Behavioral health telehealth is here to stay, but that doesn't mean the rules have stayed the same.

Important update: Per HHS telehealth policy guidance, an in-person visit within six months of an initial Medicare behavioral/mental telehealth service, and annually thereafter, is not required through December 31, 2027. The in-person visit requirement described below has been postponed and does not apply during this window.

For much of 2025 the expectation was that Medicare's in-person visit requirements would take effect and reshape when and how often clients must be seen in person. That requirement has now been deferred. Through the end of 2027, providers do not need to complete an initial in-person visit within six months of starting behavioral health telehealth, or the annual in-person visit after that. Audio-only services and home-based care also remain allowed. For a full guide to telehealth modifier and place-of-service code requirements, see our telehealth modifiers guide.

We'll break down what's in effect today, what the rule will require if it resumes, and what to document so you're ready either way.

What's Staying the Same

Let's start with the good news:

Behavioral health telehealth is now permanently covered by Medicare
Clients can still receive services from home
Audio-only visits remain billable
No changes to provider eligibility or CPT codes

That means you can continue offering care the way you have been. And through December 31, 2027, you do not need to meet the in-person visit requirements at all.

What's in Effect Right Now

This is the most important part: the in-person visit requirement is paused. An in-person visit within six months of an initial Medicare behavioral/mental telehealth service, and annually thereafter, is not required through December 31, 2027.

In practice that means:

New clients can start behavioral health telehealth without an in-person visit first
Existing clients do not need an annual in-person visit during this window
You can keep delivering audio-only and home-based care as you do today

What the Rule Will Require If It Resumes

Congress has extended the waiver of the in-person requirement before, and it could be extended again. But it's set to expire after December 31, 2027 unless lawmakers act. If the requirement does come back, here's what it would look like.

For New Clients

A Medicare client beginning telehealth would need an in-person visit with someone at your clinic first, within 6 months of starting telehealth. After that it would be one in-person visit every 12 months.

For Existing Clients

The annual in-person visit requirement would apply going forward, with timelines tied to when telehealth services began. CMS has historically treated patients who started telehealth during the pandemic as "established," and most experts expect that treatment to continue if the rule resumes.

What About Exceptions?

If the in-person visit requirement resumes after 2027, exceptions will matter again, so it's worth knowing how they work. Medicare allows exceptions when an in-person visit is clinically inappropriate or poses a significant barrier for the client.

You can use the exception if the client has:

Severe psychiatric or medical conditions
Mobility challenges or transportation limitations
Geographic or health-related barriers

And if you're unavailable? Another provider in your group and specialty can complete the in-person visit.

But here's the key: document everything. We recommend using standardized forms and inserting a clear note in the record to support the exception. Documentation gaps in telehealth claims are one of the most common drivers of claim denials in behavioral health — and exceptions without supporting notes create real audit exposure.

A Bit More Background

Back in the 2023 Physician Fee Schedule, CMS said that patients who began telehealth during the pandemic (or right after) were "established" and didn't need an in-person visit first.

Since then, Congress has repeatedly extended the waiver of the in-person visit requirement for behavioral and mental health telehealth. The current extension runs through December 31, 2027, which is why the requirement is not in effect today.

What to watch:

The waiver is set to expire after December 31, 2027 unless Congress extends it again
If it lapses, the in-person visit requirement would apply going forward
Most experts expect CMS to grandfather existing telehealth clients as established, but until there's final guidance, providers should prepare for either outcome

If you serve Medicare patients across TRICARE or dual-coverage situations, understanding how these programs interact is worth reviewing — see our breakdown of Medicare, TRICARE, TRICARE For Life, and CHAMPVA.

What Should Providers Do Now?

Even though the requirement is paused through 2027, a little preparation now keeps you ready if it resumes:

Keep track of telehealth start dates — Note when each Medicare client began telehealth so you can identify who would need an in-person visit if the rule returns
Don't scramble to schedule in-person visits — They aren't required through December 31, 2027, so there's no looming deadline to beat right now
Document exceptions thoroughly when relevant — Use clear language, standardized forms, and track them in your EHR. Using practice technology effectively makes this much easier to maintain across a caseload
Communicate with your team — Make sure front desk, clinicians, and billing staff understand the requirement is currently waived
Watch for updates near the end of 2027 — That's when the waiver is set to expire unless Congress extends it again

Making sure your Medicare provider enrollment is current remains essential — see our guide to Medicare provider enrollment for what to verify.

Final Thoughts

Medicare's telehealth policy is finally settling into something more permanent. For now, the in-person visit requirement is paused through December 31, 2027, so there's no immediate deadline to manage. By keeping track of telehealth start dates and watching for updates as that date approaches, your practice can stay ahead of any change and keep care uninterrupted.

To help us work through this blog post we have to give a big thanks to The Center for Connected Health Policy (cchpca.org). They gave us some great context and offer many informative newsletters and presentations on telehealth and specifically this change.

At BreezyBilling, we're here to help you stay on top of compliance without getting buried in paperwork. If you'd like support managing Medicare billing for your telehealth practice, get in touch with our team.

Medicare Telehealth Update: What You Need to Know About New In-Person Visit Rules for Behavioral Health Providers