QUESTION:
Are the CMS telehealth flexibilities gone for good?
ANSWER FROM HORTYSPRINGER ATTORNEY HALA MOUZAFFAR:
On September 30, 2025, many of the pandemic-era Medicare telehealth flexibilities expired. This included such provisions that allowed Medicare recipients to receive non-behavioral/mental health care in their homes and removed geographic restrictions on originating sites for such services. With their expiration, the statutory limitations that had been waived during the COVID-19 public health emergency are now back in effect.
Since the end of the COVID-19 public health emergency, Congress has repeatedly extended telehealth flexibilities to allow time for further consideration of their permanence. In September, several bills were introduced to extend the remaining flexibilities for periods ranging from seven weeks to two years, aiming to prevent a “telehealth cliff.” Unfortunately, before any action could be taken, the government shut down.
Since the expiration of the flexibilities, we have not heard much in terms of next steps for telemedicine. So far, CMS has indicated that practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to consider providing beneficiaries with an Advance Beneficiary Notice of Noncoverage (“ABN”). CMS has also noted that practitioners may choose to hold claims associated with telehealth services that are currently not payable by Medicare in the absence of Congressional action on the flexibilities.
When the government reopens, we will be watching closely to see what, if any, action Congress takes to reup some of these flexibilities or make them permanent. Unfortunately, for the time being, to guarantee payment, healthcare entities need to provide telehealth services within the confines of what CMS billing rules require, which means without many of those flexibilities we have become accustomed to. CMS issued an updated list of FAQs earlier this month to help sort through many of the changes.
If you have a quick question about this, e-mail Hala Mouzaffar at hmouzaffar@hortyspringer.com.