What Radiology Practices Need to Know About the Federal Government Shutdown
Date Posted: Tuesday,
October 14, 2025
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The federal government shutdown that began on October 1, 2025, will impact payments to radiology practices in several ways, and it is unknown how long the shutdown will last. Medicare payments will be placed on a 10-day hold, as the agency copes with staffing at about 53% of the normal level. According to a Department of Health and Human Services (HHS) contingency staffing plan, HHS will maintain such staff as is necessary to support mandatory funded activities such as Medicare and Medicaid.
The American College of Radiology (ACR) is urging practices to continue to submit claims as usual. This ACR resource is available for updates on the shutdown and how it will affect radiology practices.
They highlight these points:
- The federal No Surprises Act independent dispute resolution process is unaffected by the shutdown.
- Medicare payments will be put on a 10-day hold (submit claims as usual); 53% of CMS staff is retained.
- Medicaid is funded through Q1 FY 2026.
- CMS rulemaking and policy development may be delayed.
- COVID-era telehealth flexibilities have expired; pre-COVID rules apply.
The telehealth flexibilities that were granted in the Medicare program amid the COVID-19 pandemic expired by law as of October 1, 2025, independent of the government shutdown. This could impact interventional radiologists, radiation oncologists, and nuclear medicine specialists, who typically bill for E/M services. It is recommended that practices obtain an Advanced Beneficiary Notice (ABN) from patients before providing telehealth services.
On a broader scale, the GPCI Work Floor minimum threshold of 1.0 also expired on October 1st. This could impact more practices over a longer term. The Geographic Adjustment Factor is detailed in a recent article, "What Else is in the Medicare Proposed Rule for 2025?" (HAPUSA). Without the CR [Continuing Resolution of March 15, 2025], some areas of the U.S. would have noticed that their Medicare reimbursement decreased on April 1st by up to 2.7% in addition to the 2.83% cut across the board.
If Congress does not again pull back the GPCI adjustment, 51 payment localities across the country will see a reimbursement reduction from 1.0 to 2.7% as of October 1st.
In Mississippi, the hardest-hit locality with a 2.7% reduction, the reimbursement for some common procedures could change as follows in Table 1.
Table 1
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Code
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Description
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With 1.0 Floor
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W/O 1.0 Floor
|
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71046
|
- View chest x-ray
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$ 9.57
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$ 9.31
|
|
77067
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- Screening mammogram
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$33.29
|
$32.39
|
|
74177
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- CT abdomen/pelvis with contrast
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$79.54
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$77.39
|
|
70551
|
- MR brain, no contrast
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$64.22
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$62.49
|
|
70450
|
- CT head, no contrast
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$37.03
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$36.03
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|
76856
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- Complete pelvic ultrasound
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$29.95
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$29.14
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Other areas that would see at least a 2.0% reduction are Arkansas, part of Missouri (99), Idaho, West Virginia, Kentucky, Maine, and Utah. We don't know at this point if Medicare will process October claims at the old rates or at the reduced rates once the 10-day claims hold expires. In either case, the ultimate Congressional action or inaction could cause a future reconciliation payment or recoupment.
We are aware this will impact your practice, but at this time, there are many unknowns. While current guidance suggests that Medicare and Medicaid will remain unaffected, the broader implications—both upstream and downstream—are still unclear. Additionally, we do not yet have clarity on how other payors, including VA, CHAMPUS, TRICARE, and others, may be impacted by the shutdown. More updates are coming.
Rebecca Farrington is Chief Revenue Officer at Healthcare Administrative Partners.
www.hapusa.com
