Medicare telehealth coverage whiplash and what it means for beneficiaries
December 1, 2025
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Reprinted with permission from the November 26, 2025, edition of The Legal Intelligencer © 2025 ALM Media Properties, LLC. Further duplication without permission is prohibited. All rights reserved.
On an average day, figuring out what services are covered by Medicare can be a test of will. Add in lapsing COVID-19 waivers, a government shutdown, and a last-minute act of Congress, and herculean strength is needed to parse out the current state of affairs regarding Medicare coverage of telehealth benefits.
This article outlines the evolving rules surrounding Medicare telehealth coverage, highlighting key legislative changes and their impact on beneficiaries and healthcare providers. It clarifies which services are currently covered, which have lapsed, and which may be reinstated or made permanent.
COVID-era expansion of Medicare telehealth
In March 2020, the Coronavirus Preparedness and Response Supplemental Appropriations Act included a provision giving the Secretary of the Department of Health and Human Services (HHS) the authority to temporarily expand the coverage of telehealth services for Medicare beneficiaries. This expansion applied to both individuals covered under the original Medicare program and those who received benefits through a Medicare Advantage plan purchased through a third-party insurance company.
Prior to this expansion, coverage of telehealth was generally limited to services provided to patients while they were in an authorized healthcare facility in a rural area, likely seeking the services of a specialist not available locally. The March 2020 expansion removed the place of service restrictions on telehealth, allowing this particularly vulnerable Medicare beneficiary population to receive the healthcare services of doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers in their homes through telecommunication.
CARES Act and broader provider access
Shortly thereafter, the Coronavirus Aid, Relief, and Economic Security Act, commonly known as the “CARES Act,” further expanded telehealth benefits to include services from physical therapists, occupational therapists, speech-language pathologists, and audiologists.
The above-listed waivers were intended to last for the duration of the COVID-19 Public Health Emergency. However, the Consolidated Appropriations Act, 2022, signed into law on March 15, 2022, allowed the waivers to continue for 151 days after an end to the Public Health Emergency was declared. This action was taken after the Centers for Medicare and Medicaid Services (CMS) had already permanently expanded its coverage for behavioral health telehealth services via its Coverage Year 2022 Physician Fee Schedule. As the impacts of the COVID-19 pandemic continued, so did the waiver extensions:
- Consolidated Appropriations Act, 2023: Granted an extension until December 31, 2024
- American Relief Act of 2025: Granted an extension until March 31, 2025
- Full Year Continuing Appropriations and Extensions Act of 2025: Granted an extension until September 30, 2025
The true whiplash began when the September 30, 2025, telehealth waiver extension lapsed amid the federal government shutdown. CMS published a frequently asked questions document on October 1, 2025, which advised that, as of that date, except in the case of behavioral health services, Medicare beneficiaries would no longer have coverage for telehealth services unless they met the pre-COVID-19 specifications.
Additionally, physical therapists, occupational therapists, speech-language pathologists, and audiologists could no longer provide Medicare telehealth services, and beneficiaries would have to have one in-person behavioral health visit before qualifying for telehealth coverage.
This lapse created an administrative mess for the Medicare Administrative Contractors (MACs), who are responsible for issuing payment for original Medicare services. As discussed in the Medicare Learning Network (MLN) Connects Newsletter for November 7, 2025, CMS scrambled to gather a list of payable HCPCS codes for telehealth services to provide to the MACs so that providers of permissible telehealth services could be paid.
However, the agency struggled to accurately identify the full scope of payable claims, and as such, stated that it would be returning all held telehealth claims submitted on or before November 10, 2025, for dates of service after October 1, 2025, back to the providers. If a provider believed that its claim met the newly reinstated payment qualifications, they would need to resubmit it.
Temporary relief for Medicare Advantage plans
On November 7, 2025, the landscape temporarily cleared for Medicare Advantage plans to continue covering telehealth services. CMS announced that such plans could continue to pay for these benefits as additional telehealth benefits per the Medicare Advantage regulations until December 31, 2025, or later if allowed by congressional action.
That congressional action would come just three days later, as the Senate passed a continuing resolution to reopen the government on November 10, 2025, which included a provision to once again extend telehealth flexibilities through January 30, 2026. The House of Representatives swiftly followed in its approval of this legislation on November 12, 2025, thus concluding the six weeks of chaos surrounding Medicare telehealth benefit coverage.
Will telehealth become a permanent Medicare benefit?
It remains to be seen whether Congress will act to amend the Social Security Act to permanently allow payment for telehealth services. Although a bill titled the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, which provides for such an amendment, has been introduced in the Senate. Hopefully, for the sake of Medicare beneficiaries and their providers, passage of this bill can occur before February 2026 hits this population with a case of déjà vu.
Healthcare providers, advocacy groups, and Medicare beneficiaries should engage with lawmakers, monitor CMS updates, and prepare for potential shifts in coverage. Whether through public comment, professional associations, or direct outreach, proactive involvement can help shape a more stable and equitable future for telehealth under Medicare.
This article is a general analysis of legal and economic issues and should not be construed as advocacy for or against any policy position.
