Medicare Telehealth Reimbursement Through 2027: What to Know

Key takeaway: Congress extended Medicare's telehealth flexibilities through December 31, 2027, through the Consolidated Appropriations Act of 2026 (signed February 3, 2026). Patients can still receive Medicare telehealth at home, anywhere in the U.S., until then. Several rules are scheduled to change on January 1, 2028 unless Congress acts again, so billing and compliance teams have about fourteen months to plan.

Telehealth reimbursement rules changed again in 2026, and a lot of older guidance (including earlier versions of this post) is now out of date. This guide covers what Medicare covers today, what is scheduled to end after 2027, and the billing details that tend to trip up practices.

How long are Medicare telehealth flexibilities extended?

Through December 31, 2027. The extension was part of H.R. 7148, the Consolidated Appropriations Act of 2026, signed February 3, 2026. The flexibilities had lapsed in late January 2026, and the new law restored them for providers (Greenbaum, 2026).

Until the end of 2027, Medicare patients can receive telehealth at home or any other location, with no rural or originating-site restriction. Audio-only visits are covered where clinically appropriate. Occupational therapists, physical therapists, speech-language pathologists, and audiologists can keep billing for telehealth, and federally qualified health centers (FQHCs) and rural health clinics (RHCs) can keep serving as distant-site providers.

What is scheduled to change on January 1, 2028?

Unless Congress acts again, four things change, according to PYA:

• The rural-area and medical-facility originating-site requirements return for most services. Behavioral health is the exception.
• Physical therapists, occupational therapists, speech-language pathologists, and audiologists can no longer bill Medicare for telehealth.
• Audio-only behavioral health telehealth is limited to cases where video isn't possible or the patient doesn't consent, and the provider must have audio-video capability.
• Most patients need an in-person visit within six months before their first mental health telehealth service, then once every 12 months. Patients who start mental health telehealth on or before December 31, 2027 are treated as established and need only the annual visit.

Telehealth in the patient's home for behavioral health is permanent, and the in-person requirement for that care doesn't apply to FQHCs and RHCs until at least January 1, 2028. Policy in this area has moved quickly, so confirm the current status with CMS before you build workflows around a date.

What did the 2026 physician fee schedule change for telehealth?

The CY 2026 Medicare Physician Fee Schedule final rule made several earlier policies permanent, according to the CMS summary:

• CMS removed the split between provisional and permanent telehealth services. Review now asks whether a service can be delivered over a two-way audio-video system.
• Frequency limits on subsequent inpatient visits, subsequent nursing facility visits, and critical care consultations are permanently removed.
• Direct supervision can now be met through real-time audio and video (not audio-only) for certain incident-to diagnostic and rehabilitation services.
• New services added to the telehealth list include multiple-family group psychotherapy and group behavioral counseling for obesity.

What is G2211 and how does it relate to telehealth?

G2211 is a Medicare add-on code for the extra work of ongoing, longitudinal care, such as primary care or continuing care for a single serious or complex condition. It is not a telehealth code. It took effect January 1, 2024 (CMS, 2023).

CMS paid G2211 with office and outpatient E/M visits (99202 to 99205 and 99211 to 99215) starting in 2024. The 2026 rule extends it to home and residence E/M visits. It can't be billed when the visit centers on a procedure or another service rather than longitudinal care. Check your MAC's guidance on how G2211 applies to telehealth visits before you bill it that way.

What billing details do practices often miss?

A few specifics from PYA's provider reminders:

• Use place of service (POS) 02 for telehealth outside the home and POS 10 for telehealth in the home.
• Medicare doesn't require modifier 95 with POS 10, but commercial payers vary, so confirm each payer's rule.
• RHCs and FQHCs can keep billing HCPCS G2025 for non-behavioral telehealth through December 31, 2026.
• Requests to add or change codes on the Medicare Telehealth Services List are due February 10 each year.

Two more details come straight from CMS. Telehealth delivered to a patient at home has been paid at the non-facility rate since January 1, 2024. The originating site facility fee (Q3014) pays 80% of the lesser of the actual charge or $31.85 for 2026.

For the full list of covered services, see the CMS List of Telehealth Services. State laws and commercial payer rules still apply on top of Medicare, and the Center for Connected Health Policy tracks them by state.

Why does telehealth policy matter beyond reimbursement?

Reimbursement rules decide whether telehealth is sustainable, but the care model decides whether it works. In a Backline by DrFirst webinar on telehealth regulations, Dr. Albert Villarin, VP and CMIO of Nuvance Health, described telehealth as a way to bring a health system's clinicians to patients across a large network.

"That not only enhances the return on investment in telehealth but also advances the efficiencies being delivered by the limited numbers of employees we all have in healthcare today," he said.

That matters most for rural and underserved communities, where specialist access is thin and the home-as-originating-site rule makes the biggest difference. Telehealth also works best when patients can be reached between visits, which is where patient engagement tools fit in. For more on how telehealth fits into patient care, read The Power of Telemedicine.

How can healthcare organizations prepare for 2028?

Start with the 2028 changes that are already on the calendar. Identify which services depend on the home as an originating site, which behavioral health patients will need an in-person visit on file, and which therapy services would lose Medicare telehealth eligibility. Then confirm your documentation and scheduling workflows can capture those details.

Clinical communication tools can help here. Backline by DrFirst offers clinical communication and care coordination (CC&C) that helps care teams route consults, manage discharge and care transitions, and follow up across settings, which can make it easier to track who needs what visit and when. Rules will keep shifting, so choose tools that adapt with them. To talk through your organization's setup, contact us.

Complete the form now to learn how Backline can help your healthcare organization keep up with reimbursement policy updates! 

Sources

• Greenbaum: Medicare Telehealth Flexibilities Extended Through 2027
• PYA: Medicare Extends Telehealth Coverage Through 2027
• CMS: CY 2026 Physician Fee Schedule Final Rule Summary
• CMS: CY 2024 Physician Fee Schedule Final Rule Fact Sheet