What changed in Medicare telehealth under the 2026 spending bill

Medicare telehealth gets breathing room through 2027

Medicare telehealth rules have been on a roller coaster for the past year, with temporary extensions and the longest government shutdown in U.S. history from Oct. 1 to Nov. 12, 2025. That uncertainty eased on Feb. 3, 2026, when President Donald Trump signed H.R. 7148, the Consolidated Appropriations Act, 2026.

The law funds the federal government through Sept. 30, 2026, and, crucially for physicians, extends key Medicare telehealth flexibilities through Dec. 31, 2027.

The extension applies to the COVID-19 pandemic-era waivers that opened up telehealth beyond rural facilities and a narrow list of clinicians. It follows a short-term extension that carried Medicare telehealth coverage through Jan. 30, 2026, and sets a new end date of Dec. 31, 2027, for those flexibilities.

For primary care and other outpatient practices that built telehealth into their schedules, the law buys time and stability, but it does not make the current rules permanent.

Key flexibilities extended through December 2027

Under the new law and related Centers for Medicare & Medicaid Services (CMS) guidance, several high-impact policies now run through Dec. 31, 2027, for nonbehavioral Medicare telehealth, as follows:

• Location and geography: Medicare patients can continue to receive nonbehavioral telehealth services in their homes, with no rural or facility-based originating site requirement. Home and “any geographic location” remain permissible originating sites for covered services.
• Eligible practitioners: All professionals who are otherwise eligible to bill Medicare for their services can continue to furnish many of those services via telehealth. That includes physicians, nurse practitioners, physician assistants, clinical nurse specialists, certified nurse midwives, clinical psychologists and social workers, in addition to a broader group of therapists and audiologists.
• Safety-net providers: Federally qualified health centers (FQHCs) and rural health clinics (RHCs) can continue to serve as distant-site providers for nonbehavioral telehealth services under the current extension through Dec. 31, 2027. CMS has confirmed that they may bill most nonbehavioral telehealth encounters using HCPCS code G2025 through Dec. 31, 2026.
• Audio-only telehealth: For nonbehavioral services, Medicare continues to allow audio-only telehealth when it is clinically appropriate and if the service is on the telehealth list. For behavioral and mental health care, the ability to deliver covered services via audio-only technology is now a permanent part of Medicare policy when the patient cannot use, or does not consent to, video.
• Mental health and hospice: The law delays the in-person visit requirement for most mental health telehealth services until Jan. 1, 2028, and preserves the ability to use telehealth for face-to-face hospice recertification encounters through the end of 2027.

All together, those provisions largely keep in place the virtual care playbook that practices have been using since the COVID-19 pandemic.

Patients can stay at home, clinicians can connect from their offices or homes and a wide range of outpatient services can remain on the telehealth schedule.

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Billing and supervision rules that carry forward

Alongside the statutory extension, CMS has used recent Medicare Physician Fee Schedule rules and subregulatory guidance to lock in several billing and supervision policies that matter for day-to-day practice operations, including the following:

• Place-of-service and payment rates: For Medicare fee-for-service claims, CMS instructs clinicians to continue using place-of-service (POS) code 02 for telehealth provided outside the patient’s home and POS 10 for telehealth provided in the home. Telehealth services delivered to patients in their homes are paid at the nonfacility rate, aligning reimbursement with traditional office visits rather than facility-based payment.
• Frequency limits and direct supervision: CMS has permanently removed the prior frequency limits for subsequent inpatient visits, subsequent nursing facility visits and critical care consultations delivered via telehealth. In addition, starting Jan. 1, 2026, the definition of “direct supervision” for many services allows the supervising practitioner to be virtually present through real-time audio and video, rather than physically in the office, as long as other requirements are met.
• Rules for teaching physicians: Teaching physicians may maintain a virtual presence for Medicare telehealth services involving residents, using real-time audio and video to meet presence requirements in all teaching settings. That flexibility is now baked into the telehealth rules rather than tied to the public health emergency.
• Non–face-to-face services: CMS continues to treat non–face-to-face care management and remote monitoring codes separately from those on the telehealth list. Services such as chronic care management, behavioral health integration, principal illness navigation and many remote patient monitoring codes are not subject to the Section 1834(m) telehealth restrictions, which means they do not depend on the 2027 telehealth extender.

The 2028 telehealth cliff

The new law postpones, but does not eliminate, a significant shift in Medicare telehealth policy. CMS’ February 2026 Telehealth Frequently Asked Questions and related materials outline what happens if Congress does not act again before Jan. 1, 2028.

For nonbehavioral telehealth services, Medicare is scheduled to revert to the longstanding prepandemic rules on Jan. 1, 2028. That would mean the following:

• Beneficiaries generally must be located in a qualifying medical facility in a rural area to receive covered telehealth services.
• Home would no longer count as an originating site for most nonbehavioral telehealth.
• The expanded list of practitioners would contract, and certain therapists and audiologists would no longer be allowed to furnish Medicare telehealth services.
• Hospitals could no longer bill for outpatient therapy, diabetes self-management training or medical nutrition therapy delivered remotely by hospital staff to patients in their homes.

For behavioral and mental health, many of the pandemic-era flexibilities are now permanent. Beneficiaries can continue to receive behavioral telehealth in their homes with no geographic restrictions, and audio-only telehealth remains an option when appropriate.

However, starting in 2028, new mental health telehealth patients will again be required to have an in-person visit before and during ongoing virtual care, with the specific timing and exceptions outlined in CMS guidance.

The 2028 timeline also matters for RHCs, FQHCs and hospital-based behavioral health services. CMS says it’s aligning behavioral health services furnished remotely by hospital staff and virtual behavioral health visits in RHCs and FQHCs with the broader telehealth rules, and that in-person visit requirements will not apply in those settings until at least Jan. 1, 2028, absent further action by Congress or CMS.

What practices should do now

The extension through 2027 gives practices a window to stabilize telehealth workflows rather than constantly reacting to short-term patches. But it also sets a clear horizon: Unless Congress or CMS changes course, nonbehavioral Medicare telehealth will face tighter location and practitioner limits starting in 2028.

In the near term, practices can do the following:

• Confirm that scheduling, front-desk and billing teams understand that home remains an eligible originating site for nonbehavioral telehealth through 2027, with no rural requirement.
• Review which clinicians in the practice are using telehealth and verify that their services are on the Medicare telehealth list and are billed with the correct POS codes and any applicable modifiers.
• Map which patients rely on audio-only telehealth, which services are delivered through hospital-based or health-system staff into patients’ homes, and where therapists and other nonphysician practitioners are using telehealth to reach Medicare patients.
• Begin planning for the 2028 in-person requirements for new mental health telehealth patients, including how to track “established” patients who began telehealth services before that date.

Those steps can help reduce surprises if Congress does not address the 2028 cliff, while still taking full advantage of the stability that the 2027 extension provides today.