October 08, 2025|Client Alerts
Medicare Telehealth Flexibilities Expire: What Providers Need to Know
By Jasmine Vargas
On September 30, 2025, the Medicare telehealth flexibilities enacted during the COVID-19 public health emergency expired. Effective October 1, 2025, coverage reverted to pre-pandemic rules under 42 U.S.C. § 1395m, limiting reimbursement based on geography, originating site, practitioner type, and service modality. Patients are generally no longer permitted to receive most services from home, and coverage for audio-only visits has been restricted primarily to behavioral and mental health services. Only certain practitioners—including physicians, nurse practitioners, physician assistants, clinical psychologists, and a limited list of others—may furnish covered telehealth services.
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) have different rules depending on the type of visit:
- Mental health visits: FQHCs and RHCs may continue providing mental health services via live video or audio-only telemedicine under CMS’s permanent definition, reimbursed at the usual PPS/AIR rate. Beginning January 1, 2026, prior and subsequent in-person visit requirements apply for home-based mental health visits unless the patient and provider document that the risks of in-person visits outweigh the benefits.
- Medical visits: Telehealth coverage for medical visits at FQHCs and RHCs remains available only through December 31, 2025, reimbursed via G2025 (not PPS/AIR). In the 2026 PFS, CMS has proposed extending this authority for an additional year, but the proposal has not yet been finalized. If the extension is not finalized, FQHCs and RHCs will lose the ability to provide and bill for medical visits via telehealth after December 31, 2025, and pre-pandemic originating site and other telehealth restrictions would again apply.
Despite bipartisan support for continuing telehealth, Congress failed to act before the September 30 deadline. The Telehealth Modernization Act (H.R. 5081/S. 2709) would extend flexibilities through 2027, while the CONNECT for Health Act (H.R. 4206/S. 1216) would permanently remove statutory barriers, including geographic and originating site restrictions. These proposals remain pending. However, as of October 1, no extension has been enacted, and Medicare coverage is governed strictly by the statutory pre-pandemic rules.
Key changes include:
| Flexibility | Effective October 1, 2025 |
| Originating Site | Restricted to specific sites: provider offices, hospitals, skilled nursing facilities, and patient’s home (only for End-Stage Renal Disease or Substance Use Disorder treatment). Mental health patients must meet in-person visit requirements. |
| Geographic Restrictions | Patients must reside in rural Health Professional Shortage Areas or outside Metropolitan Statistical Areas, except for End-Stage Renal Disease or Substance Use Disorder, acute stroke, or mental health care. |
| Audio-Only Telehealth | Audio-only telehealth is covered for behavioral and mental health services when the patient cannot or chooses not to use video technology, provided the provider is capable of delivering services via video. |
| Providers eligible to furnish covered Telehealth Services | Limited to: physicians, PAs, NPs, CNS, nurse-midwives, clinical psychologists, social workers, dietitians/nutritionists, CRNAs, marriage/family therapists, and mental health counselors. |
| Mental Health | Initial in-person visit required within six months prior; follow-ups every 12 months unless documented exception agreed. |
This communication is not intended to create or constitute, nor does it create or constitute, an attorney-client or any other legal relationship. No statement in this communication constitutes legal advice nor should any communication herein be construed, relied upon, or interpreted as legal advice. This communication is for general information purposes only regarding recent legal developments of interest, and is not a substitute for legal counsel on any subject matter. No reader should act or refrain from acting on the basis of any information included herein without seeking appropriate legal advice on the particular facts and circumstances affecting that reader. For more information, visit www.buchalter.com.
