The expiration of the Medicare telehealth waivers on September 30, 2025, has created significant uncertainty for providers as longstanding flexibilities have been scaled back or altered. While Congress continues to negotiate a government funding package that may reinstate some of these flexibilities, permanent statutory restrictions are now in effect layered with Centers for Medicare and Medicaid Services (CMS)’ guidance that is at times ambiguous or unclear. As a result, providers are facing complex questions regarding in-person visit requirements, billing procedures, and the applicability of policies across different care settings. As a result, CCHP has created two new resource documents in an effort to add some clarity to the currently quite complex landscape.
- FAQ Document: outlines common questions CCHP has received in regard to telehealth, including mental health and FQHC/RHC information.
- Summary Chart: outlines current permanent telehealth policy as CCHP understands it today, with accompanying source citations and insights.
Additionally, keep in mind that on October 1, 2025, CMS issued updated guidance regarding Medicare telehealth claims during the shutdown via a special edition of the Medicare Learning Network (MLN) Newsletter. In the update, CMS states that when legislative payment provisions are scheduled to expire, CMS directs Medicare Administrative Contractors (MACs) to implement a temporary claims hold, typically of up to 10 business days. The hold is meant to prevent a large reprocessing of claims if Congress acts after the statutory expiration date, which was September 30, 2025. CMS also suggested that without further Congressional action, providers that deliver telehealth services and are now not eligible for Medicare payment as of October 1, 2025, may want to provide patients with an Advance Beneficiary Notice of Noncoverage. Stakeholders, including the American Telemedicine Association (ATA), are advocating that Congress include a retroactive statement in any future funding fix, to reassure providers that reimbursement of telehealth services delivered during the waiver gap period will eventually be provided. For more information regarding the recent expiration of Medicare telehealth waiver policies, please also review last week’s #TelehealthTuesday newsletter, as well as CCHP’s summer newsletter series regarding the return to more restrictive Medicare policies:
FAQ RESOURCE DOCUMENT
 CCHP has developed a new FAQ to help providers and stakeholders navigate the expiration of Medicare telehealth flexibilities on October 1, 2025, and is designed to address the most common questions CCHP has received through its technical assistance channels in recent weeks. The FAQ highlights where CMS has offered clear direction, and where additional gaps still remain. The document addresses some of the most pressing issues and concerns around mental/behavioral health requirements, FQHC and RHC billing, and the implications for Medicaid, Medicare Advantage, and private payers. Its goal is to clarify areas of uncertainty, highlight what CMS has (and hasn’t) said, as well as point providers toward best practices until additional guidance is released. Questions covered in the FAQ include:
- Do I need to conduct a new in-person visit for behavioral health patients who were established via telehealth before the new Medicare requirements took effect?
- How do I document the exception for the annual in-person mental health visit when the risks or burdens outweigh the benefits?
- How will CMS know if a telehealth service qualifies as “mental/behavioral health”? How should we indicate this when billing?
- Can a Physician Assistant (PA) or Nurse Practitioner (NP) meet the in-person requirement for Medicare mental health telehealth services?
- Can FQHCs and RHCs continue to bill for telehealth (or telecommunications) services for non-behavioral health after September 30, 2025?
- Can FQHCs and RHCs provide mental health services now that the waivers are expired, and are they subject to the in-person requirements?
- Will the end of the Medicare telehealth flexibilities affect Medicaid or other private payers?
CHART: TELEHEALTH MEDICARE POST-SEPTEMBER 30, 2025
In addition to the above FAQ, CCHP has also created a detailed chart outlining current Medicare telehealth policy, exceptions that exist in permanent law, source documentation, and additional notes. This matrix is designed to give providers a quick reference point when interpreting evolving policy. |