Medicare Telehealth Update: New In-Person Visit Rules Effective January 2026

Major changes are coming for clinicians who provide telehealth services to Medicare beneficiaries, but with an important delay built in. Although Medicare has finalized rules reinstating in-person visit requirements for mental health telehealth services, Congress has delayed enforcement of these requirements until 2028 through the recently passed Department of Health and Human Services (DHHS) budget packet. 

In short, the rules have been in effect since January 31, 2026, but CMS will not enforce them until 2028, giving clinicians additional time to prepare. Here’s what you need to know to stay compliant and plan ahead. 

Why This Matters

Since 2020, mental health providers could conduct Medicare covered sessions fully via telehealth under temporary COVID-era flexibilities. Those waivers have officially ended, and Medicare’s statutory in-person requirements have returned. 

However, the DHHS budget legislation delays enforcement of the in-person mental health telehealth requirement until 2028, meaning clinicians will not be penalized for noncompliance before that date. This enforcement delay provides breathing room, but practices should still understand the rules now so they can prepare ahead of time. 

Requirements Once Enforced

When enforcement begins in 2028, clinicians providing telehealth to Medicare clients will be required to meet the following standards:

• New Medicare clients must have an in-person visit within 6 months before their first home-based telehealth mental health service.
• After a patient begins telehealth, Medicare requires at least one in-person visit for each client every 12 months.
  • Limited exceptions remain available when the clinician and patient agree that the risks or burdens of an in-person visit outweigh the benefits.
  • When an exception applies, it must be fully documented in the medical record.

These requirements apply to all mental health services delivered via telehealth to Medicare beneficiaries, unless an exception applies.

What This Means Right Now

The rule is technically in effect, but CMS will not enforce compliance until 2028, per the DHHS budget bill. Clinicians may continue providing Medicare mental health services via telehealth without meeting the in-person requirements during the enforcement delay period. That said, CMS guidance may continue to evolve, and practices should stay informed. 

Existing Medicare Clients

CMS clarified that the 6-month pre-telehealth in-person requirement does not apply to beneficiaries who began receiving mental health telehealth services in their homes on or before January 30, 2026.

Those patients are automatically considered established for telehealth purposes. This means:

• No initial in-person visit is required for them after the rule becomes active.
• They must still have one in-person visit every 12 months beginning in 2026, unless an allowed exception is documented.

This clarification removes significant uncertainty for practices with long-term telehealth clients.

To protect your practice, it’s best to:

1. 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.
2. Document what they tell you in your records.
3. Note in each client’s chart why an in-person visit may not be appropriate or feasible, if applicable. 

What About Medicare Advantage Plans?

Medicare Advantage (MA) plans can implement their own telehealth coverage policies as long as they meet or exceed Medicare minimum standards. Because MA plans vary significantly:

• Always verify in-person visit rules directly with the MA plan.
• Document guidance received.
• Update workflows for plan-specific telehealth requirements.

If You Operate a Fully Virtual Practice

Even if you’ve transitioned to a fully remote practice, you’ll still need a way to conduct required in-person visits to satisfy the Medicare rule. This could include:

1. Renting a part-time or shared professional office,
2. Partnering with another local clinician for in-person encounters, or
3. Conducting in-home visits (as long as your Medicare enrollment lists that service type).

If you cannot meet Medicare’s in-person requirements, you may have to issue an Advance Beneficiary Notice (ABN) and treat the session as cash-pay, since Medicare may not reimburse it.

If you provide telehealth services from your home, CMS will require you to list your home address as a service location. This address will be publicly available once registered. If you prefer not to publish your home address, here are a few alternatives to consider:

• Rent a shared or part-time professional office. Split the rental costs among multiple providers if possible.
• Partner with another local clinician. Some practices informally share space for Medicare administrative purposes. If permitted in your region, you may list a colleague’s office as your service location and use it when in-person visits are required.
• Register a HIPAA-compliant coworking or clinical suite. This allows you to maintain a professional address without a full commercial lease.

Always confirm service location requirements with your local Medicare Administrative Contractor (MAC), as interpretations and enforcement details may vary by region.

Preparing Your Practice

Even with enforcement delayed until 2028, here are a few proactive steps to plan now:

1. Audit Your Medicare Telehealth Caseload. Identify which patients are:  
   • New (will require a 6-month prior in-person visit),  
   • Established before January 30, 2026 (grandfathered),  
   • Established after that date (subject to the new rules).
2. Plan for in-person options, whether that means part-time office access or home visits.
3. Update your Medicare enrollment to include any new practice locations or in-home services. For guidance, see the following PECOS Enrollment Tutorials:
   • Change of Information for an Individual Provider
   • Change of Information for an Organization/Supplier
4. Document thoroughly when clients qualify for exceptions.
5. Communicate with your patients early about potential changes to care.

Early preparation helps avoid rushed compliance later.

Where to Stay Informed

For ongoing updates and policy tracking, you can visit:

• Center for Connected Health Policy (CCHP)

• CMS Telehealth Guidance

• Telehealth Resource Centers

You can also subscribe to CCHP’s free policy newsletter for real-time telehealth updates.

Key Takeaways

• Enforcement delayed until 2028: Medicare’s in-person requirements for mental health telehealth resumed January 31, 2026, but enforcement is delayed until 2028 under the DHHS budget bill.

• New Medicare clients: Require an in-person visit within 6 months before the first home-based telehealth session.

• Existing Medicare clients: If they started telehealth on or before January 30, 2026, they do not need the initial 6-month in-person visit; only annual in-person visits.

• All Medicare clients: Require at least one in-person visit every 12 months unless a documented exception applies.

• Plan now: Update workflows, verify with MA plans, document exceptions, and ensure you have a plan for in-person encounters.