Providers who offer telehealth services to Medicare patients take note: many key telehealth flexibilities that have been in effect since the COVID-19 public health emergency will expire on March 31, 2025. These changes are crucial for both healthcare providers and patients to understand, as they impact the availability of telehealth services for Medicare patients. Below please find some key takeaways from recent congressional updates and policy changes.

What’s Changing?

The following pre-Covid-19 restrictions will be reinstated as of April 1, 2025:

  • Home-Based Telehealth Services: The physical location of the patient once again matters. Providers will need to ensure that only approved services are provided via telehealth to patients physically located at approved originating sites. Other than for behavioral/mental health care, treatment for substance use disorder (SUD), and a few other specific exceptions, a patient’s home is unlikely to be a Medicare-approved originating site.
  • Geographic Restrictions: Providers will also need to confirm that the geographical location of the patient qualifies for Medicare reimbursement of telehealth services. For example, under Medicare’s pre-pandemic rules, originating sites must be located in a rural Health Professional Shortage Areas (HPSA) or in non-Metropolitan Statistical Areas (non-MSA county), or participating in a telemedicine demonstration project. These requirements will again take effect starting April 1, 2025.
  • Exceptions: There are no geographic restrictions for SUD treatment, mental health services, home dialysis for ESRD patients, or diagnosis and treatment of acute stroke.
  • Provider Eligibility: All eligible Medicare providers can offer telehealth services through March 31, 2025. The telehealth expansion provided qualified occupational therapists, physical therapists, speech-language pathologists, and audiologists with temporary dispensation to bill for telehealth services. Starting April 1, 2025, these providers will no longer be able to bill Medicare for telehealth services. Instead, only physicians and practitioners (as defined by federal law) will have these privileges.
  • In-Person Visit Requirements: An in-person visit within six months of an initial Medicare behavioral/mental telehealth service, and annually thereafter, will once again be required. For FQHCs and RHCs, this requirement is waived until January 1, 2026.
  • Audio-Only Services: With the exception of behavioral/mental telehealth services, Medicare will no longer cover audio-only communication platforms to deliver telehealth services after March 31, 2025.

What’s Not Changing?

The following telehealth policies for behavioral and mental health services have been made permanent:

  • Home-Based Behavioral Health Services: Medicare patients can permanently receive telehealth services for behavioral/mental health care in their homes.
  • Geographic Restrictions: There are no geographic restrictions for originating sites for Medicare behavioral/mental telehealth services, and FQHCs and RHCs can permanently serve as a Medicare distant site provider for behavioral/mental telehealth services.
  • Audio-Only Communication: Behavioral/mental telehealth services in Medicare can permanently be delivered using audio-only communication platforms.
  • Provider Eligibility: Marriage and family therapists and mental health counselors can permanently serve as Medicare distant site providers.

Keep an Eye on Controlled Substances

The Drug Enforcement Administration (DEA), jointly with the Department of Health and Human Services (HHS), has extended the full set of telemedicine flexibilities regarding the prescribing of controlled medications as were in place during the COVID-19 public health emergency, through December 31, 2025. Additionally, on January 16, 2025, the DEA (in conjunction with HHS) announced two final rules and a notice of proposed rulemaking to make permanent some temporary telemedicine flexibilities established during the COVID-19 public health emergency while also establishing new patient protections, including certain registration exemptions for U.S. Department of Veterans Affairs practitioners, an expansion of buprenorphine treatment via telehealth, and requiring online telemedicine platforms to register with the DEA.

Congressional Extensions and Expirations

At the end of 2024, Congress extended many of the above Medicare telehealth flexibilities through March 31, 2025, but some key provisions already expired on December 31, 2024, including first-dollar coverage of telehealth services under high deductible health plans (HDHPs) and health savings accounts (HSAs).

This summary addresses some key changes that will take effect on April 1, 2025, but is not an exhaustive list of updates or advice on any specific situation. Unless Congress steps in to further extend telehealth flexibilities established during the Covid-19 pandemic, numerous federal Medicare telehealth waivers will be affected. In addition, various exceptions may apply, depending upon the type of service, type and location of the provider, and other factors.

If you have specific questions about these changes or their potential impact on your practice, please feel free to reach out to the attorneys listed below.

February 27, 2025