Telehealth Coverage Changes: Key Deadlines and Updates for Medicare Providers
Healthcare providers who provide telehealth to Medicare patients need to get ready for significant policy changes based on the expiration of major telehealth provisions from the COVID-19 public health emergency on March 31, 2025. The modifications extend pre-pandemic guidelines that will affect telehealth services availability and who can act as providers.
Key Changes Effective April 1, 2025
The Medicare program requires patients to seek telehealth care services at approved originating locations, which do not include home visits for most appointments, but provides exceptions for behavioral health, substance use disorder, and specific condition treatments. Some telehealth services like behavioral health treatment together with substance use disorder (SUD) treatment and specific conditions remain exempt from origin site requirements.
Telehealth services receive Medicare reimbursement exclusively for rural areas designated as Health Professional Shortage Areas (HPSAs) and non-Metropolitan Statistical Areas (non-MSA counties) except in cases of Substance Use Disorder treatment and specific conditions that affect home dialysis services and mental health and acute stroke care delivery.
The telehealth billing rights of occupational therapists, physical therapists, speech-language pathologists, and audiologists will vanish while these services will become limited to physicians among federal law-defined practitioners.
In-Person Visits:
All Medicare behavioral/mental health telehealth patients must receive an in-person visit both within six months following their initial service delivery and every following year. The Federal health care facilities identified as Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) have permanent exemption from this requirement until January 1, 2026.
The discontinuation of audio-only telehealth services stands except in cases of behavioral/mental health care, according to Medicare.
Permanent Telehealth Policies:
Telehealth services for behavioral health care will become permanent by maintaining home-based flexibility and geographic restriction exemptions along with the option to provide services through audio-only methods. The Medicare provision permits marriage and family therapists together with mental health counselors to continue their status as eligible Medicare providers.
Controlled Substance Prescriptions:
The Drug Enforcement Administration (DEA) together with the Department of Health and Human Services (HHS) have authorized extended telemedicine prescribing rules for controlled substances up to December 31, 2025. The new set of guidelines contains long-term flexible measures and patient safety measures.
Congressional Considerations:
Congress maintained certain telehealth provisions through March 31, 2025, yet let the health savings account (HSA) first-dollar coverage together with high-deductible health plan (HDHP) benefits expire on December 31, 2024. Additional laws need to be enacted to support the continuation of telehealth benefits that emerged during the pandemic period.
