What Mental Health Therapists Need to Know About Telehealth Coverage, In-Person Requirements, and Reimbursement Rules, 2.1
In October 2025, I wrote Medicare, Telehealth Coverage & the Government Shutdown: What You Need to Know 2.0, about how the government shutdown prevented Congress from extending the Medicare telehealth waiver for the in-person visit requirement. The status of telehealth flexibilities continues to evolve, this time for the better, though again only short-term.
On November 12, 2025, Congress temporarily funded the government, extending Medicare telehealth coverage through January 30, 2026. If you want the recent history of the telehealth waiver, read my previous blog post. Keep reading to learn what mental health providers need to know about current telehealth regulations and Medicare reimbursement.
What Changed After the Government Re-Opened?
Due to the short-term funding bill, telehealth providers can continue operating without:
- the in-person visit requirement every 12 months for existing Medicare patients
- the initial in-person visit requirement for new Medicare clients receiving teletherapy
Important: This good news is temporary. Congress has yet to codify these telehealth flexibilities into permanent law. Without action, the waiver expires on January 30, 2026, unless Congress passes long-term legislation making telemental health flexibilities permanent or temporarily extends them again.
To understand what could happen if Congress doesn’t make telehealth flexibilities permanent, read my previous blog post on the status of Medicare telehealth.
Permanent Medicare Telehealth Benefits for Mental Health Services
Several conditions for mental health telehealth coverage under Medicare are now permanent, regardless of temporary extensions. According to Telehealth.org, the following telehealth benefits are permanently covered:
- Medicare telehealth covers mental health treatment without geographic restrictions
- Telemental health clients can receive services in their homes permanently
- Audio-only telehealth coverage remains permanent for mental health services when the provider has video capability, but the patient cannot or does not consent to video
- Marriage and family therapists and mental health counselors can permanently serve as Medicare providers for telehealth services
- Telehealth reimbursement for behavioral health services delivered in patients’ homes is set at the higher non-facility rate
Medicare Advantage Plans: Telehealth Coverage for Existing Clients
Medicare Advantage plans must cover everything Original Medicare covers. Federal law (42 CFR § 422.101) specifies that Advantage plans must cover telehealth for mental health services.
However, in-person visit requirements may vary by plan. For accurate telehealth billing information, contact individual Medicare Advantage plans for their specific telehealth policies.
Retroactive Medicare Reimbursement: What the Funding Bill Covers
According to Telehealth.org, the proposed government funding bill doesn’t mention retroactive Medicare reimbursement for past telehealth services. However, sections 116-119 of the bill’s summary do allow the government to make retroactive payments to:
- Federal employees
- States governments
- Other necessary expenses.
Therefore, providers should not expecmay not get retroactive reimbursement for telehealth services provided during the funding gap. Additionally, it remains important to maintain detailed mental health documentation for all services provided.
Future Uncertainty: What Happens After the January 2026 Deadline
With the extension only through January 30, 2026, mental health providers face another telehealth crisis point in less than three months. This creates ongoing uncertainty and frusteration for telemental health practices and Medicare billing.
Why This Creates Problems for Providers
This pattern of short-term extensions creates:
- Uncertainty for telemental health practices
- Planning difficulties for mental health providers
- Anxiety about future Medicare billing requirements
- Barriers to patient care continuity
Telehealth Advocacy and Legislative Action – It Matters
The repeated short-term extensions create exhausting uncertainty for mental health providers and barriers for patients seeking telemental health care. Multiple bills are pending in Congress, including:
These bills would make telehealth flexibilities permanent and eliminate the in-person requirement for mental health telehealth services.
You can help by writing to your House Representative and Senator about the benefits of permanent telehealth coverage. Organizations like NASW, APA, and the American Telemedicine Association are actively lobbying for these changes in telehealth policy.
Key Points to Include in Your Advocacy
When contacting legislators, mention:
- How telehealth expands access to mental health care
- The burden of repeated short-term extensions
- Patient stories showing telemental health effectiveness
- Economic benefits of telehealth services
Telehealth for Medicaid, Commercial Insurance, and Out-of-Network Providers: What Applies to Your Practice
- Medicaid Telehealth and Commercial Insurance: The in-person visit requirement officially applies only to Medicare telehealth. However, Medicaid and commercial insurers often follow Medicare’s lead. Given budget pressures, some insurers may adopt similar restrictions to limit telehealth reimbursement costs.
- Out-of-Network Telehealth Providers: While OON providers aren’t bound by Medicare billing requirements, clients may find their insurance company won’t reimburse them for telehealth services that don’t meet the in-person requirement. This could affect whether clients receive reimbursement after paying their teletherapy provider.
Recommendation: Check with individual insurance companies, as telehealth coverage policies may vary by policy and by state.
Actions Mental Health Providers Can Take Now
- Continue providing telehealth services to Medicare clients without the in-person requirement
- Stay informed about telehealth regulations and Medicare compliance
- Watch for Documention Wizard updates as we approach the January 30, 2026 telehealth deadline
- Maintain accurate mental health documentation for all telehealth sessions
- Ensure your telehealth platform meets HIPAA compliance standards
- Join professsional organizations advocating for change
Though there is bipartisan support for telehealth and hope for another extension or elimination of the in-person visit requirement, nothing is guaranteed.
Healthcare and mental health organizations are advocating for permanently dropping the in-person requirement. This milestone would support access to telemental health care, which is a desperately needed win for mental health providers and clients alike. Taking a few moments to contact your congress people could increase access to care and access to clients.
Beth Rontal, LICSW, a private practice therapist and the Documentation Wizard® is a nationally recognized consultant on mental health documentation. Her Misery and Mastery® trainings and accompanying forms are developed to meet strict Medicare requirements. Beth’s Documentation Wizard training program helps clinicians turn their clinical skill and intuition into a systematic review of treatment that helps to pass audits, protect income, maintain professional standards of care, reduce documentation anxiety and increase self-confidence. Beth’s forms have been approved by 2 attorneys, a bioethicist, and a billing expert and have been used all over the world. She mastered her teaching skills with thousands of hours supervising and training both seasoned professionals and interns when supervising at an agency for 11 years. Her newest initiative, Membership Circle, is designed to empower psychotherapists to master documentation with expert guidance, efficient strategies, and a supportive community.