Wiki Urgent: Telehealth effective 10/1/25, covered by Medicare, Medicaid and private insurances?

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Biller2023

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I read articles that say effective 10/1/25 Medicare will not reimburse for telehealth services. Is the same for all medicaid and private insurances?
I called medicare today and spoke with a representative who said "for dates of service on or after 10/1/25 you may want to obtain ABN from medicare beneficiaries due to the pending legislature" but she didn't say that medicare will not pay for telehealth services effective 10/1/25.

So, should we see all our patients in-person only. Will Medicaid and Private insurances pay for telehealth services or will they also follow medicare's guidelines.

Please respond as soon as possible. Thank you.
 
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There are many posts about this in the forum. Summary: each commercial payer decides if they will cover telehealth, and which set of codes/POS/modifiers they want. Many have previously stated they are following Medicare guidelines, but they can set whatever rules they wish. You should check your payor contracts and/or policies.
There are those of us still keeping our fingers crossed that Congress will eventually pass legislation to permanently extend the telehealth rules backdating to 10/01/2025.
 
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Telehealth extensions will end on September 30, 2025.
Starting October 1, 2025, Medicare telehealth policy will revert to pre-COVID PHE (March 2020) rules, and telehealth services will no longer be reimbursed under the previous flexibilities.
Effective for dates of service on or after 10/01/2025, all appointments must be conducted in person.
Audio-only will no longer be broadly covered, except:
  • When the patient is in their home AND the distant site provider has the capability to use live video but the patient cannot or does not wish to use it.
  • Home as the originating site will only remain for:
  • Treatment for a substance use disorder and co-occurring mental health conditions
  • Mental/behavioral health services (if all in-person visit requirements are met)
  • End-stage renal disease (ESRD) home dialysis services
All other telehealth visits must take place at eligible facilities in approved geographic locations.
 
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Biller2023 said:
I read articles that say effective 10/1/25 Medicare will not reimburse for telehealth services. Is the same for all medicaid and private insurances?
I called medicare today and spoke with a representative who said "for dates of service on or after 10/1/25 you may want to obtain ABN from medicare beneficiaries due to the pending legislature" but she didn't say that medicare will not pay for telehealth services effective 10/1/25.

So, should we see all our patients in-person only. Will Medicaid and Private insurances pay for telehealth services or will they also follow medicare's guidelines.

Please respond as soon as possible. Thank you.
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Does this include psychiatry services?
 
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drsmith1999@gmail.com said:
Are the commercial insurance limited to rural areas the same as Medicare? We started using the Medicare Telehealth Payment Eligibility Analyzer for all patients using Telehealth.
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Where are you finding the Medicare Telehealth Payment Eligibility Analyzer? All I am finding is that telehealth is now limited to rural areas , behavioral health only. Thanks in advance
 
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