The Telehealth Cliff Has Arrived: What's Changing And What To Watch

On October 1st, certain key telehealth flexibilities created during the COVID-19 public health emergency (“PHE”) expired as the government shutdown began. The Centers for Medicare & Medicaid Services (“CMS”) issued a number of telehealth waivers during the PHE, some of which were extended through September 30, 2025 by the Full-Year Continuing Appropriations Act, 2025 (“CAA”). The flexibilities expired as legislative efforts to once again extend the flexibilities, including through the House Committee's stop-gap government funding Continuing Resolution, failed to pass.

The flexibilities that expired on October 1, after being extended by the CAA, are:

• Definition of “Originating Site”:  The CAA extended the definition of “originating site” to mean any site in the U.S., including the home of an individual. An “originating site” is the location where the individual receiving telehealth services is located at the time such services are furnished via a telecommunications system.
• Definition of “Practitioner”:  The CAA extended the definition of “practitioner” to include a qualified occupational therapist, qualified physical therapist, qualified speech-language pathologist, or qualified audiologist. Prior to the PHE, a “practitioner” was limited to a physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, or registered dietitian or nutrition professional.
• RHC and FQHC Telehealth Services: The CAA extended the authorization for Rural Health Clinics (“RHCs”) and Federally Qualified Health Centers (“FQHCs”) to provide and be reimbursed for telehealth services.
• In-Person Visit Requirement for Telehealth Mental Health Services: The CAA delayed the Medicare reimbursement requirement for a physician or practitioner to conduct an in-person exam within six months prior to an initial telehealth service for purposes of diagnosis, evaluation, or treatment of a mental health disorder.
• Audio-Only Telehealth:  The CAA allowed for coverage and reimbursement of telehealth services furnished using audio-only telecommunications technology.
• Recertification of Eligibility for Hospice Care: The CAA extended the permissible use of telehealth for conducting face-to-face encounters prior to recertification of eligibility for hospice care.
• Hospital at Home:  The CAA extended acute care hospital at home flexibilities. 

CMS has begun to offer updated guidance reflecting the expiration of these flexibilities. CMS updated the MLN Booklet on Evaluation and Management Services to explain that the statutory restrictions that governed Medicare telehealth services prior to the PHE will again take effect for most telehealth services beginning October 1, 2025.¹

CMS also published a special edition MLN Connects Bulletin on October 1, 2025 announcing the following updates, but subsequently removed the Bulletin from its website without explanation:

• For select legislative payment provisions (“extenders”) set to expire, the Bulletin instructed all Medicare Administrative Contractors (“MACs”) to implement a temporary claims hold. Such a hold typically lasts up to ten business days and helps ensure that Medicare payments remain accurate and comply with statutory requirements. This hold would be intended to avoid the need to reprocess a large volume of claims if Congress acts after the expiration date. The impact on providers should be minimal due to the 14 days MACs must wait prior to paying any claim. Providers would be able to submit claims during the hold, but payments would not be released until it is lifted.
• If Congress does not take further action, as of October 1, 2025, many of the statutory restrictions that applied to Medicare telehealth services before the COVID-19 Public Health Emergency will once again be enforced. These renewed limitations include prohibiting many telehealth services provided to beneficiaries in their homes or outside designated rural areas, and requiring in-person hospice recertifications. In certain instances, these restrictions may affect beneficiaries' continued eligibility for other Medicare benefits.
• Practitioners providing telehealth services that are not covered by Medicare after October 1, 2025, should consider issuing an  Advance Beneficiary Notice of Noncoverage to affected beneficiaries. It is recommended that practitioners closely monitor Congressional developments and consider holding claims for telehealth services not payable by Medicare in the absence of legislative changes. Furthermore, specific categories of practitioners may become ineligible for Medicare payment for telehealth services.²

There is bipartisan support for extending telehealth flexibilities, but the timing of any future extension and whether it might be applied retroactively remains uncertain. CMS' likely approach to the expirations also appears undetermined, as demonstrated by its rapidly rescinded guidance. In the meantime, providers furnishing telehealth services should evaluate their practices for compliance with the post-PHE regulatory landscape.

Footnotes

1. CMS, MLN006764 – Evaluation and Management Services (Sept. 2025), available at:  https://www.cms.gov/files/document/mln006764-evaluation-management-services.pdf.

2. Palmetto GBA, MLN Connects for Wednesday, October 1, 2025 (Oct. 1, 2025), available at: https://www.dmepdac.com/palmetto/jmhhh.nsf/DID/CQ6HASGLIW.

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