Health Law Alert by Lamb McErlane Attorneys Vasilios J. Kalogredis, Esq. and Sonal Parekh, Esq.

Recent federal action has once again reshaped the Medicare telehealth landscape. After a period of uncertainty tied to funding lapses and expiring statutory waivers, Congress and the Administration have extended many of the pandemic-era telehealth flexibilities through January 30, 2026. While the extension provides short-term stability for providers and patients, it also sets the stage for significant operational and compliance decisions in the coming year.

Many of the broad telehealth flexibilities that providers have relied on since the COVID-19 public health emergency (PHE) are rooted in statutory waivers to Section 1834(m) of the Social Security Act. When a continuing resolution was not in place at the start of the federal fiscal year, those waivers briefly expired, creating operational and reimbursement uncertainty. Congress subsequently acted to reinstate coverage retroactively and extend most flexibilities through January 30, 2026. Although this extension offers temporary relief, it does not eliminate the underlying statutory constraints that could reemerge absent further congressional action.

What Telehealth Flexibilities Remain in Effect Through January 30, 2026 

1. Patient Location and Geographic Restrictions – Through January 30, 2026, Medicare beneficiaries may continue to receive non-behavioral health telehealth services in their homes, regardless of whether they are located in a rural or urban area. During this period, the home and other non-facility settings remain permissible originating sites. Absent further legislative action, these geographic and originating-site flexibilities for non-behavioral health services are scheduled to sunset after January 30, 2026.

2. Expanded List of Distant Site Practitioners – Medicare continues to permit an expanded range of practitioners to furnish and bill for telehealth services through January 30, 2026. This includes, among others: physical therapists, occupational therapists, speech-language pathologists, audiologists, marriage and family therapists, and mental health counselors. Beginning January 31, 2026, several of these practitioner categories will no longer be eligible to furnish Medicare telehealth services unless Congress acts to extend or make these changes permanent.

3. Audio-Only Telehealth Services – Medicare beneficiaries may continue to receive certain telehealth services via audio-only communication through January 30, 2026. This flexibility remains especially important for patients who lack access to video-enabled technology or decline its use. For behavioral and mental health services, audio-only telehealth has been made permanent under certain conditions, including practitioner documentation of the patient’s inability or refusal to use video. 

4. Behavioral and Mental Health Telehealth: Permanent vs. Temporary Rules – Behavioral health telehealth remains an area of relative stability compared to other service lines. For example, (i) geographic and originating-site restrictions for behavioral and mental health services have been permanently removed; (ii) beneficiaries may continue to receive behavioral health telehealth services in their homes; and (iii) audio-only behavioral health services are permanently permitted, subject to statutory conditions. However, the in-person visit requirement—which generally requires an in-person, non-telehealth visit within six months prior to the first mental health telehealth service and annually thereafter—remains waived only through January 30, 2026, with limited exceptions for established patients. 

5. Hospitals, FQHCs, and RHCs – Hospitals may bill for certain outpatient therapy, diabetes self-management training, and medical nutrition therapy services furnished remotely by hospital staff to patients in their homes through January 30, 2026. Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) may continue to serve as distant site providers for both behavioral and non-behavioral telehealth services through at least December 31, 2026, using established HCPCS codes. 

6. Teaching Physician Virtual Presence and Supervision – CMS has finalized additional flexibilities effective January 1, 2026 which offer meaningful operational flexibility for academic and hospital-based practices. Specifically: (i) teaching physicians may satisfy presence requirements virtually for Medicare telehealth services; and (ii) virtual direct supervision is permitted for many services that do not carry a global surgery indicator.

While Medicare policy often sets the tone for telehealth adoption, private payor telehealth requirements remain largely state-driven. Private payor coverage, licensure requirements, and telehealth technology remain governed largely by state law, which continues to vary significantly. Providers offering telehealth services across state lines should continue to evaluate both licensure obligations and private payor coverage mandates on a state-by-state basis, independent of Medicare’s temporary flexibilities.

Practical Takeaways for Providers

• January 2026 is a real deadline. Providers should assume temporary flexibilities will expire absent further legislation.
• Identify risk areas now. Audit which service lines and practitioner types rely on time-limited waivers.
• Plan for in-person touchpoints. Behavioral health providers should prepare workflows to meet in-person visit requirements if waivers lapse.
• Expect continued uncertainty. Despite broad bipartisan support, cost concerns remain a significant barrier to permanent reform.

Telehealth has become a core component of care delivery rather than an emergency substitute. Yet, Medicare’s telehealth framework continues to be treated as temporary. Providers who plan ahead (i.e., proactively assess their telehealth models, reimbursement dependencies, and compliance risks) will be best positioned to navigate the legal landscape that follows January 2026.

If you have questions about how these developments may affect your telehealth operations, reimbursement strategy, compliance obligations, or need assistance with other health law matters, please feel free to contact Bill Kalogredis, Esq. or Sonal Parekh, Esq.

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Vasilios J. (Bill) Kalogredis, Esq. has been advising physicians, dentists, and other healthcare professionals and their businesses as to contractual, regulatory and transactional matters for over 50 years. He is Chairman of Lamb McErlane PC’s Health Law Department. Bill can be reached by email at bkalogredis@lambmcerlane.com or by phone at 610-701-4402.

Sonal Parekh, Esq., is an associate at Lamb McErlane PC who focuses on healthcare transactional matters and a broad range of healthcare regulatory-related issues on behalf of healthcare systems, physicians, dentists, and other healthcare providers, and is a pharmacist by education and training. Sonal can be reached by email at sparekh@lambmcerlane.com or by phone at 610-701-4416.

*This alert is for educational purposes only and is not intended to be legal advice. Should you require legal advice on this topic, any health care matter, or have any questions or concerns, please contact Vasilios J. (Bill) Kalogredis, Esq. or Sonal Parekh, Esq.