Telehealth Billing Updates Clinics Need to Know in 2025-2026

Telehealth has graduated from stopgap to staple. The next 18 months will reward clinics that move from ‘waiver survival’ to ‘rule-driven operations.’ This guide distills the latest changes and proposals that will shape billing, coding, and compliance through 2025 & 2026. Let’s dive in.

Medicare Telehealth at a Crossroads Between Stability and Change

Medicare’s telehealth rules are in a transition period. For now, most patients can keep using telehealth from home through September 30, 2025. This means you don’t need to be in a rural area or travel to a clinic,  your home counts as the ‘originating site.’ Doctors, nurse practitioners, and other eligible providers can deliver care virtually, and in some cases, even audio-only visits are still allowed.

Medicare also pays at-home telehealth claims at the same rate as in-office visits, and limits on how often patients in hospitals or nursing homes can use telehealth are currently suspended. Training programs can keep using virtual supervision through the end of 2025 (CMS 2025 Telehealth FAQ, Telehealth.HHS.gov).

For behavioral and mental health, the rules are even stronger: home-based care, audio-only visits, and expanded provider eligibility have been made permanent (Telehealth.HHS.gov Behavioral Health). But, starting January 1, 2026, Medicare will require at least one in-person visit with the provider (or a colleague from the same group) before continuing ongoing telehealth services (CMS 2025 Telehealth FAQ).

The catch is what happens after September 30, 2025 if Congress doesn’t act. Without new legislation, many of the temporary flexibilities end. That would mean no more telehealth from home for most non-mental health services, except for rural patients or those at approved facilities. Policymakers are calling this a potential ‘telehealth cliff’ (CMS Physician Fee Schedule 2025 Fact Sheet, Foley & Lardner Policy Advisory, American Medical Association update). The good news is that there’s already bipartisan support in Congress to prevent this, bills are being discussed that could make these telehealth freedoms permanent.

• Through Sept 30, 2025: home telehealth allowed, audio-only allowed in some cases, broad provider eligibility, normal payment rates, training via virtual supervision.
  
• Behavioral/Mental health: permanent home access and audio-only, but in-person visit required starting Jan 1, 2026.
  
• After Sept 30, 2025 (if no action): home use for most non-mental health visits ends; rural/facility limits return; Congress may extend or make permanent.

Controlled Substance Prescribing by Telehealth Faces a 2026 Transition

The DEA (Drug Enforcement Administration) and HHS (Department of Health and Human Services) have extended pandemic-era telemedicine flexibilities for prescribing controlled substances through December 31, 2025. That means doctors and other qualified clinicians can continue following the same rules they’ve used in recent years to prescribe medications like ADHD (Attention-Deficit/Hyperactivity Disorder) drugs or certain anxiety treatments without requiring an initial in-person visit (DEA Notice, HHS Telehealth Guidance). For now, the ‘status quo’ holds through the end of 2025.

At the same time, the DEA has started moving toward a permanent system. In January 2025, they proposed three new rules that would create a ‘special registration’ pathway. Under this model, qualified clinicians could prescribe certain controlled substances (Schedule III–V) via telemedicine, without an in-person exam, if they meet specific requirements. This is expected to become the long-term framework, likely shaping 2026 operations (DEA Rulemaking Update).For behavioral health and addiction care, this is especially important. Some legal and policy experts highlight that new allowances for treating opioid use disorder (OUD) with virtual visits take effect March 21, 2025. This gives providers a clearer roadmap for continuing medication-assisted treatment programs via telehealth (Hendershot Cowart P.C. analysis).

• Through Dec 31, 2025: pandemic-era flexibilities remain, clinicians can prescribe controlled substances via telemedicine under existing rules.
  
• 2025 rulemaking: DEA is building a special registration system for Schedule III–V prescribing without an in-person visit.
  
• Behavioral health impact: expanded tele-prescribing options for addiction/OUD medications effective March 21, 2025.
  
• Action for clinics: continue 2025 workflows but design policies with the 2026 registration model in mind.

Modifier 95 and POS Codes Continue but New Telehealth E/M Codes Arrive

In 2025, the coding rules for telehealth remain mostly familiar but with some important updates to watch. The Place of Service (POS) codes stay the same. POS 10 means the patient is at home, while POS 02 means the patient is somewhere else (such as a clinic or office). Medicare confirms that when patients are seen at home, services are still reimbursed at the non-facility rate,  generally the higher ‘office rate’ rather than the lower ‘facility rate’.

The familiar Modifier 95 continues in 2025 as well. This code is added to telehealth claims to show the service was delivered virtually. Medicare Administrative Contractors (MACs) such as Noridian and Novitas have posted guidance that Modifier 95 should be used through at least September 30, 2025, but clinics should always double-check their MAC’s page for payer-specific updates (Noridian, Novitas).The biggest change for 2025 comes from the new CPT telemedicine-specific codes. The AMA introduced new evaluation and management (E/M) codes that explicitly cover telemedicine, including fresh audio-only codes that replace the old 99441–99443 series. These new codes are designed to match the structure of in-person visits, making documentation and billing alignment more straightforward (AMA CPT 2025). Clinics will need to confirm which payers, including Medicare, have officially adopted these codes before using them.

• POS codes: POS 10 = patient’s home; POS 02 = telehealth not at home; home-based visits paid at office (non-facility) rates.
  
• Modifier 95: still required through Sept 30, 2025 (verify with your MAC).
  
• 2025 CPT updates: new telemedicine E/M codes, including audio-only replacements for 99441–99443.
  
• Action steps: update EHR picklists, payer crosswalks, superbills, and billing cheat sheets; keep POS and modifier rules visible for billing staff.

CMS Telehealth Categories Highlight What Stays Permanent and What Expires in 2025

Every year, CMS (Centers for Medicare & Medicaid Services) publishes an official Medicare Telehealth List, which outlines which services are approved for telehealth. For 2025, CMS not only kept many existing services but also added some new ones. For example, caregiver training has been added on a provisional basis, while certain services, like PrEP counseling and safety-planning interventions, are now permanent. CMS also confirmed that the suspension of certain frequency limits (rules about how often a service can be billed via telehealth) will continue in 2025.

One important detail: the CMS list labels services by Category.

• Permanent means the service is permanently part of the telehealth list.
  
• Category 3 means temporary, the service is available for now, but could expire if Congress does not act after September 30, 2025.
  

For clinics, the action step is to download the 2025 Telehealth List (ZIP file), compare it with the codes your clinic uses most often, and flag which ones fall under Category 3. That way, you’ll be ready to adjust quickly if those codes are not extended past the 2025 deadline.

• New in 2025: caregiver training (temporary), PrEP counseling (permanent), safety-planning interventions (permanent).
  
• Frequency limits: still suspended for certain services in 2025.
  
• Categories to track: permanent vs. Category 3 (temporary until Sept 30, 2025).
  
• Action for clinics: map your most-used codes against the CMS 2025 list and mark Category 3 services for possible changes.

Telehealth Billing Rules Today and the Proposed Path Forward

In 2025, CMS used the Physician Fee Schedule (PFS) Final Rule to clear up how Remote Therapeutic Monitoring (RTM) and Remote Patient Monitoring (RPM) should be billed. These clarifications focus on how providers track time spent and how care teams share responsibilities, with the goal of reducing friction and making billing match real-world digital care (CMS 2025 PFS Final Rule, Tenovi summary).

Looking ahead to 2026, the proposed rule (released July/Aug 2025) takes things further. CMS is considering new RPM/RTM codes, including options that cover just 10 to 19 minutes of reviewing patient data or interacting with patients. This could make billing more flexible for clinics handling shorter but frequent interactions. Even more significant, CMS is openly asking for feedback on software-as-a-service (SaaS) pricing under Medicare, a strong sign that digital platforms and analytics tools will have a bigger role in reimbursed care (National Rural Health Association, McDermott Health Law, National Law Review).

For clinics, the immediate step is to stay aligned with the 2025 clarifications and prepare for possible 2026 changes. That means making sure your care-team documentation is clean, especially around who can count supervision time and whether it falls under general or direct supervision (MD Revolution). At the same time, map your current RPM/RTM minutes against the proposed 2026 code structure so you can pivot smoothly once new codes are finalized.

• 2025 (current): CMS clarified time tracking, care-team workflows, and billing alignment for RPM/RTM.
  
• 2026 (proposed): new codes for shorter time blocks (10 to 19 minutes); CMS exploring SaaS-based pricing for digital health platforms.

Remote Monitoring Rules Gain Clarity While 2026 Proposals Signal Change

When it comes to telehealth payment in 2025, state rules and commercial payer policies still vary widely. Some states require insurers to cover telehealth services (coverage parity), but fewer require insurers to pay the same rates as in-person visits (payment parity). According to the Center for Connected Health Policy (CCHP), coverage parity is now common, but only about half of states mandate full payment parity. The exact number changes, so it’s important to check the live maps before planning your clinic’s revenue projections (CCHP Policy Maps, CCHP Policy Finder).

The National Conference of State Legislatures (NCSL) notes that around 24 states currently mandate payment parity, but that figure can shift as new laws are passed (NCSL Telehealth Explainer). For Medicaid and private payer contracts, the CCHP’s Policy Finder is the go-to tool for up-to-date, state-by-state guidance, and it’s especially useful when negotiating contracts or planning visit mixes into 2026 (Public Health Institute, CCHP).

For clinics, the action step is clear, before entering 2026 payer contracts, export your state’s policies from CCHP’s Policy Finder and align your fee schedules and prior-authorization rules with the 2025 CPT telemedicine codes. This way, your billing and financial planning will reflect both federal updates and state-level payer realities.

• Coverage vs. payment parity: most states require coverage parity; fewer (≈24) mandate payment parity.
  
• Durable resources:
  
  • CCHP Policy Maps (see private payer parity filter).
    
  • CCHP Policy Finder (state-by-state Medicaid/private payer rules).
    
  • NCSL Telehealth Explainer.

What Matters Most for Clinics Preparing for the Next Two Years

To stay ahead in 2025 and 2026, clinics need a clear readiness plan that balances today’s billing rules with tomorrow’s policy changes. For 2025, the focus should be on stabilizing compliance and workflows. 

That means locking in the key federal dates: 

• September 30, 2025, when non-behavioral Medicare telehealth flexibilities could expire if Congress does not act; 
• December 31, 2025, when the DEA’s tele-prescribing flexibilities end; and 
• January 1, 2026, when the in-person requirement returns for behavioral telehealth (with some CMS allowances) (CMS Telehealth Guidance, DEA Telemedicine Updates, Telehealth Resource Centers).

In addition, clinics should refresh coding and documentation now. That includes importing the 2025 CPT telemedicine codes, updating visit templates, and making sure EHR prompts remind staff to use the correct POS 10/02 and Modifier 95 when required. Staff should also be retrained to capture documentation details such as site, modality (video vs. audio-only), consent, technology used, and payer-specific frequency rules. For prescribing, policies should remain aligned with the DEA/HHS extension through 2025, while preparing to pivot to the special registration model in 2026 (SMFM coding update, DEA policy).

Looking ahead, the second part of the plan is to pre-position for 2026. Clinics should create a scenario plan in case Congress does not extend non-behavioral telehealth flexibilities after September 2025. That means building scheduling logic to shift patients away from “home-based” visits unless their category stays eligible. On the remote monitoring side, practices should align RPM/RTM minutes with the proposed 2026 code structure and prepare for a software-as-a-service (SaaS) reimbursement model (McDermott Health Law). For behavioral care, practices will need to schedule the required in-person touchpoints to maintain eligibility, using CMS’ allowance for same-group substitutes as a fallback. Finally, contracting for 2026 should be guided by CCHP and NCSL parity resources so payer negotiations reflect the latest state-level parity laws, especially for tele-mental health, chronic care, and remote monitoring (CCHP Policy Finder, NCSL Telehealth Policy).

• Stabilize 2025:
  
  • Track key dates: Sept 30 (Medicare flexibilities), Dec 31 (DEA flexibilities), Jan 1, 2026 (behavioral in-person rule).
    
  • Import 2025 CPT codes; update visit templates; add EHR prompts for POS 02/10 and Modifier 95.
    
  • Retrain staff on documentation (site, modality, consent, frequency rules).
    
  • Keep prescribing policies aligned with DEA/HHS extension.
    
• Pre-position for 2026:
  
  • Build contingency plans if Medicare “home” flexibilities expire Oct 1, 2025.
    
  • Map RPM/RTM minutes to 2026 proposed codes; prepare for SaaS reimbursement.
    
  • Plan behavioral care workflows with required in-person visits.
    
  • Use CCHP/NCSL parity data to guide payer contract negotiations.

Here’s You Telehealth Fast Facts for Daily Huddles

For quick updates your team can use in daily huddles, here are the must-know telehealth highlights for 2025 & 2026. These cover Medicare, DEA, coding, RPM/RTM, and compliance in short, practical soundbites.

• Medicare home telehealth (non-behavioral): available through Sept 30, 2025; after that, it reverts unless Congress extends it (Telehealth.HHS.gov).
  
• Behavioral/mental health telehealth: home access and audio-only are permanent, but the in-person requirement returns Jan 1, 2026 (with CMS flexibility for same-group substitutes) (Telehealth.HHS.gov, CMS FAQ).
  
• DEA tele-prescribing: flexibilities last until Dec 31, 2025; DEA is preparing a special registration model for long-term rules (DEA Telemedicine Guidance).
  
• Billing mechanics: keep using POS 10 (home, non-facility rate) and POS 02 (other sites, facility rate); apply Modifier 95 as required by your MAC or payer (CMS Telehealth FAQ).
  
• CPT 2025 update: new telemedicine-specific E/M codes, including audio-only analogs that replace 99441–99443 (SMFM summary).
  
• RPM/RTM: the 2026 proposal introduces more granular codes (10–19 min blocks) and opens discussion on SaaS pricing for digital health platforms (McDermott Health Law).
  
• HIPAA compliance: pandemic-era flexibilities ended in 2023; landline audio-only calls aren’t covered by the Security Rule, but VoIP, mobile, and app-based calls count as electronic PHI and must be fully HIPAA-secure (AHA guidance, HHS FAQ).

Final Notes on Telehealth Compliance and Updates

Clinic leaders can stay ahead of 2025–2026 telehealth changes by using a simple ‘Do / Build / Check’ framework. This helps separate what needs attention right now, what should be built in the next few months, and what to monitor regularly.

Do (now)

Lock in the key compliance dates so you don’t miss critical policy shifts. That means embedding Sept 30, 2025 (possible end of Medicare non-behavioral telehealth flexibilities), Dec 31, 2025 (DEA prescribing flexibilities end), and Jan 1, 2026 (behavioral telehealth in-person requirement) into your EHR/PMS reminders and payer contract calendars (CMS, DEA). Download the official CY 2025 Telehealth List and compare it against your top visit types, and make sure your system has POS automation and modifier prompts tied to patient location (CMS Telehealth Services List).

Build (next 60 to 90 days)

 Prepare forward-looking playbooks. Draft a DEA transition SOP that points to the special-registration rules and creates a pharmacist escalation path (DEA updates). Create a 2026 RPM/RTM billing playbook that maps new proposed time-based codes to clinical minutes, device use, and staffing (McDermott Health Law). Also, design a behavioral telehealth compliance calendar that ensures required in-person visits are scheduled every 12 months beginning in 2026, with flexibility for same-group substitutes (Telehealth Resource Centers).

Check (quarterly)

Build a routine of checking for updates. Review your MAC’s telehealth modifier and POS pages for “through” date changes, keep up with CMS’ Physician Fee Schedule (PFS) updates in both final and proposed rules, and monitor CMS telehealth FAQ revisions (CMS, Federal Register). For state-level shifts, use the CCHP Policy Finder and NCSL resources to track parity laws and Medicaid updates that may affect your contracts, especially for FQHCs and RHCs (CCHP, NCSL).

• Do (now): Add key compliance dates to your systems; download and reconcile the CMS 2025 Telehealth List; turn on POS/modifier automation.
  
• Build (next 60–90 days): Draft DEA transition SOP; create RPM/RTM 2026 billing playbook; set up behavioral telehealth compliance calendar.
  
• Check (quarterly): Monitor MAC policy pages, CMS PFS updates/FAQs, and CCHP/NCSL parity maps for state and commercial payer changes.