On December 21, President Biden signed the American Relief Act, 2025 into law, which provides government funding through March 14, 2025. Medicare telehealth flexibilities were extended until March 31, 2025. 

The Alliance advocates to remove barriers and restriction for the use of telehealth. See below for a few of our top federal priorities. See here for a full list.

During the COVID-19 pandemic, DEA granted a temporary exception to allow practitioners to prescribe controlled substances via telehealth. On November 15, 2024, DEA and HHS released a one-year extension of current telemedicine flexibilities through December 31, 2025.

This action followed a large stakeholder effort led by the Alliance for Connected Care as well as congressional leaders from the Senate and House. To the Alliance’s understanding, the permanent regulation is still progressing.

The Alliance for Connected Care continues to lead an all-hands on deck advocacy effort around this issue. Please reach out to Rikki Cheung (rikki.cheung@connectwithcare.org) for additional information.

See more information on the Alliance’s advocacy on this here.

Medicare coverage of RPM is expanding in the fee schedule, and we expect a number of additional developments in the RPM space in 2024 – including advocacy around changes to regulatory requirements around codes. Most recently, the AMA has considered major changes to remote monitoring codes.

The Alliance continues to address regulatory barriers to RPM. Find more information here.

During the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services (CMS) moved to allow practitioners to render telehealth services from their home without reporting their home address on their Medicare enrollment while continuing to bill from their currently enrolled location. CMS extended this waiver through December 31, 2025 in the Calendar Year (CY) 2025 Physician Fee Schedule final rule.

The ability to bill a currently enrolled location does not alleviate barriers for virtual-only practitioners without a physical practice location to report other than their homes. 

Find out more here.

Section 3701 of the CARES Act created a temporary safe harbor that allowed employers and health plans to provide pre-deductible coverage of telehealth services for individuals with a high deductible health plan coupled with a health savings account (HDHP-HSA). The safe harbor allowed individuals with these plans to access telehealth services before their annual deductible was met, ensuring that employers and plans could support patients that were leveraging virtual care to access a range of critical health care services during the pandemic.

The Alliance catalyzed policy changes to allow for this HDHP telehealth flexibility at the start of the COVID-19 pandemic in March 2020.

This policy expired on December 31, 2024.

Find out more here.

History of Medicare Telehealth

Statutory Restrictions under Section 1834(m) of the Social Security Act

Section 1834(m) of the Social Security Act (42 U.S.C. 1395m) restricts utilization of and reimbursement for telehealth and remote patient monitoring services in the traditional Medicare fee-for-service (FFS) program by narrowly defining conditions around eligibility for coverage. As a result, the benefits offered by these advanced technologies are limited to certain groups of beneficiaries. A primary limitation is the originating site restriction, which requires the patient receiving the telehealth service to be in specific sites and geographic regions to qualify for Medicare coverage. Generally, covered telehealth services must be provided in rural areas as determined by the Department of Health and Human Services (HHS).

Section 1834(m) of the Social Security Act

(42 U.S.C. 1395m)

Originating Site Requirements
Location of the patient when the service being delivered via a telecommunications system

  • Geographic eligibility: Eligible locations for the originating site must be identified either as:
    • A rural Health Professional Shortage Area (HPSA) located either outside of a Metropolitan Statistical Area (MSA) or within a rural census tract; or
    • A county outside of an MSA.
  • Each calendar year, the geographic eligibility of an originating site is established based on the status of the area as of December 31st of the prior calendar year.
  • Eligible facilities include:
    • Physicians’ offices; Hospitals; Critical Access Hospitals (CAH); Rural Health Clinics; Federally Qualified Health Centers; Hospital-based or CAH-based Renal Dialysis Centers (including satellites); Skilled Nursing Facilities (SNF); and Community Mental Health Centers (CMHC).

Distant Site Requirements
Location where the physician or other licensed practitioner delivering the service is located when the time the service is provided via a telecommunications system

  • Distant site cannot be the same location as the originating site.
  • Providers serving at the distant site must be licensed to provide the service under state law.
  • Eligible physician or practitioner includes:
    • Physicians; Nurse practitioners (NPs); Physicians assistants (PAs); Nurse-midwives; Clinical nurse specialists (CNS); Certified registered nurse anesthetists; Clinical psychologists (CP) and clinical social workers (CSW); or Registered dietitian or nutrition professional.
    • Does NOT include a federally qualified health center (FQHC) or rural health center (RHC).

Temporary Medicare Flexibilities

Will expire after March 31, 2025, as per the American Relief Act, 2025.

  • FQHCs and RHCs can serve as a distant site provider for non-behavioral/mental telehealth services
  • Medicare patients can receive telehealth services in their home
  • There are no geographic restrictions for originating site for non-behavioral/mental telehealth services
  • Some non-behavioral/mental telehealth services can be delivered using audio-only communication platforms
  • An in-person visit within six months of an initial behavioral/mental telehealth service, and annually thereafter, is not required
  • Telehealth services can be provided by all eligible Medicare providers

Eligible Technologies
Eligible telecommunications systems must use interactive audio and video equipment that results in real-time communication between the provider and beneficiary. Store- and-forward technologies, such as those that allow for the electronic transmission of digital images, like pictures and x-rays, or prerecorded videos, are permitted only in federal demonstration programs conducted in Alaska and Hawaii.

Eligible Services
Eligible services include, but are not limited to, office or other outpatient visits, professional consultations, individual psychotherapy, pharmacologic management and individual and group medical nutrition therapy services.

Current Procedural Terminology (CPT) Codes and Billing

  • The specific telehealth-delivered services eligible for Medicare reimbursement are identified by Current Procedural Terminology (CPT) billing codes. Each year, the Centers for Medicare and Medicaid Services (CMS) accepts submissions from the public to add or delete CPT codes for reimbursement for telehealth-delivered services.
  • CY2015 Changes: On October 31 2014, CMS finalized a rule adding seven new telemedicine billing codes to the 2015 Medicare physician fee schedule. These new codes are for psychotherapy services, prolonged office visits, annual wellness visits, and related matters. In addition, the rule increased by 0.8 percent Medicare payments to telehealth originating sites in 2015.

Reimbursement Rates
Provider reimbursement rates for telehealth-delivered services are the same as the current Physician Fee Schedule. In addition, the originating site is eligible to receive a facility fee. Claims for reimbursement are submitted with the appropriate CPT code for the professional service provided and the telehealth modifier “GT” –“via interactive audio and video telecommunications system.”

The COVID-19 Pandemic

Secretary Azar used his authority under the Public Health Service Act to declare a public health emergency across the entire United States on January 31, 2020 giving HHS additional emergency powers to respond to the coronavirus. On March 13, 2020, President Trump declared a national emergency, unlocking additional powers, under section 1135 of the Social Security Act.

On March 5, 2020, Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act, waiving restrictions on telehealth in Medicare fee-for-service to enable more seniors to access care from the safety of their own homes during the public health emergency.

On March 21, 2020, Congress subsequently passed the Coronavirus Aid, Relief and Economic Security (CARES) Act, providing even greater flexibility for telehealth services.

As a result of the COVID-19 pandemic, CMS has made permanent certain telehealth changes for Medicare:

  • Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as a distant site provider for behavioral/mental telehealth services
  • Medicare patients can receive telehealth services for behavioral/mental health care in their home
  • There are no geographic restrictions for originating site for behavioral/mental telehealth services
  • Behavioral/mental telehealth services can be delivered using audio-only communication platforms
  • Rural Emergency Hospitals (REHs) are eligible originating sites for telehealth

Upcoming Notable Dates – Telehealth Flexibilities