Medicare will require in-person visits for telehealth mental health services beginning October 1, 2025, unless Congress extends current waivers before the September 30 deadline.
What happened
Congress established telehealth waivers during the COVID-19 pandemic that allowed behavioral health providers to treat Medicare patients remotely without requiring in-person visits. These waivers enabled mental health providers to scale their operations and expand access to care. However, the waiver that eliminates the in-person visit requirement expires on September 30, 2025. Starting October 1, Medicare will revert to its pre-pandemic policy requiring practitioners to see patients in person within six months before beginning telehealth sessions, then annually thereafter. This requirement applies specifically to mental health services and does not include substance use disorder treatment. Congress has not acted to make this waiver permanent or extend it further.
The backstory
During the pandemic, Congress and Medicare implemented multiple waivers to accelerate telehealth adoption in behavioral health care. The policy changes removed geographic restrictions and allowed audio-only services. Some waivers have since become permanent through regulation or statute, including the elimination of geographic and originating site restrictions, permission for audio-only telehealth, and broader coverage in FQHCs and RHCs. However, the in-person visit requirement waiver remains temporary and faces expiration.
Going deeper
Several behavioral health flexibilities will remain permanent:
- No geographic or originating site restrictions - providers can serve patients in their homes regardless of location
- Audio-only telehealth permitted without requiring video
- Federally Qualified Health Centers and Rural Health Clinics can permanently serve as distant site providers for behavioral health services
Proposed rules from CMS and the DEA could expand access further. CMS's proposed 2026 Medicare Physician Fee Schedule would permanently allow direct supervision of behavioral health services via real-time interactive audio-visual technology. The DEA considers rules permitting controlled substance prescribing for substance use disorder treatments without in-person visits.
What was said
Congress extended telehealth waivers through the Full-Year Continuing Appropriations and Extensions Act, 2025 (H.R. 1968). Section 2207 of the legislation extends several telehealth flexibilities that were set to expire on March 31, 2025, through September 30, 2025. The law specifically delays "the in-person requirements under Medicare for mental health services furnished through telehealth" by changing the implementation date from "on or after April 1, 2025" to "on or after October 1, 2025" in multiple sections of the Social Security Act.
Why it matters
This policy might change how behavioral health companies operate under Medicare. Many telehealth-based mental health providers have built their business models around remote care delivery, serving patients in underserved areas where in-person mental health services are limited. The return of the in-person visit requirement could force providers to either establish physical locations near their patient populations, limit their Medicare patient base, or stop accepting Medicare altogether.
The bottom line
Behavioral health providers must act immediately to prepare for this change. They should contact Congressional representatives to advocate for waiver extensions, develop plans to bring patients in for in-person visits, and create communication strategies for staff and patients about upcoming policy changes. Providers should also prepare contingency plans for patients who cannot access in-person visits, including care transitions or out-of-pocket payment options.
FAQs
Does the in-person requirement apply to all telehealth services under Medicare?
No, it only applies to behavioral health services, not substance use disorder treatment.
How will this change affect Medicare patients in rural areas?
Patients in rural areas may face reduced access to care if providers cannot offer local in-person visits.
Will providers face penalties if they continue telehealth without an in-person visit?
Yes, Medicare claims could be denied or rejected if requirements are not met.
Can audio-only telehealth still be used after September 30, 2025?
Yes, audio-only behavioral health services remain permanently covered.
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