LUGPA Policy Alert: Government Shutdown Impacts on Urology Practices and Patients

As of midnight, September 30, 2025, the federal government has entered a shutdown following Congress’s failure to enact a continuing resolution (CR) to extend fiscal year 2025 funding. While negotiations may continue, immediate impacts are already being felt across federal agencies, including Medicare operations and telehealth coverage. For independent urology practices, these disruptions may affect both reimbursement timelines and patient access to care.

Medicare Operations During the Shutdown

  • Claims Processing: CMS has directed Medicare Administrative Contractors (MACs) to implement a temporary claims hold of up to 10 business days. Providers may continue submitting claims, but payments will be delayed until the hold is lifted. This standard measure prevents reprocessing if Congress acts retroactively, and generally minimizes cash flow disruptions given the 14-day Medicare payment floor.
  • Staffing Reductions: With approximately half of CMS staff retained, policymaking, rulemaking, and non-essential operations are paused. This reduction could delay work on upcoming regulations that directly impact urology practices, including the finalization of the 2026 Physician Fee Schedule.

Telehealth Flexibilities Expire October 1, 2025

One of the most significant immediate effects of the shutdown is the expiration of Medicare telehealth flexibilities first enacted during the COVID-19 Public Health Emergency. Without Congressional action, Medicare coverage reverts to pre-pandemic rules for most non-behavioral health services. Key changes include:

  • Home and Geographic Waivers: Telehealth delivered from a patient’s home or outside rural areas will no longer be covered.
  • Audio-Only Services: Medicare will no longer reimburse audio-only visits for non-behavioral care, limiting options for patients without video capability.
  • Clinician Eligibility: Certain practitioners will lose authority to bill Medicare for telehealth services.
  • FQHCs and RHCs: Federally Qualified Health Centers and Rural Health Clinics cannot serve as distant-site providers.
  • Hospital-at-Home Authority: Expiration of the waiver program will reduce access to home-based acute care alternatives.

These lapses impact practices that rely on telehealth for follow-up visits, managing chronic conditions, and post-procedure monitoring. Urology patients, especially those in underserved, rural, or mobility-limited populations, may face new barriers to care, including longer wait times, increased travel burdens, and potential delays in diagnosis or treatment.

 

Immediate Steps for Practices

  • Advance Beneficiary Notice (ABN): Consider issuing ABNs to patients for services that may not be covered during the lapse.
  • Claims Management: Practices may choose to hold telehealth claims until Congressional or CMS guidance provides clarity.
  • ACO Exception: Clinicians participating in the Medicare Shared Savings Program Accountable Care Organizations retain telehealth flexibilities through CY 2025, regardless of the shutdown.

Additional Impacts

  • Medicare Payments: Short-term delays are expected. A prolonged shutdown could create significant cash flow challenges if payment adjustments are made prospectively rather than retroactively.
  • Community Programs: While some health programs have limited funding buffers, extended disruptions may strain referral networks and patient support services.
  • FDA Operations: FDA user-fee funded programs continue, but new submissions for device approvals—including urology-related technologies—are on hold.

Advocacy and Next Steps

LUGPA is closely monitoring the shutdown and its effects on Medicare telehealth coverage, payment systems, and agency operations. Our advocacy will continue to focus on securing permanent telehealth reforms, protecting patient access, and ensuring stability for independent practices.

Members are encouraged to review telehealth compliance protocols, prepare contingency plans for patient communication, and stay alert for further guidance.