New Medicare Telehealth Rules: Key Changes and Practical Workarounds

Updated: October 9, 2025

URGENT: Telehealth Policy Update (October 9, 2025)

We understand the confusion following the lapse of many Medicare telehealth flexibilities on September 30, 2025. This situation has been compounded by the ongoing government shutdown. While there is broad, bipartisan support in Congress to extend these waivers, and legislation to do so was prepared, it could not be passed before the shutdown took effect.

This delay is likely temporary, and Congress may ultimately pass a measure that retroactively reinstates the waivers once the shutdown is resolved. However, this outcome is not guaranteed. Therefore, our guidance is to remain cautious and compliant with the legally reinstated rules (such as the in-person visit requirements) to safeguard against the worst-case scenario. Adhering to the new rules now ensures payment regardless of future legislative action.

In-Person Visit Requirements (Waiver Period ended on Sept. 30, 2025)

As the telehealth landscape continues to evolve, staying informed about Medicare guidelines is crucial for delivering consistent, high-quality mental health care. At Help Therapy, we are committed to supporting our providers through these transitions—ensuring you can continue to offer top-tier care with minimal disruption.

Established Patients

• Annual Requirement: An in-person visit is required at least once every 12 months.

• Waiver Period Exception: Patients who began telehealth during the waiver period (ending September 30th) are not required to have an immediate in-person visit. The 12-month period begins on the date the telehealth waiver expires, and providers have one year from that date to complete the annual in-person visit.

  
  

New Patients

• Visit Window: For new patients, an in-person visit must be completed within six months before initiating telehealth services.

Exceptions & Alternatives

Medicare provides flexibility for established patients when in-person visits are impractical:

• Exceptions for Annual Visits for Established Patients: If an in-person visit creates undue hardship (e.g., travel challenges or medical conditions), document the reason in the patient’s records.

• Alternative Provider Support: If an in-person visit is required but you are unable to conduct it, another provider in the same group practice may perform the visit.

• Help Therapy’s Group Practice Support: Providers can collaborate within our network to fulfill visit requirements. Contact providerrelations@helptherapy.com if interested.

Documentation Best Practices

Proper documentation is vital to ensure compliance and to safeguard both providers and patients. Beyond noting that an in-person visit may be impractical, it is important to document the clinical reasoning behind this decision. According to the CY 2022 CMS PFS final rule, this detailed documentation should include:

• Risk-Benefit Agreement: Document if both the patient and practitioner agree that the benefits of an in-person, non-telehealth service are outweighed by the risks and burdens for a given 12-month period.

• Specific Risks and Burdens: Clearly note scenarios where an in-person service might be detrimental, such as:

  • Disruption in Service Delivery: An in-person visit could interrupt or complicate ongoing care.

  • Potential Worsening of the Patient’s Condition: The visit might exacerbate existing conditions or trigger new issues.

  • Undue Hardship: This includes significant travel difficulties or hardships imposed on the patient or their family—especially if the patient lives out of town or in another state.

  • Maintenance Level of Care: In cases where the patient is in partial or full remission and only requires ongoing, maintenance-level care.

  • Risk of Disengagement: If there is a clinical judgment that requiring an in-person visit may lead to the patient discontinuing effective care.

  
  

By thoroughly recording these factors, providers can justify exceptions to the in-person visit requirement for established patients while mitigating audit risks.

Next Steps for Providers

• Comprehensive Documentation: Document all exceptions and patient agreements meticulously to support compliance and mitigate audit risks.

• Leverage Group Practice Support: Utilize available group practice resources when in-person visits are needed and you are unable to conduct them personally.

  
  

For more information, refer to the APA Telehealth Requirement Article or consult your local Medicare Administrator.

Questions? We’re here to help—reach out anytime!

Note: The information in this article reflects the status of telehealth policies and government payer updates at the time of publication. Circumstances may change as new legislation or guidance is issued. While we stand by the accuracy of this information, we encourage readers to verify the most current updates with official sources or reach out to us with specific questions.