Medicare coverage for telehealth services?
In a significant development for remote healthcare, Medicare has announced that telehealth services will continue to be available to beneficiaries beyond September 2025. However, the coverage will undergo notable changes and potential exclusions starting October 1, 2025.
Currently, Medicare covers a wide range of telehealth services, including occupational therapy evaluations, physical therapy evaluations, group psychotherapy, speech therapy, therapeutic exercises, and doctor's office visits. These services can be accessed via phone or computer, and individuals pay the same amount for telehealth services as they would for in-person services, with Medicare Part B covering 80% of the cost and the individual covering the remaining 20%.
From October 1, 2025, most telehealth services will require the patient to be in a rural area to qualify for coverage. Exceptions include mental and behavioral health services, which will continue to be covered when provided to patients at home. Providers can also use audio-only methods for these services when video is unavailable.
The Centers for Medicare & Medicaid Services (CMS) is proposing to simplify the review process for the Medicare Telehealth Services List by eliminating the distinction between “permanent” and “provisional” telehealth codes. This means all services meeting statutory requirements would be treated as permanently covered. Some services have been proposed for addition, such as family psychotherapy and group behavioral counseling for obesity, while others like dialysis procedures and home INR monitoring were declined due to clinical and procedural concerns.
Telehealth coverage will be functionally limited starting October 1, 2025, due to statutory authority restrictions. Some services that require clinical "hands-on" care may no longer qualify for telehealth coverage, such as dialysis procedures and certain telemedicine evaluation and management codes that are not separately payable. Coverage for telehealth services outside rural areas (except behavioral health) will be restricted.
It is essential for individuals to consult their healthcare professional directly to determine whether they offer telehealth services and their costs. Medicare Advantage (Part C) generally offers similar telehealth coverage as Medicare Parts A and B, but private insurers administer these plans, so coverage may vary. Some Medicare Advantage plans may offer expanded telemedicine services, especially if a person participates in an Accountable Care Organization (ACO).
Telehealth services may include preventive health screenings, routine office visits, and mental health services. However, it's important to note that remote healthcare does not work for all medical concerns, and some services may still require in-person visits.
The need for telehealth services surged during the COVID-19 pandemic as many people could not or preferred not to leave their homes to go to a healthcare facility. Medicare expanded its coverage for telehealth during this period, but these restrictions will again be effective in September of 2025.
Telehealth first evolved in the late 1950s, and since then, it has become an increasingly important part of modern healthcare. As we move forward, it is crucial for individuals to stay informed about the changes in telehealth coverage to ensure they have access to the healthcare services they need.
Starting October 1, 2025, coverage for most telehealth services under Medicare will be limited to rural areas, with exceptions for mental and behavioral health services that can be accessed from home. The Centers for Medicare & Medicaid Services (CMS) is simplifying the review process for telehealth services, eliminating the distinction between permanent and provisional codes. However, some services requiring clinical hands-on care may no longer qualify for telehealth coverage, such as dialysis procedures and certain telemedicine evaluation and management codes. It's advisable for individuals to consult their health providers to determine the costs and availability of telehealth services, as Medicare Advantage plans may offer expanded telemedicine services.
To ensure access to necessary healthcare services, it's essential for individuals to stay informed about the changes in telehealth coverage. Telehealth has become an integral part of modern health-and-wellness, offering services like preventive health screenings, routine office visits, and mental health services. However, in-person visits may still be necessary for some medical concerns. As science continues to evolve, telehealth services will undoubtedly play a significant role in the future of healthcare.
