As of October 1, 2025, new federal rules are back in effect for clinicians providing telehealth services to Medicare clients. These changes stem from the expiration of the COVID-era waiver that temporarily lifted in-person visit requirements. Until new legislation is enacted, providers should operate under the assumption that the in-person requirements are in full effect.
If you see Medicare patients via telehealth, here’s what you need to know to stay compliant and plan ahead.
Why This Matters
For the past few years, Medicare clinicians have been able to meet with patients virtually under expanded telehealth flexibilities. Those waivers officially expired on September 30, 2025, and Congress has not yet taken action to extend or modify them.
As a result, the original federal in-person visit requirements are now active again, as defined under 42 CFR 410.78.
What’s Required Now
Clinicians providing telehealth to Medicare clients must now meet the following standards:
- New Medicare clients: You must see the client in person within six months prior to the first telehealth session.
- All Medicare clients: You must see each client in person at least once every 12 months thereafter.
These requirements apply to all mental health services delivered via telehealth to Medicare beneficiaries, unless an exception applies (see below).
Existing Medicare Clients
There’s some uncertainty about whether established Medicare clients need an initial in-person visit before continuing telehealth sessions after October 1st.
Some guidance from CMS and the APA suggests that only the annual in-person visit is required for existing clients. However, interpretations vary.
To protect your practice, it’s best to:
- Confirm directly with your local Medicare Administrative Contractor (MAC) for clarification. Not sure who your MAC is? Visit Who are the MACs to find out.
- Document what they tell you in your records.
- Note in each client’s chart why an in-person visit may not be appropriate or feasible, if applicable.
Exceptions to the In-Person Visit Requirement
Certain clients may qualify for exceptions, but they must be clearly documented in the patient’s medical record. Exceptions may include:
- Clients for whom an in-person visit is not appropriate or feasible, such as those with limited mobility, transportation barriers, or who live in remote areas.
- Clients receiving treatment for substance use disorder, or for a substance use disorder with a co-occurring mental health condition.
Both the clinician and the patient must agree that the burdens or risk of an in-person visit outweigh the benefits for an exception to apply.
Considerations for Medicare Advantage Plans
If your client is enrolled in a Medicare Advantage (MA) plan, the rules may differ. Since MA plans are administered by private carriers (e.g., UnitedHealthcare, Aetna, or Cigna), each plan has some flexibility in how they apply Medicare’s telehealth policies.
Be sure to contact the MA plan directly to confirm their requirements before scheduling telehealth visits.
If You No Longer Have an Office
Even if you’ve transitioned to a fully remote practice, you’ll still need a way to meet in person to satisfy the Medicare rule. This could include:
- Using a shared or part-time office space, or
- Conducting in-home visits (as long as your Medicare enrollment lists that service type).
If you continue seeing a Medicare client via telehealth without meeting the in-person requirement, you may have to issue an Advance Beneficiary Notice (ABN) and treat the session as cash-pay, since Medicare may not reimburse it.
Preparing Your Practice
Given the uncertainty and administrative complexity, here are a few proactive steps to take now:
- Verify with your MAC what applies to your region and document all communications.
- Plan for in-person options; whether that means part-time office access or home visits.
- Update your Medicare enrollment to include any new practice locations or in-home services. For guidance, see the following PECOS Enrollment Tutorials:
- Document thoroughly when clients qualify for exceptions.
- Communicate with your patients early about potential changes to care.
Where to Stay Informed
For ongoing updates and policy tracking, you can visit:
You can also subscribe to CCHP’s free policy newsletter for real-time telehealth updates.
Key Takeaways
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The COVID-era telehealth waiver expired on September 30, 2025, reinstating the in-person visit requirement.
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New Medicare clients: in-person visit required within six months before telehealth.
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All Medicare clients: in-person visit required every 12 months.
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Exceptions exist but must be clearly documented.
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Stay proactive by verifying details with your Medicare contractor and plan how to meet compliance.
