/>iIn the final hours of 2024, Congress passed a six-month extension of the Medicare telehealth flexibilities through its 2025 funding bill, pushing the expiration date to September 30, 2025. Now, with that deadline quickly approaching, many telehealth providers are left wondering whether Congress will act in time.
As things stand today, it is uncertain whether the Medicare telehealth flexibilities will be extended. Although Congress faces tight fiscal constraints and competing priorities, there continues to be strong bipartisan support for maintaining telehealth access, making another extension likely but not guaranteed. Below, we discuss what is at stake, what actions are currently on the table, and what telehealth stakeholders can do to help move the needle.
What Is at Stake
Without an extension from Congress, the Medicare telehealth flexibilities will expire on October 1, 2025, reverting to the pre-COVID-19 framework — one that serves only a limited portion of the Medicare population. Below is a summary of the key components of the flexibilities as they currently stand and the policies that would go into effect if the flexibilities expire, based on 42 U.S.C. § 1395m and 42 C.F.R. § 410.78. This summary is not exhaustive and may omit certain nuances.
| Flexibility | Current (through 9/30/25) | After Expiration (10/1/25) |
|---|---|---|
| Originating Site | Any U.S. location, including the patient’s home | Limited to certain locations, for example: Provider’s officeHospitalSkilled nursing facility Home of a patient with end-stage renal disease (ESRD) receiving home dialysisHome of a patient receiving treatment for substance use disorder (SUD) or a co-occurring mental health disorderHome of a patient receiving diagnosis, evaluation, or treatment for a mental health disorder (if the in-person visit requirement is met) |
| Geographic Restrictions | No geographic restrictions | Patients must be located in a rural health professional shortage area or in a county not included in a Metropolitan Statistical Area except for patients: With ESRD receiving dialysis at a hospital- or critical access hospital-based renal dialysis center, at a renal dialysis facility, or at home Receiving diagnosis, evaluation, or treatment for an acute strokeReceiving treatment for SUD or a co-occurring mental health disorderReceiving diagnosis, evaluation, or treatment for a mental health disorder (if the in-person visit requirement is met) |
| Audio-Only Visits | Available for any telehealth service, if clinically appropriate | Limited to patients receiving telehealth services at home if the provider is technically capable of using audio-video technology but the patient cannot or will not use video |
| Expanded Provider Types | Any health care provider eligible to bill Medicare, including occupational therapists, physical therapists, speech-language pathologists, and audiologists, etc. | Limited to: PhysiciansPhysician assistantsNurse practitionersClinical nurse specialistsNurse-midwivesClinical psychologistsClinical social workersRegistered dietitians or nutrition professionalsCertified registered nurse anesthetistsMarriage and family therapistsMental health counselors |
| FQHC/RHC as Distant Site | Federally qualified health centers (FQHCs) and rural health clinics (RHCs) are eligible distant sites. | FQHCs and RHCs are not eligible distant sites. |
| Mental Health In-Person Visit | No in-person visit requirement | For patients receiving diagnosis, evaluation, or treatment for a mental health disorder, an in-person visit is required: Within six months prior to the initial telehealth visit; andEvery 12 months thereafter while the patient is receiving telehealth services; Unless the provider and patient agree the risks and burdens outweigh the benefits of an in-person visit and the provider documents the reason for the decision in the patient’s medical record. In-person visit requirements for FQHCs and RHCs resume January 1, 2026. |
If the Medicare telehealth flexibilities expire, Medicare Administrative Contractors who process claims for Medicare payment may begin enforcing the telehealth coverage restrictions and denying claims for noncompliant services starting October 1, 2025. Many commercial insurers and state Medicaid programs model their coverage policies on Medicare payment policies. As a result, a federal rollback in Medicare telehealth coverage could prompt these payors to scale back their own telehealth benefits for 2026.
Where Congress Stands
Pending Legislation
Several bills have been introduced in 2025 that would extend the Medicare telehealth flexibilities or make them permanent. Among the most viable are:
- Telehealth Modernization Act (H.R. 5081 / S. 2709)
- Introduced September 2, 2025, by Rep. Buddy Carter (R-GA) and Rep. Debbie Dingell (D-MI) and September 4, 2025, by Sen. Tim Scott (R-SC), Sen. Brian Schatz (D-HI), Sen. Cindy Hyde-Smith (R-MS), Sen. Kirsten Gillibrand (D-NY), Sen. Thom Tillis (R-NC), and Sen. Angus King (I-ME)
- The bill would extend the Medicare telehealth flexibilities through September 30, 2027.
- CONNECT for Health Act of 2025 (S. 1261 / H.R. 4206)
- Reintroduced April 2, 2025, by Sen. Brian Schatz (D-HI) and 60 other Senators, and June 26, 2025, by Rep. Mike Thompson (D-CA), Rep. David Schweikert (R-AZ), Rep. Doris Matsui (D-CA), and Rep. Troy Balderson (R-OH)
- This comprehensive bipartisan bill would make the Medicare telehealth flexibilities permanent.
FY 2026 Spending Bills
Both the House and Senate are advancing their FY 2026 Labor-Health and Human Services appropriations bills, which could carry extensions of the Medicare telehealth flexibilities. However, in their current form, neither version includes explicit language confirming the flexibilities will be extended beyond September 30, 2025.
A Brief History
Congress first implemented the Medicare telehealth flexibilities during the COVID-19 PHE in 2020. The flexibilities were later extended, or made permanent in certain cases, through the 2021 Consolidated Appropriations Act (CAA), 2022 CAA, and 2023 CAA. In mid-December 2024, a draft of the year-end spending bill proposed extending all Medicare telehealth flexibilities and telehealth policies in place before January 1, 2025, for an additional two years. However, just days before a potential government shutdown on December 20, 2024, the deal was unexpectedly scrapped, prompting last-minute negotiations to salvage key provisions. Ultimately, Congress extended the flexibilities through March 31, 2025, in the 2025 American Relief Act and again through September 30, 2025, in the 2025 Full-Year Continuing Appropriations and Extensions Act. For more details, refer to our prior discussions detailing the extensions provided in the 2022 CAA, 2023 CAA, and 2025 American Relief Act.
Make Your Voice Heard
Demonstrating widespread agreement across the health care industry, 350 organizations, including the American Telemedicine Association and the Alliance for Connected Care, have already sent a letter urging Congress to act on the Medicare telehealth flexibilities before they expire at the end of the month. Stakeholders who rely on the flexibilities are strongly encouraged to contact their local Congressperson or the White House. Continuing to urge Congress to extend or permanently adopt the flexibilities will be essential to ensuring continued Medicare reimbursement for telehealth services.
Bottom Line
Although the Medicare telehealth flexibilities are set to expire on September 30, 2025, momentum for another extension is building in these final days before the deadline. Congress has extended the flexibilities multiple times with strong bipartisan support, and several bills introduced this year, including the Telehealth Modernization Act and the CONNECT for Health Act, show continued interest in preserving Medicare reimbursement for telehealth services. If Congress can agree on a viable funding offset, such as savings from pharmacy benefit manager reform, site-neutral payments, or Medicare Part B adjustments, a permanent adoption of the flexibilities may be a possibility. That said, with appropriations bills still subject to ongoing negotiations, nothing is guaranteed. As a result, stakeholders should continue to keep pressure on Congress to act.
