Earlier this year, Medicare telehealth flexibilities lapsed for 43 days. Practices that hadn't paid attention suddenly found services they'd been billing under temporary extensions were no longer covered. Congress stepped in and extended them again. They'll expire again.
If your practice relies on telehealth and you're not tracking what's permanent versus what's on borrowed time, you're one congressional inaction away from a billing disruption you didn't see coming.
Here's the current state, without the noise.
What's Permanent
Two things changed permanently and they matter.
Marriage and family therapists and mental health counselors are now permanently eligible as Medicare distant site providers. This was a long time coming — these provider types were excluded from Medicare telehealth entirely until temporary COVID flexibilities opened the door. That door is now permanently open.
The in-person visit requirement — which previously required an in-person appointment within six months of initiating telehealth services — is waived through December 31, 2027.
What's Still Temporary
The broader Medicare telehealth flexibilities that most practices rely on — including expanded eligible service types, audio-only coverage for behavioral health, and the geographic site waiver that allows patients to be seen at home — are extended, but not permanent.
Two bills are currently in play: S.2709 would extend flexibilities through September 2027. H.R.4206 would make them permanent. As of now, neither has passed. Congress has a track record of extending these provisions at the last minute, sometimes after they've already lapsed. Don't count on the extension until it's signed.
The Private Payer Problem
Medicare policy gets the most press, but most solo practices bill primarily commercial insurance. The picture there is more fragmented.
44 states have telehealth laws on the books. Only 23 require payment parity — meaning the payer has to reimburse telehealth services at the same rate as in-person. If you're in a state without parity requirements, your payer may be reimbursing telehealth at a lower rate and you may not have noticed.
What to Do Right Now
There are three things worth doing this week.
First, audit which of your current services rely on temporary Medicare telehealth flexibilities. Know what would change for your practice if the extensions expired without renewal.
Second, pull the telehealth policy documentation for your top three commercial payers. Most payers post these on their provider portals. Read what's actually covered — policies have changed since you first set up telehealth.
Third, if you're in a state without parity laws, compare what you're being reimbursed for telehealth versus in-person for the same codes. If there's a gap, it may be worth adjusting your in-person volume for the codes where the rate difference is significant.
Don't Panic, But Don't Ignore It
The practices that handle telehealth billing well aren't the ones that track every news cycle. They're the ones that audited their payer policies once, set up a reminder to re-check annually, and know exactly which services depend on something that could change.
Do that audit. It takes an afternoon.
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