August is already upon us and we now find ourselves quickly approaching the current expiration date for the Medicare telehealth waivers (September 30, 2025). As it stands now, without further Congressional action, the Medicare telehealth policies will soon revert back to their permanent requirements, which will reduce the amount of Medicare enrollees who will be able to access services via telehealth due to the various limitations that will again be enforced. Additionally, just last month, the Centers for Medicare and Medicaid Services (CMS) released their proposals for the 2026 Physician Fee Schedule (2026 PFS) (for more information on the 2026 PFS telehealth proposals, please see CCHP’s Fact Sheet), which includes proposed rules that would also impact permanent Medicare telehealth policies. Therefore, we have several factors at play that could impact the state of telehealth in Medicare starting on October 1, 2025 if no further action is taken by Congress. For some, this will be the first time they will be experiencing the impacts of permanent telehealth Medicare policies, and the reversion back may cause some confusion. In an effort to mitigate some of the potential confusion, CCHP will be running a newsletter series exploring what the Medicare telehealth policy environment could look like if Congress takes no further action and the current waivers expire on September 30, 2025. Each edition will focus in on a specific aspect of the permanent policies pertaining to telehealth – this week we will start the series by focusing in on Medicare’s location requirements.
WHO MAKES THE POLICIES?
Before we get into the specifics of Medicare telehealth location policies, it is important to understand the different entities that are involved in making this program’s policies. Certain telehealth Medicare policies are embedded in federal law and to make any changes to those current policies, Congress would need to pass legislation and the President would need to sign it into law. There are also however, some policies that are not specifically in federal law, allowing CMS the option to develop those policies further without waiting for Congressional direction. In some scenarios, Congress may pass a law, however the details and specifics of how that law will be implemented and enforced is left to the agency charged with administering that law, for example, an agency such as CMS. It is important to understand the origin of each policy because that is what determines who has say over changing it. If a policy is specifically in federal statute, CMS cannot act, and must wait for Congress. However, if the origin lies within a CMS regulation or policy, then CMS can make a change themselves through regulation or administrative policy, such as via the annual PFS. In last week’s newsletter, CCHP covered several pending federal bills that address, and in most cases seek to remove, the restrictive telehealth requirements found in statute that may potentially again take effect October 1, 2025. For more information, we encourage you to refer to last week’s #TelehealthTuesday newsletter for detailed summaries and analysis.
PERMANENT MEDICARE TELEHEALTH POLICY ON LOCATION
As most readers likely know, the location requirements in Medicare have been waived since 2020. Medicare’s telehealth policy around location primarily deals with the patient location. There are also some rules around the location of the provider, however the temporary waivers that have been in place over the last several years have been primarily about where the patient is located. There are two statutory requirements in Medicare regarding the location of the patient (referred to as the “originating site”) that must be met in order to make the telehealth visit eligible for coverage and reimbursement:
- The Geographic requirement, and
- The Site requirement, more specifically, the type of building the patient is in when the telehealth visit takes place.
Under the geographic requirement, the originating site must be in one of the following:
- A rural health professional shortage area (HPSA);
- Located in a county that is not included in a Metropolitan Statistical Area (MSA); or
- Within a federal telehealth demonstration project.
CMS provides an eligibility analyzer where you can type in an address to see if your location geographically qualifies for Medicare telehealth coverage. Certain exceptions also apply to the geographic requirement (see Exceptions section below).
In addition to the geographic requirement, there is also the site requirement that must be considered. Under Medicare statute, the patient’s location must fall into one of the eligible settings for the telehealth encounter to be covered and reimbursed by Medicare – current eligible sites under Medicare include:
- Physician/Practitioner Office
- Critical Access Hospital (CAH)
- Rural Health Clinic (RHC)
- Federally Qualified Health Center (FQHC)
- Hospital
- Hospital-based or CAH-based renal dialysis center
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- Skilled Nursing Facility
- Community Mental Health Center
- Renal Dialysis Facility
- A Rural Emergency Hospital
- A Mobile Stroke Unit (for acute stroke)
- The patient’s home (only applies to ESRD treatment, SUD and mental health services under certain circumstances)
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Exceptions to Geographic & Site Requirements
It is important to note that there are current exceptions to the geographic and site requirements. As you can see in the above list, both “Mobile Stroke Unit” and the “Patient’s Home” note certain exceptions. These exceptions are also part of permanent telehealth Medicare policy and are mostly embedded in federal statute. More specifically, these exceptions include:
- The geographic restriction, often referred to as the “rural requirement”, does not apply to the treatment of acute stroke, home dialysis for patients with end stage renal disease (ESRD), or substance use disorder (SUD), and under certain circumstances, also for the provision of mental and behavioral health services. Therefore, if an acute stroke patient covered by Medicare was located in downtown Los Angeles and was treated via telehealth for a service that was on the eligible telehealth services list (more on that in a future #TelehealthTuesday edition), that patient location would qualify in this limited circumstance.
- The patient can also be at home during the telehealth interaction for certain treatments related to SUD. (The ESRD geographic exception is specifically related to home services). Again, in certain circumstances (see exceptions below), mental and behavioral health services would also qualify for an exception to the site location.
Mental Health Exceptions
The exceptions to the location requirements for telehealth when providing mental/behavioral services via telehealth are a little more nuanced. There are two different scenarios involving the treatment of mental and behavioral health via telehealth and the requirements that must be met in order for the service to qualify for coverage and reimbursement by Medicare:
- Scenario 1: If the patient is being treated for SUD and a co-occurring mental/behavioral health condition, the service may take place in the patient’s home when conducted via telehealth. The geographic requirement would also not apply.
- Scenario 2: If the patient is being treated for a mental/behavioral health condition via telehealth, the originating site does not have to meet the geographic requirement and can be the patient’s home, if the patient has a prior in-person visit with the telehealth provider no earlier than 6 months prior to when the telehealth visit takes place, and every 12 months thereafter.
There are more nuances and details to Scenario 2, but for the purposes of this newsletter these are the two primary situations in which the provision of mental and behavioral health services can be covered via telehealth without specifically meeting the location requirements. Keep an eye out for a future edition of this series that delves more deeply into the complex policies around telemental health coverage in Medicare.
2026 PFS IMPACTS
Some of you may be wondering, should the proposed 2026 PFS become final, will the telehealth policies make any changes to the aforementioned location requirements? The quick answer is, “no”. Given that these policies related to the originating site are very specifically laid out in federal law, CMS has limited opportunities through their PFS process to change or expand the policies around patient location as it relates to telehealth. However, there are some creative adjustments that CMS can make that are not specifically related to statutory telehealth originating site policies, which could alternatively expand allowable locations a bit, but that is for a future edition.
In summation, if Congress takes no further action on the temporary Medicare telehealth waivers and the current extension expires, and the proposed 2026 CMS Physician Fee Schedule (PFS) is finalized as written, then below is what Medicare’s telehealth location policies will look like beginning October 1, 2025:
MEDICARE ORIGINATING SITE (PATIENT LOCATION) REQUIREMENTS
(chart is current as of August 5, 2025) |
| Requirement |
Waiver Policy |
Permanent Policy |
2026 PFS Change |
| Geographic Requirement |
Waived until
Sept. 30, 2025 |
In a HPSA, located in a county that is not included in a MSA OR in a federal telehealth demonstration project. |
N/A |
| Site Requirement |
Waived until
Sept. 30, 2025 |
- Physician/Practitioner Office
- Critical Access Hospital (CAH)
- Rural Health Clinic (RHC)
- Federally Qualified Health Center (FQHC)
- Hospital
- Hospital-based or CAH-based renal dialysis center
- Skilled Nursing Facility
- Community Mental Health Center
- Renal Dialysis Facility
- A Rural Emergency Hospital
- A Mobile Stroke Unit (for acute stroke care)
- The patient’s home (certain exceptions)
|
N/A |
| Exceptions to Geographic Requirement |
N/A |
- Stroke
- ESRD
- SUD
- Under certain circumstances, the provision of mental and behavioral health services
|
N/A |
| Exceptions to Site Requirement |
N/A |
- Stroke
- ESRD
- SUD
- Under certain circumstances the provision of mental and behavioral health services
|
N/A |
Next Tuesday CCHP will be sending you a full newsletter (as we typically do on the second Tuesday of each month), but the following edition of this #TelehealthTuesday series will be titled:
“Eligible Providers: What the FQHC?”
Stay tuned! Find the original resource at : https://www.cchpca.org/all-telehealth-policies/ |
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