Medicare News for Telehealth Providers

As of October 1, 2025, many COVID-era telehealth flexibilities expired because Congress did not extend them. This means several pre-pandemic restrictions on Medicare telehealth payments are now back in effect.

Key points:

Telehealth limitations reinstated: Medicare will no longer pay for most telehealth services provided to patients in their homes or outside rural areas, except for:

• Behavioral and mental health services
• Monthly ESRD-related assessments
• Telehealth services provided by qualifying ACO participants under the Medicare Shared Savings Program
• Hospice recertifications again require in-person visits

CMS actions since Oct. 1, 2025:

• CMS directed Medicare Administrative Contractors (MACs) to pay only telehealth claims that clearly meet legal requirements.
• Claims are being paid when CMS can confirm they are for behavioral/mental health services or fall within approved HCPCS codes.
• Claims with place of service code 10 (home) and mental/behavioral health diagnoses (F01.A0–F99) are being processed unless performed by PTs, OTs, SLPs, or audiologists.

Unpaid/held claims:

CMS has been unable to automatically identify all eligible claims (especially those protecting patient privacy or coming from ACO clinicians). These claims have been on hold due to system limitations.

Next steps:

To resolve this, CMS will return all currently held telehealth claims (submitted on or before Nov. 10, 2025, with dates of service on or after Oct. 1, 2025) to providers.

• Returned claims will include CARC 16 and RARC M77 messages.
• Providers may resubmit claims that meet statutory telehealth requirements.

Additional details and claim submission guidance are available on CMS’s All Fee-For-Service Providers | CMS webpage.

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