On March 14, 2025, as part of a spending bill to avert a federal government shutdown, Congress extended COVID-era telehealth “waivers” applicable to Medicare until September 30, 2025.  These were originally scheduled to end March 31, 2025.

This is welcome news for health care organizations who have relied on the flexibility offered by these waivers to extend access to telehealth services for Medicare beneficiaries and other patients nationwide since the COVID-19 pandemic. However, this represents another short-term extension by the government and poses questions on whether all or some of the telehealth flexibilities will be codified into law.

As a reminder, a set of key waivers to Medicare telehealth payment restrictions were enacted under the Social Security Act temporarily in connection with COVID-19 pandemic measures. These statutory waivers have now been extended by act of Congress multiple times, and this latest extension will have the following impacts related to telehealth:

• Telehealth at Home: Medicare patients will continue to be able to receive telehealth services in their homes and in any other location in the country through at least September 30, 2025.
  • In the absence of this extension, Medicare beneficiaries would have only been permitted to receive telehealth services in certain approved health care facilities in rural locations (outside of metropolitan statistical areas) as of April 1, 2025.
  • Note that the Social Security Act does include a narrow exception that permits telehealth services in the home (or other locations) for patients in specific circumstances approved by law or regulation, including patients being treated for acute stroke symptoms, patients with a substance use disorder diagnosis, or patients with a mental health disorder (but see the additional in-person requirement for mental health telehealth treatment noted below), and patients on home dialysis for related clinical assessments.
• Audio-Only Telehealth: Telehealth services can continue to be provided via audio-only communications systems.
  • Without the extension, telehealth services would no longer have been available via audio-only systems as of April 1, 2025, and to be reimbursed for telehealth services would require the use of approved interactive telecommunications systems only (which are defined generally to refer to audio/video equipment allowing for two-way real-time interactive communications between the patient and provider, except in narrow exceptions for store-and-forward technology under telemedicine demonstration programs).
• Telehealth Providers: Medicare patients can continue to receive telehealth services from all types of approved Medicare-enrolled providers (the waiver permits qualified occupational therapists, physical therapists, speech-language pathologists, and audiologists to furnish services via telehealth and be paid by Medicare for doing so).
• FQHC/RHC Telehealth: Federally qualified health centers (FQHCs) and rural health clinics (RHCs) can continue to provide telehealth services to patients in other locations.

Additionally, the legislation extends until October 1, 2025, the effective date of a requirement for reimbursement by Medicare of telehealth services to a Medicare beneficiary for purposes of diagnosis, evaluation, or treatment of a mental health disorder that:

1. the provider must have furnished a Medicare-covered item or service to the beneficiary in-person (without the use of telehealth) within the prior 6 months before furnishing such telehealth services, and
2. the provider must continue to furnish Medicare-covered items or services in-person (without the use of telehealth) to the beneficiary at least once a year following each subsequent telehealth service.
   1. The annual in-person follow-up is not required if the provider and beneficiary agree the risks of an in-person service outweigh the benefits.

Once required, the foregoing in-person visit requirement could also be fulfilled by another provider of the same specialty in the same group as the provider furnishing the telehealth service if the telehealth provider is not available to do so.

Despite this temporary reprieve to sustain current telehealth waivers through September 30, 2025, health care organizations should start preparing now for the potential end of the waivers and additional restrictions on telehealth services as soon as October 1, 2025. Moreover, health care organizations should also be aware that additional flexibilities and waivers tied to the COVID-19 era remain in place but are scheduled to expire at the end of 2025, including DEA tele-prescribing flexibilities previously discussed here.

Seth Orkand contributed to this article