The Telehealth Coverage Act of 2025 amends Title XVIII of the Social Security Act to remove sunset dates and permanently preserve a broad set of Medicare telehealth flexibilities that were implemented during the COVID-19 emergency. The bill rewrites date-limited provisions in section 1834(m) to apply “beginning on the first day” of the emergency period in section 1135(g)(1)(B), expands eligible provider types, continues audio-only coverage where previously authorized, extends Acute Hospital Care at Home waiver flexibilities, and makes targeted changes for hospice recertification, cardiopulmonary rehab, and the Medicare Diabetes Prevention Program (MDPP).
Beyond permanence, the bill imposes new operational requirements: the Secretary must establish coding/modifier rules (effective January 1, 2026) to identify telehealth furnished via vendor platforms and incident-to telehealth claims, and CMS is authorized to implement many changes by program instruction. It also directs HHS to issue best-practice guidance for serving individuals with limited English proficiency and requires outreach on medication‑induced movement disorder screening via telehealth — changes that will affect providers, telehealth vendors, billing systems, and compliance programs.
At a Glance
What It Does
Amends section 1834(m) to replace expiration dates with language tying telehealth flexibilities to the emergency period start date, effectively making many pandemic-era rules permanent for services furnished on or after that start date. The bill adds mandatory use of codes/modifiers to flag platform-owned or platform-arranged telehealth and incident-to telehealth, and gives the Secretary authority to implement changes by program instruction.
Who It Affects
Physicians, nurse practitioners, physician assistants, telehealth platform vendors that contract with providers, federally qualified health centers (FQHCs) and rural health clinics (RHCs), hospice providers, virtual MDPP suppliers, and beneficiaries — especially those in rural or limited-English-proficiency populations.
Why It Matters
Permanentizing flexibilities removes the uncertainty that drove rapid operational changes during the emergency but shifts the compliance baseline: systems must capture new modifiers and vendors face new reporting/accountability risk. The changes also broaden who can furnish telehealth services, enable virtual-only MDPP suppliers to bill Medicare across state lines, and formalize HHS guidance and outreach obligations that will shape access and quality standards.
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What This Bill Actually Does
The bill rewrites the Medicare telehealth statutory text to remove the temporary end-date language that tied expanded telehealth coverage to March 31, 2025, and instead anchors the expansions to the first day of the emergency period specified in section 1135(g)(1)(B). Practically, that means the waivers and flexibilities adopted during the public health emergency no longer expire by statute for services furnished on or after that emergency start date.
The bill targets the statutory provisions in section 1834(m) governing telehealth payment and coverage and makes parallel edits so FQHCs, RHCs, and a broader set of practitioners can continue to furnish and be paid for telehealth services under Medicare.
The Act preserves earlier allowances for audio-only services in specific circumstances, while also clarifying where audio-only is not sufficient (for example, it explicitly permits video-based in-home cardiopulmonary rehab but excludes audio-only for that service). It eliminates prior in-person requirements that applied to certain categories of services — such as mental health, substance use disorder services, and some ESRD-related visits — making telehealth an acceptable substitute for what had required face-to-face contact.
For hospice recertification, the bill allows the required face-to-face encounter to be conducted via telehealth in most cases, but it also carves out exceptions (areas under hospice enrollment moratoria, providers under enhanced oversight, or certain unenrolled/opt-out practitioners).A major operational change is the mandatory coding/modifier regime. By January 1, 2026, HHS must require one or more codes or modifiers to identify claims where telehealth was furnished through a telehealth platform owned by or contracted with the clinician, and to flag telehealth claims furnished incident-to a practitioner’s professional service.
Hospice telehealth encounters tied to recertification must also carry a telehealth modifier beginning January 1, 2026. These rules are written to increase transparency about vendor involvement and incident-to arrangements, but they will require updates to billing software, payer adjudication logic, and audit protocols.Outside payment mechanics, the bill extends the Acute Hospital Care at Home waiver flexibilities beyond the emergency period, tasks HHS with issuing best-practice guidance within one year on telehealth for individuals with limited English proficiency (developed in consultation with a list of stakeholders), allows online-only MDPP suppliers to enroll and bill beginning January 1, 2026 (including cross‑state billing for online MDPP services), and directs HHS to provide provider education on screening for medication-induced movement disorders and how to code these services when furnished through telehealth.
Several provisions explicitly allow CMS to implement changes by program instruction, which shortens the pathway to operational guidance but reduces rulemaking formality.
The Five Things You Need to Know
The bill amends section 1834(m) to remove March 31, 2025 sunset language and make pandemic-era telehealth flexibilities apply “beginning on the first day” of the emergency period in section 1135(g)(1)(B).
HHS must establish one or more codes or modifiers by January 1, 2026 to flag telehealth claims furnished via vendor-owned or vendor-arranged virtual platforms and telehealth furnished incident-to a professional service.
Hospice face-to-face encounters required for recertification may be conducted via telehealth, but encounters on or after January 1, 2026 must include a specified telehealth modifier and certain exceptions apply (moratoria, enhanced oversight, unenrolled/opt-out clinicians).
The Medicare Diabetes Prevention Program (MDPP) must allow virtual-only suppliers to enroll and submit claims beginning January 1, 2026, and the bill removes limits on the number of times an individual may enroll in MDPP.
HHS must issue best-practice guidance within one year for furnishing telehealth to individuals with limited English proficiency and must provide outreach to clinicians about telehealth screening for medication-induced movement disorders.
Section-by-Section Breakdown
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Make pandemic-era telehealth flexibilities permanent
This part edits multiple subsections of 1834(m) to eliminate date-based expirations and instead apply the telehealth flexibilities to services furnished on or after the first day of the emergency period cited in section 1135(g)(1)(B). The practical effect is statutory permanence for many coverage decisions that CMS adopted during the COVID emergency, including expanded eligible provider categories and treatment of certain telehealth modalities. Because the edits replace sunset language with a start-date anchor, the provision does not create new temporary timelines; it changes the statutory baseline so these authorities no longer lapse by the previously specified date.
FQHCs/RHCs, practitioner expansion, and audio-only treatment
These clauses specifically preserve telehealth payment pathways for federally qualified health centers and rural health clinics and broaden the statutory list of practitioners who may furnish telehealth to Medicare beneficiaries. The bill retains the audio-only allowance where the Secretary has previously identified services appropriate for audio-only, but other program text (e.g., for cardiopulmonary rehab) narrows audio-only eligibility to protect clinical quality. Administratively, CMS will need to maintain all existing policy decisions that operationalized audio-only coverage when converting statutory permanence into claims rules.
Elimination of in-person requirements for certain services
The bill removes several in‑person prerequisites that previously limited telehealth for categories such as mental health, substance use disorder treatment, stroke telehealth, and certain ESRD-related visits. It reorganizes section 1834(m) (striking and redesignating paragraphs) so that the statutory command explicitly treats these services as permissible via telehealth without prior face-to-face encounters. Operational implications include revised documentation expectations and revised audit criteria for encounters that would previously have been in-person only.
Hospice recertification via telehealth and modifier requirement
The bill allows the face-to-face encounter required before hospice recertification to be performed via telehealth beginning on the emergency period start date, but adds three carve-outs where telehealth is not permitted (areas with hospice enrollment moratoria, providers under enhanced oversight, and certain unenrolled/opt-out clinicians). Separately, Section 3 requires that hospice encounters conducted via telehealth on or after January 1, 2026 include specified modifiers or codes to indicate telehealth use. This creates both access flexibility for most hospice patients and a clear coding obligation for hospice claims that CMS can monitor.
Required modifiers for platform-based and incident-to telehealth claims
Section 1834(m) gains a new paragraph directing the Secretary to require codes or modifiers, by January 1, 2026, that identify telehealth claims furnished through virtual platforms owned by or under payment arrangements with clinicians, and telehealth furnished incident-to a clinician’s professional service. The provision targets transparency around platform ownership and contractor relationships and is likely intended to support oversight of potential kickbacks, split-fee arrangements, or improper billing; it will require significant payer and provider system updates.
Extend Acute Hospital Care at Home waiver flexibilities
This section amends the statutory language for the Acute Hospital Care at Home demonstration so the waiver flexibilities apply on or after the first day after the end of the emergency period in section 1135(g)(1)(B). The change preserves hospital-at-home operational models adopted during the emergency, allowing them to continue under Medicare without reissuance of temporary waivers tied to the public health emergency end date.
LEP guidance, in‑home cardiopulmonary rehab, and MDPP virtual suppliers
Section 5 directs HHS to issue best-practice guidance within one year for serving limited-English-proficiency patients via telehealth, developed with stakeholders ranging from tech vendors to interpreter associations. Section 6 permits cardiopulmonary rehabilitation items and services to be furnished in the home using video-based (not audio-only) real‑time communications and clarifies virtual clinician presence for those services. Section 7 requires HHS to revise MDPP regulations so that online-only suppliers can participate and submit claims beginning January 1, 2026, sets the administrative location rule for online suppliers, allows cross‑state MDPP claims where the beneficiary is in a different state than the supplier, and removes limits on re-enrollment in MDPP.
Outreach on medication-induced movement disorder screening
HHS must use existing communication channels to educate Medicare clinicians about periodic screening for medication‑induced movement disorders associated with mental health treatments, including guidance on furnishing such screenings through telehealth and on appropriate evaluation and management coding. The requirement is education‑focused rather than prescriptive but signals a policy priority to improve remote recognition of these adverse effects.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries in rural and underserved areas — the statutory permanence of telehealth and explicit support for FQHC/RHC telehealth keeps ongoing remote access to behavioral health, chronic care, and certain specialty services that were expanded during the emergency.
- Virtual MDPP suppliers and online wellness companies — the bill allows online-only MDPP suppliers to enroll and bill Medicare and to serve beneficiaries across state lines beginning January 1, 2026, opening a national market for virtual diabetes prevention providers.
- Behavioral health and SUD providers who rely on telehealth — removing in-person prerequisites for many mental health and substance use disorder services preserves a sustainable telehealth care pathway for these services.
- Hospice patients who have difficulty with in-person visits — telehealth recertification options can reduce travel burdens and help maintain continuity of hospice care, subject to the specified carve-outs.
- Limited-English-proficiency beneficiaries — required HHS guidance on interpreter integration, multilingual patient materials, and accessible portals is intended to improve telehealth usability and reduce language-related access barriers.
Who Bears the Cost
- Providers and hospice programs — must update electronic health records, scheduling and billing systems to capture the new modifiers/codes, revise compliance programs, and train staff on new documentation and coding requirements.
- Telehealth platform vendors — will face increased scrutiny and reporting expectations because CMS must require modifiers identifying platform ownership or payment arrangements, potentially affecting contractual models and revenue sharing.
- Medicare Claims Administrators and CMS — will need to revise adjudication logic, develop new claims-edit rules, and build audit protocols to implement modifier-based oversight and cross-state MDPP billing.
- Small and rural providers without robust IT resources — may incur disproportionate administrative and capital costs to meet video-based requirements for services (e.g., cardiopulmonary rehab) where audio-only is excluded.
- Compliance and legal teams — will need to reassess incident-to billing, platform contracting arrangements, and risk of increased audits or investigations driven by the new transparency provisions.
Key Issues
The Core Tension
The central dilemma is access versus accountability: the bill locks in broad telehealth access gains that improve convenience and reach for beneficiaries, but it simultaneously creates new oversight and coding requirements meant to protect program integrity — requirements that increase administrative burden and shift the compliance risk profile for clinicians, hospice programs, and digital vendors. Reasonable stakeholders will disagree about how much operational friction is acceptable to secure transparency and fraud prevention.
The bill makes strategic choices that favor access but leave several operational questions unresolved. First, tying permanent coverage to the ‘‘first day of the emergency period’’ is a drafting approach that preserves the emergency-based policy signal while removing the prior sunset.
It does not, however, directly resolve state licensure limits, scope-of-practice differences, or other non‑federal barriers that still limit cross‑state telehealth practice. Second, the required modifier regime aims to promote transparency about platform ownership and incident-to arrangements, but the statute leaves key definitional details — what constitutes an ownership interest, a ‘‘payment arrangement,’’ or the technical content of incident-to telehealth — to the Secretary.
Those definitions will determine whether common marketplace contracts trigger disclosure and how aggressive enforcement will be.
The bill also delegates substantial authority to implement changes by program instruction. That accelerates the pathway to operational rules but reduces the formal notice-and-comment opportunities usually available through rulemaking, raising concerns about stakeholder input on complex billing and cross-state issues.
Finally, the MDPP online-supplier and cross-state billing permission is a major access win, but it creates integrity and oversight challenges: CMS must reconcile enrollment sourcing, beneficiary verification, state consumer protection regimes, and payment integrity controls for remote suppliers. Small providers could find themselves disadvantaged by the administrative costs of compliance even as larger virtual vendors scale nationally.
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