🚨 Medicare Telehealth Update – Effective Today (October 1, 2025)

Section 2207 of the Full-Year Continuing Appropriations and Extensions Act, 2025 extended many pandemic-era telehealth flexibilities only through September 30, 2025. Starting today, several pre-COVID statutory limitations are back in effect for most Medicare telehealth services:

• Geographic restrictions are back — telehealth services must now be provided in rural areas.
• Location limitations apply — patients must be in eligible originating sites (e.g., clinics, hospitals).
• Practitioner scope is narrowed — only certain provider types may deliver telehealth services.

📅Key Updates to Know:

• New telehealth codes added Jan 1, 2025, include caregiver training (CPT 96202–96203, 97550–97552, G0539–G0543), PrEP counseling (G0011, G0013), and safety planning (G0560).
• Evaluation & Management services continue to include G3002–G3003 and G0316–G0318.
• Audio-only telehealth remains permissible if video is not consented to or the patient is unable.
• Behavioral/mental health telehealth retains permanent flexibilities (home-based care, audio-only options, FQHC/RHC eligibility).

💡Billing rules:

• POS 02 = patient not at home
• POS 10 = patient at home (paid at non-facility rate)
• Modifier 95 applies for outpatient therapy telehealth services

📉 Implications:

• Practices must reassess telehealth workflows, billing strategies, and patient communication.
• Revenue risks loom for providers unprepared for the shift.
• Commercial payers may follow Medicare’s lead, adding complexity.

📌 Action for Providers: Review your telehealth service lines to ensure compliance with the reinstated restrictions and updated billing rules. Specifically, we recommend:

• Audit current telehealth services for Medicare compliance.
• Update scheduling, documentation, and consent protocols.
• Educate staff and patients on coverage changes.
• Monitor legislative developments — bills like the Telehealth Modernization Act aim to extend flexibilities through 2027.

The updated CMS Medlearn E/M Booklet can be accessed here: MLN006764 – Evaluation and Management Services