Why is this happening?

Here we are; we hoped it wouldn’t happen, but the telehealth waivers have expired. In March of 2025 we received a near 11^th hour reprieve in the form of H.R. 1968 (2025) that provided the extension of telehealth flexibilities through September 30^th, 2025. Many of us had hoped for a similar reprieve this time around, but, unfortunately, that has not come to pass as no additional legislation addressing telehealth was passed prior to the government shutdown.

When does this take effect?

As of Wednesday, October 1, 2025 many of the telehealth practices we’ve come to rely on in the last 5 years have reverted to their pre-Covid-19 Pandemic structures. Hopefully physicians’ offices have taken the preceding 6 months to plan how they would handle an abrupt transition should this occur.

Who can provide care to Whom and How can telehealth be provided?

Commercial plans unrelated to Medicare may not be affected by these policy lapses. Medicaid telehealth eligibility is typically left to the state government overseeing the Medicaid benefits. Pennsylvania’s Act 42 of 2024 provides a framework for Medicaid to cover telehealth for beneficiaries.  Medicare beneficiaries, including those on Medicare Advantage plans will most likely be affected.

Medicare regularly updates the list of services that can be provided via telehealth. You can access the Medicare Telehealth Services list here. This is a list of covered services that are applicable if you meet the other requirements to bill for telehealth. Services provided must utilize combined audio-visual communications. There is an exception for audio only if the provider is capable of providing audio-visual but the patient is unable or does not consent to audio visual; this applies specifically to services to be provided in the patients home (ESRD, Mental Health, stroke, and SUD). (CCHP, 2025c)

Note that if you are a member of an applicable Accountable Care Organization, ACO, and billing under the ACO Tax ID these rules differ for you under the authority of the Bipartisan Budget Act of 2018 (CMS, 2025). ACOs can receive payment for telehealth services provided to beneficiaries that are listed on the Assignment List Report, ALR, that they received on a quarterly basis. (CMS, n.d.) Per the Medicare Learning Network services permissible under Medicare rules during Calendar year 2025 can still be billed by ACOs without further Congressional Action. (CMS, 2025)

Some providers that were able to provide services under the telehealth flexibilities are now ineligible to provide these services. Occupational Therapists, Physical Therapists, Speech-Language Pathologists, and Audiologists claims for services are no longer payable now that the waivers have expired. (National Consortium of Telehealth Resource Centers [NCTRC], 2025) Physicians, Nurse Practitioners, Physician Assistants, Nurse-Midwives, Clinical Nurse Specialists, Registered Dietitians, Certified Registered Nurse Anesthetists, Clinical Psychologists, Marriage and Family Therapist, & Clinical Social Workers claims are still payable if geographic and site requirements are met due to enumeration in the Social Security Act as covered providers. (CCHP, 2025b)

Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) can continue to provide mental health services to their patients due to the definitions of these visits as established by Medicare under Centers of Medicare and Medicaid Services lawful authority. FQHCs and RHCs must still meet the in-person visit timing requirements for claims to be considered valid. FQHCs and RHCs can continue to provide medical visit services through December 31, 2025 at current rates. (CCHP, 2025b)

What care can be provided and what steps to consider.

Acute Stroke, Substance Use Disorder (SUD), and End Stage Renal Disease (ESRD) are not subject to Geographic or Site Requirements.  Behavioral and Mental Health appointments can still be provided via telehealth to patients located in their home if the patient has had an initial in-person visit within the preceding 6 months before the appointment.  Patients would need to continue to see the provider in-person 1 time per 12 months to continue to be eligible for telehealth services from home. (Center for Connected Health Policy [CCHP], 2025a)

Medicare Learning Network advises providing Medicare Beneficiaries that are receiving telehealth services with an Advanced Beneficiary Notice of Non-Coverage (ABN) to document that the patient was advised before the service was provided of the likelihood their insurance would not cover the service. It is also advisable to hold claims that are considered non-payable by Medicare without further congressional action. (Centers for Medicare & Medicaid Services [CMS], 2025) Continued provision of non-covered telehealth services may lead to denials of claims or loss of revenue if coverage is not applied retroactively. (Mid-Atlantic Telehealth Resource Center [MATRC], personal communication, October 1, 2025)

Under a combined rule from the U.S. Department of Health and Human Services and the U.S. Drug Enforcement Agency, through December 31, 2025, Schedule III-V controlled substances can be prescribed after review of a patient’s Prescription Drug Monitoring Program (PDMP) for up to a 6 month period without a prior in person visit requirement to avoid lapses in treatment. (21 CFR) As of January 1, 2026, the in person visit requirement will return without further legislative action or DEA rule provisions.

Hospital at Home programs are no longer able to bill to Medicare Fee for Service with the expiration of flexibilities. Any facilities utilizing such arrangements would be risking the need to absorb financial risk. (NCTRC, 2025)

WHERE

The location of the patient during provision of telehealth services is paramount to acceptability of claims. Per the Center for Connected Health Policy, outside of the previously mentioned exclusion for claims submitted under an ACO, the Originating Site for patients must meet both a geographic and a site requirement for telehealth claims to be reimbursable. (CCHP, 2025a)

The Originating Site is where the patient is located while receiving services per Code of Federal Regulations 42. (1997). A patient must be physically located in an originating site that is in an identified Health Professional Shortage Area (HPSA) that is not in a Metropolitan Statistical Area (MSA) for claims to be valid. (U.S. Department of Health and Human Services [HHS],2025)

Originating sites include Physician Offices, Hospitals, Critical Access Hospitals, Rural health Clinics, Rural Emergency Hospitals, Hospital Based Renal Dialysis Centers, Federally Qualified Health Centers, or Skilled Nursing Facilities. (CCHP, 2025a) You can use the Health Resources and Services Administration’s Analyzer to determine if the patient’s location meets this requirement.