Telehealth policy updates
Telehealth
The following summary outlines changes to Medicare telehealth flexibilities upon expiration of the federal Public Health Emergency (PHE) for COVID-19 on May 11, 2023. The AAN always recommends that members verify state-specific regulations with their institution, third-party payer, and malpractice carrier.
For questions, please email practice@aan.com.
Key updates
May 11, 2023: The Federal COVID-19 Public Health Emergency ends.
November 2024: The Drug Enforcement Administration (DEA) again extends the telemedicine prescribing flexibilities stemming from the PHE through December 31, 2025.
January 2025: Telehealth codes and rules to begin under the CMS CY 2025 Physician Fee Schedule Final Rule.
March 15, 2025: The Full-Year Continuing Appropriations and Extensions Act, 2025 extends many of the telehealth flexibilities allowed through emergency PHE waivers through September 30, 2025, overriding the previous extension that was due to expire on April 1, 2025. For more information about the temporary flexibilities included in this legislation, see below.
Temporary telehealth flexibilities
Some telehealth flexibilities will require legislative action from Congress to implement beyond September 2025, whereas others fall under the regulatory authority of various federal agencies such as the CMS or the DEA.
| Telehealth Flexibility | Details | Action Required |
| Geographic and originating sites | Medicare beneficiaries can access telehealth services from any location in the U.S., including in rural and urban areas across state lines (geographic flexibility), and from home or other settings (originating site flexibility). | Legislative |
| Provider address | Providers who render most telehealth services from their homes can rereport their practice location instead of their home address in their Medicare enrollment. | Regulatory |
| Virtual direct supervision | The presence and “immediate availability” of the supervising practitioner may occur via real-time audiovisual communication technology for services furnished by auxiliary personnel or incident to a physician’s service. | Regulatory |
| Virtual supervision of residents | Teaching physicians may maintain a virtual presence via real-time audiovisual communication technology during the key portion of the Medicare telehealth service furnished with residents in all teaching settings (rural or urban). However, virtual supervision is only permitted when a service is furnished virtually, i.e., when the patient, resident, and teaching physician are all in separate locations using real-time audiovisual communication technology. | Regulatory |
| Telehealth Flexibility | Details | Action Required |
| Eligible practitioners | Medicare will continue to reimburse OTs, PTs, SLPs, audiologists, and other practitioners for professional services delivered via telehealth. | Legislative |
| FQHCs and RHCs | Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) may serve as distant sites (the site at which the provider is located) for non-mental health telehealth services. | Legislative |
| Telehealth Flexibility | Details | Action Required |
| Audio-only telehealth | Reimbursement of certain audio-only telehealth services for non-mental health visits provided to patients in their homes. | Legislative |
| Expanded set of telehealth services |
Medicare will continue to reimburse the codes that were added to its on a temporary basis.
Note: CMS considers “telehealth” services as those that serve as a 1:1 replacement for in-person service, and does not include other communication technology-based services, such as virtual check-ins. |
Regulatory |
| Virtual prescribing of controlled substances |
The DEA, jointly with SAMHSA, issued a that will maintain the complete set of telemedicine flexibilities regarding the prescription of controlled medications that were in place during the PHE.
|
Regulatory |
| Hospice | Providers can conduct the face-to-face encounter prior to recertification of eligibility for Medicare hospice benefits via interactive audiovisual telehealth technology. | Legislative |
| Frequency limitations | Certain subsequent inpatient visits, nursing facility visits, and critical care consultations will not be subject to frequency limitations when provided via telehealth. | Regulatory |
| Pre-deductible coverage of telehealth services |
Employers and health plans can offer pre-deductible coverage of telehealth for patients with a high-deductible health plan paired with a health savings account. Note: This provision was not included in the March 2025 Continuing Appropriations and Extensions Act. This flexibility expired on January 1, 2025. |
Legislative |
What varies by state
- Licensure requirements. Some states have exceptions that allow out-of-state providers to provide telehealth under certain conditions, but many scope of practice laws continue to evolve.
- Coverage and payment parity for private payers and Medicaid. About half of states have passed payment parity laws and some state Medicaid programs have vastly broadened the types of services and modalities allowed via telehealth.
- Online prescribing, as highlighted above.
What ended immediately after the PHE
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The HHS Office for Civil Rights will no longer apply enforcement discretion to telehealth providers who use virtual platforms that do not fully comply with HIPAA requirements.
- Hospitals will no longer receive an originating site fee unless the patient receives telehealth services while located in the hospital.
- CMS will no longer permit virtual check-ins and e-visits for new patients.
- Practitioners can no longer waive the 20% beneficiary copay for Part B services.
Permanent policies after the PHE
- Medicare reimbursement for behavioral/mental telehealth services (including audio-only in some cases), provided there is an in-person visit within the first six months prior to the initial telehealth visit and every 12 months thereafter (with certain exceptions). These services can be provided in a patient’s home without meeting geographic requirements.
- Note: The implementation of the in-person requirement is delayed until September 30, 2025, as enacted in the March Continuing Appropriations and Extensions Act, 2025.
- Reimbursement to for mental health services delivered via audio-only (in certain cases) or real-time audiovisual communications technology.
AAN telehealth advocacy
View the AAN's recent comment letters and learn how you can advocate for telehealth.
Questions?
Email practice@aan.com to reach staff and member experts.