially if MACs exhaust their operating funds. [www.acep.org]
Impact on Telehealth Services
The pandemic-era Medicare telehealth waivers expired on September 30, 2025. This means:
- PTs, OTs, and SLPs are no longer eligible Medicare telehealth providers.
- Patients must be in rural areas and at an approved originating site (not their home) to receive telehealth services reimbursed by Medicare. [www.aamc.org]
APTA Guidance for Providers
The American Physical Therapy Association (APTA) has issued clear guidance:
- Continue treating Medicare patients.
- Continue submitting claims.
- Monitor CMS and MAC updates.
- Expect delays in provider enrollment, audits, and telehealth reimbursements. [www.apta.org]
FAQs from PT Clinic Owners
Here are the most common questions we’ve received:
Q: Should we stop seeing Medicare patients?
A: No. Medicare coverage continues. You should continue treating patients and submitting claims.
Q: Will we get paid?
A: Yes, but expect a short delay. Claims are being held temporarily, but payments will resume once the hold is lifted.
Q: Can we still bill for telehealth?
A: Only if the patient is in a rural area and at an approved originating site. Most home-based telehealth services are no longer reimbursed.
Q: What about Medicaid and commercial payors?
A: Medicaid payments are expected to continue through the first quarter of FY 2026. Commercial payors are not affected by the shutdown.
Q: Should we notify patients?
A: Not necessarily. Patient coverage remains intact. However, you may want to inform patients about telehealth limitations.
MBC’s Recommendations
- Continue Treating Patients: Medicare coverage is active. Don’t disrupt care.
- Submit Claims Promptly: Even during the hold, submitting claims ensures timely processing once payments resume.
- Track Payment Timelines: Expect a 10-business-day hold, followed by the standard 14-day payment floor.
- Monitor CMS & APTA Updates: We’re watching closely and will notify you of any changes.
- Prepare for Retroactive Adjustments: If Congress reinstates expired payment add-ons, MACs may reprocess claims.
We’re Here for You
Medical Billing Center is actively monitoring the situation and following APTA and CMS guidance. We’ll continue to advocate for our clients and provide updates as they become available. If you have questions or concerns, reach out to your MBC account manager or email us directly.