Medicare Updates

The following information is accurate as of 10/1/2025 and do not reflect any potential changes that have occurred since the date of this posting.

Since Congress did not pass a bill extending or eliminating the in person requirement, all Medicare Telehealth providers must be aware of the consequences and following requirements

Much of the following information comes from Barbara Griswold, LMFT.  Barbara has provided a number of webinars for Zur pertaining to notes, treatment plans and insurance matters.  Learn more about Barbara her courses and her contributions to the field. 

All NEW Medicare telehealth clients that you see beginning October 1st: As the law is currently written, you must see them in-person at least one time prior to initiating  telemental health.  Thereafter, you must see them at least once annually.

For EXISTING Medicare telehealth clients, this is murkier.  The law seems to say you must see existing clients in-person before your first telehealth session after Sept. 30t.  Yet, this APA article and a CMS article suggest that this may not be required, just the annual in-person visit. 

According to CMS, “the regulations at 42 CFR 410.78(b)(3)(xiv)describe two exceptions to the in-person requirements:

● Patients who already get telehealth … and have circumstances where in-person care may not be appropriate

● Groups with limited availability for in-person…visits [may] arrange for practitioners to provide in-person and telehealth visits with different practitioners

Exceptions to the in-person visit requirement require a clear justification documented in the patient’s medical record.” 

Before proceeding, verify with your Medicare contractor.  Be prepared for long wait times.  Be sure to document what you are told, and also document in the client’s chart, why they cannot come in person.

Important Note:  In a previous article we mentioned that clinicians may choose to charge the client directly for services provided after October 1st if a client cannot come into the office. However, this may not be accurate and the rules seem to be open to interpretation.  

What is clear is that a Medicare contracted provider (participating provider) cannot bill a patient for a service Medicare will pay for.  What is less clear, is if the client cannot come into your office, whether Medicare’s denial of claims constitutes a non-covered service or whether the denial is based on the clinician non-compliance.