APA Services will continue to support legislative efforts to eliminate the in-person telehealth requirement, including but not limited to the Telemental Health Care Access Act (H.R. 3884 / S. 2011). The new APA/APA Services Response Center provides an up-to-date overview of all the association’s advocacy efforts.
American Psychological Association. (2025, September 4). The telehealth waiver: What psychologists need to know. https://www.apaservices.org/practice/reimbursement/government/medicare-inperson-telehealth-requirement
What is Congress currently doing on telehealth?
Congress is returning to Washington following its traditional month-long August recess, and is immediately faced with several imminent legislative deadlines it needs to address before the end of September. These include concluding its work around the federal budget for Fiscal Year 2026, as well as addressing several expiring health care policies, including a delay of the in-person visit requirement for Medicare coverage of telehealth services.
Is Congress likely to act on telehealth?
Access to health care services via telehealth has broad bipartisan support in Congress, but with little time remaining before the deadline, it appears unlikely that Congress will enact a permanent solution on Medicare telehealth coverage at this time. However, Advocacy staff are hearing that Congress is more likely to include another short-term delay of the in-person visit requirement in either a budget bill or a separate package of health care extenders. Advocacy staff continues to work alongside its partners on telehealth policy, including the American Telemedicine Association, to press members of Congress to act before the September 30 deadline.
Can CMS remove the in-person requirement through rulemaking like the Physician Fee Schedule?
No. Congress created the in-person visit requirement through a legislative Act, which can only be undone or delayed by a subsequent Act of Congress.
If the telehealth waiver expires (on September 30, 2025) will in-person visits be required?
Yes, in-person visits will be required within 6 months prior to an initial telehealth visit and every 12 months thereafter.
Is there an exception for the initial 6-month visit for established patients who are already being treated via telehealth?
Yes, if the telehealth waiver expires and the Medicare in-person requirement goes into effect, established patients who began treatment while the waiver was in effect and are currently receiving behavioral health services via telehealth do not need to have an in-person visit within 6 months of the September 30 expiration date.
In the Calendar Year (CY) 2023 Centers for Medicare and Medicaid (CMS) Physician Fee Schedule final rule, CMS implemented the provisions of the Consolidated Appropriations Act of 2021, which included the in-person requirements. CMS stated that if a beneficiary has been receiving behavioral health services via telehealth due to the flexibilities specific to the Public Health Emergency (PHE) in effect at the time, then they would not require an initial in-person visit within that 6-month period. The provider would need to comply with the requirement to have an in-person visit annually moving forward.
From page 69464: “However, we clarify that we do not believe this requirement applies to beneficiaries who began receiving mental health telehealth services in their homes during the PHE. In other words, if a beneficiary began receiving mental health telehealth services during the PHE or during the 151-day period after the end of the PHE, then they would not be required to have an in-person visit within 6 months; rather, they will be considered established and will instead be required to have at least one in-person visit every 12 months (so long as any such subsequent telehealth service is furnished by the same individual physician or practitioner or a practitioner of the same sub-specialty in the same practice).”
Important: The 151-day period extension was only in the context of the PHE. Since the PHE has concluded, there would be no 151-day period extension after the waivers expire.
For an established patient, when will the clock start ticking on the 12-month time frame?
The clock starts ticking on October 1, 2025, since the waiver is currently set to expire on September 30, 2025.
What about new patients, after the waiver expires?
For new patients, providers must have seen the patient in person within the previous 6 months before starting telehealth services.
Are there exceptions to the requirement for an in-person visit within 6 months before initiating telehealth services for new patients?
No. In the CY 2022 CMS PFS final rule, CMS stated: “We note that there is no exception to the statutory requirement that the physician or practitioner must furnish to the beneficiary an in-person, non-telehealth service within 6 months prior to initiation of mental health services via telehealth.” Note: This is for new telehealth patients, not established telehealth patients.
Are there exceptions for the subsequent in-person visit every 12 months?
Yes, for both established and new patients. In the CY 2022 CMS PFS final rule CMS stated: “Specifically, if the patient and practitioner agree that the benefits of an in-person, non-telehealth service within 12 months of the mental health telehealth service are outweighed by risks and burdens associated with an in-person service, and the basis for that decision is documented in the patient’s medical record, the in-person visit requirement will not apply for that particular 12-month period. For example, situations in which the risks and burdens associated with an in-person service may outweigh the benefit could include, but are not limited to, instances when an in-person service is likely to cause disruption in service delivery or has the potential to worsen the patient’s condition(s). The risks and burdens associated with an in-person service could also outweigh the benefit if a patient is in partial or full remission and only requires a maintenance level of care. Other examples of such instances may include the clinician’s professional judgment that the patient is clinically stable and/or that an in-person visit has the risk of worsening the patient’s condition, creating undue hardship on self or family, or if it is determined that the patient is at risk for disengagement with care that has been effective in managing the illness. Practitioners must also document that the patient has the ability to obtain any needed point of care testing, including vital sign monitoring and laboratory studies. Practitioners must note the exception for any applicable 12-month interval.”
The annual in-person visit can be with the treating provider or with another provider who has the same subspecialty and works in the same practice.
Psychologists are encouraged to develop record-keeping procedures to meet documentation requirements in the event of a Medicare audit. If you do not have a subsequent in-person visit annually with an ongoing Medicare patient, you will need to have clear documentation in the patient’s chart as to why you did not, such as if the patient lives out of town or in another state, making travel an undue hardship, or if the patient may discontinue care if an in-person visit is required. More examples are shared in the CY 2022 CMS PFS final rule.
You are also encouraged to connect with your local Medicare Administrative Contractor for additional specifics on documentation requirements. We recommend that, whenever feasible, providers get into the habit of seeing ongoing Medicare telehealth patients once in person annually.
