Telehealth reimbursement policy has shaped how millions of patients reach their providers over the past decade. For care organizations, the rules that govern payment are the difference between a sustainable virtual care program and one that stalls. This guide walks through the history of telehealth reimbursement policy, where Medicare stands now, and what providers should watch heading toward the next deadline.
A Short History of Telehealth Reimbursement Policy
For most of Medicare’s history, telehealth reimbursement policy was narrow. Coverage was limited to patients in rural areas who traveled to an approved clinical site, called an originating site, to connect with a distant provider. The patient’s home did not qualify. Audio-only visits were not reimbursed. These restrictions kept telehealth a small share of Medicare spending for years.
That changed in March 2020. The COVID-19 public health emergency (PHE) prompted the Centers for Medicare and Medicaid Services (CMS) to waive most of the old limits. Patients could receive covered services at home, geographic restrictions were suspended, and audio-only visits were reimbursed for the first time at scale. These waivers were tied to the PHE rather than written into permanent law.
When the PHE ended, Congress stepped in to keep the flexibilities alive. The Consolidated Appropriations Act of 2023 extended most Medicare telehealth waivers past the emergency period. Since then, telehealth reimbursement policy has moved forward through a series of short-term extensions rather than one permanent statute. That pattern is central to understanding the uncertainty providers still face.
How Telehealth Reimbursement Policy Works Under Medicare
Medicare telehealth reimbursement policy rests on a few core questions. Where is the patient located? Who is providing the service? What technology is used? And is the specific service on the Medicare Telehealth Services List? Each answer affects whether a claim is covered and paid.
Two categories matter most. Behavioral and mental health telehealth has become the more stable category, with several flexibilities written into permanent law. Non-behavioral telehealth, which covers most other services including many that support remote patient monitoring programs, has stayed on temporary extensions that Congress must renew.
The Current State of Telehealth Reimbursement Policy
Telehealth reimbursement policy went through a turbulent stretch in late 2025 and early 2026. The flexibilities lapsed briefly during the federal government shutdown that began October 1, 2025. A continuing resolution signed November 12, 2025 reopened the government and restored the waivers retroactively through January 30, 2026.
Congress then passed a broader funding package. On February 3, 2026, President Trump signed the Consolidated Appropriations Act of 2026 (H.R. 7148), which retroactively extended the major Medicare telehealth flexibilities through December 31, 2027. CMS confirmed that claims filed during the coverage gaps would be paid as if no lapse had occurred.
What Is Covered Through December 31, 2027
Under the current extension, the following non-behavioral telehealth flexibilities remain in effect through the end of 2027:
1) Home as an originating site
Medicare patients can receive covered telehealth services in their homes.
2) No geographic restrictions
The rural-area requirement stays waived, so patients in urban and suburban settings qualify.
3) Expanded practitioners
Physical therapists, occupational therapists, speech-language pathologists, and audiologists can continue to furnish and bill for telehealth services.
4) FQHCs and RHCs as distant sites
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as distant-site providers for non-behavioral services.
5) Audio-only coverage
Certain non-behavioral services delivered by audio-only telephone remain reimbursable.
The package also extended the Acute Hospital Care at Home program through September 30, 2030.
What Is Now Permanent
Behavioral and mental health telehealth is the more settled part of telehealth reimbursement policy. Medicare patients can permanently receive behavioral and mental health telehealth in their homes, with no geographic restrictions. Two-way, real-time audio-only communication is a permanent option for services furnished to a patient at home when the provider is capable of video but the patient cannot or will not use it. The in-person visit requirement for behavioral telehealth is deferred until January 1, 2028.
What Providers Should Watch
The Drug Enforcement Administration extended its telehealth controlled-substance prescribing flexibilities through December 31, 2026. Without a further extension or a permanent rule, providers would return to the in-person examination requirement under the Ryan Haight Act of 2008.
CMS has signaled a process change worth noting. In the CY2026 Physician Fee Schedule Final Rule (CMS-1832-F), the agency stated that future updates to this policy will be issued through subregulatory guidance rather than formal rulemaking. Providers should monitor CMS FAQs, not just the annual fee schedule, to stay current.
Why Telehealth Reimbursement Policy Matters for RPM and RTM
Telehealth reimbursement policy and remote monitoring reimbursement are related but distinct. The telehealth flexibilities described above govern live, encounter-based virtual visits. Remote patient monitoring and remote therapeutic monitoring (RTM) are billed under their own CPT code families, which do not carry the same geographic and originating-site limits that historically applied to telehealth visits.
Still, the two work together. A patient enrolled in an RPM program often connects with a care team through a virtual visit, and stable telehealth coverage keeps that pathway open. When telehealth reimbursement policy is uncertain, program planning across virtual care becomes harder, which is why care organizations track these deadlines closely.
RPM data transmits automatically from connected devices, giving care teams a steady view of a patient’s vitals between visits. That continuity supports proactive, preventive care, which is the goal behind reimbursement in the first place: keeping patients healthier and lowering the cost of avoidable complications.
Telehealth Reimbursement Policy: Frequently Asked Questions
1) Can Medicare patients receive telehealth at home in 2026?
Yes. Under the Consolidated Appropriations Act of 2026, Medicare beneficiaries can receive covered telehealth services from any location, including their home, with no geographic restrictions through December 31, 2027, as long as the service is on the Medicare Telehealth Services List.
2) When do the current telehealth flexibilities expire?
The major non-behavioral flexibilities expire December 31, 2027, unless Congress acts again. Behavioral and mental health telehealth flexibilities are largely permanent, and the behavioral in-person requirement is deferred until January 1, 2028.
3) Does Medicare still pay for audio-only telehealth?
Yes, within limits. Certain non-behavioral audio-only services are reimbursable through December 31, 2027. For behavioral health, audio-only is a permanent option under defined conditions, including documentation that the patient could not or would not use video.
4) Is telehealth reimbursement policy the same as RPM reimbursement?
No. Telehealth reimbursement policy covers live virtual visits and their geographic and site rules. RPM and RTM are billed under separate CPT code families that do not carry those same restrictions, though both support virtual care programs.
5) How should providers stay current on telehealth reimbursement policy?
Watch CMS guidance closely. In the CY2026 Physician Fee Schedule Final Rule, CMS said future policy updates will come through subregulatory guidance and FAQs rather than formal rulemaking, so annual rules alone will not capture every change.
Understanding Telehealth Reimbursement Policy
Telehealth reimbursement policy has moved from a narrow, rural-only benefit to a broad set of flexibilities that keep patients connected to care at home. The history shows a consistent pattern: emergency waivers, followed by short-term Congressional extensions, followed by the next deadline. Today, non-behavioral flexibilities run through December 31, 2027 under the Consolidated Appropriations Act of 2026, behavioral health coverage is largely permanent, and CMS now updates the policy through guidance. Providers who track these dates and watch CMS FAQs can plan virtual care programs with more confidence.
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