Medicare Telehealth Flexibilities Have Expired

Key takeaways:

• Flexibility Dramatically Shifts: With no FY 2026 spending invoice handed, the federal government shutdown triggered a rollback to pre-pandemic Medicare telehealth reimbursement insurance policies, limiting affected person areas and eligible suppliers and requiring in-person visits at sure intervals for psychological well being companies; discover a abstract right here.
• Non permanent Claims Maintain in Impact: CMS has instructed MACs to briefly maintain claims to keep away from reprocessing if flexibilities are reinstated. Suppliers can nonetheless submit claims, however funds are paused.

With Congress unable to cross a FY 2026 spending invoice, the federal government formally shut down on October 1, 2025. With it, the Medicare telehealth flexibilities have lapsed.

We are actually again to the pre-pandemic restrictions on Medicare reimbursement for telehealth, which suggests:

• Sufferers have to be positioned in sure well being care amenities (with restricted exceptions for sure end-stage renal illness, substance use dysfunction, and psychological well being dysfunction sufferers)
• Solely sure suppliers are eligible to ship telehealth companies
• For psychological well being dysfunction sufferers, in-person visits are required inside six months earlier than the primary telehealth go to and each 12 months thereafter

For extra on what Medicare telehealth coverage appears to be like like post-expiration, learn: Medicare Telehealth Flexibilities: Countdown to September 30, 2025.

In an replace issued the morning of Oct. 1, the Facilities for Medicare & Medicaid Providers (CMS) directed all Medicare Administrative Contractors to implement non permanent claims maintain to keep away from having to reprocess giant volumes of claims ought to Congress reinstate the flexibilities.

Suppliers could proceed submitting claims throughout this era, however funds is not going to be launched till the maintain is lifted. Through the lapse, CMS reminds suppliers to think about whether or not issuing an Advance Beneficiary Discover of Noncoverage can be acceptable when delivering telehealth companies which will not be lined by Medicare.