10/01/2025
We’re sharing a quick update on today’s federal government shutdown and how it may affect Medicare ambulance payments.
What happened (today, Oct 1, 2025):
• Medicare operations continue; claims should still process and pay on normal timelines.
• The temporary ambulance payment add-ons (+2% urban, +3% rural, +22.6% super-rural) expired Sept 30, 2025 and require Congressional action to be extended.
How this could impact payments:
• If Congress passes a funding bill within 2 weeks and includes an extension, MACs should have time to adjust during the standard 14-day payment hold with no change expected on paid amounts.
• If a deal comes after 2 weeks, Medicare may pay claims for DOS on/after Oct 1 without the add-ons until an extension is enacted; if Congress later makes add-ons retroactive, MACs would reprocess to add them back.
• Some enrollment/revalidation and audit activities could slow if the shutdown persists.
• Separately, telehealth flexibilities and Hospital-at-Home waivers also expired and need renewal by Congress.
What you should do now:
1. Continue normal claim submissions, no coding/claim changes needed today.
2. Watch remittance advice for DOS Oct 1, 2025 and forward for potential removal of add-ons.
3. Flag those claims in case of retroactive extension and automatic MAC reprocessing.
4. Reach out if you see unexpected payment changes, we’ll review and advise next steps.
We’ll keep monitoring Congressional action and will update you if anything changes. If you have questions about specific claims, reply to this email and our team will assist.
BREAKING: Government Shutdown & Ambulance Add-Ons: What You Need to Know | PWW Advisory Group
October 1, 2025 What Happened? Congress failed to pass a funding package by midnight last night. That means a federal government “shutdown” begins TODAY, October 1, 2025, and lasts until Congress passes another funding package for the federal government. Right now, we are uncertain as to how lon...