Medicare Telehealth extension

[CarabinerSD]

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https://www.axios.com/2025/11/12/shutdown-deal-extends-medicare-telehealth-coverage

The Senate deal to reopen the government would extend Medicare telehealth coverage through Jan. 30 and pay retroactively for virtual care services delivered during the government shutdown.


Where it stands: Medicare's authority to pay for virtual care outside of rural health settings expired when the shutdown began on Oct. 1, prompting providers to cancel appointments or face the prospect of not getting paid.

• Medicare telehealth coverage has broad bipartisan support — but it hasn't yet been made permanent, in part because doing so could cost billions of dollars.

Zoom out: The Senate deal would also extend other health policies that expired last month, including a program that allows hospitals to deliver institutional-level care in Medicare patients' homes.

• The bill also continues extra Medicare payments for hospitals with low patient volumes and disproportionate numbers of senior patients, as well as funding for community health centers, teaching health centers and the National Health Service Corps.
• It also delays scheduled Medicare payment cuts, including for laboratory tests, and a major cut to hospitals' Medicaid payments.

Biggest takeaway for me:

• The policies are all retroactively extended from Oct. 1 through Jan. 30.

 

[CleanUp]

What happens on Feb 2 2026?

 

[CarabinerSD]

What happens on Feb 2 2026?

Same thing that happened on 10/1/25 last month... more political games.

 

[SpineandWine]

Question
@BobBarker - do most insurance take telehealth? How about Medicaid?

 

[BobBarker]

Yes. Everything here except a couple random commercial plans allows telehealth. I have one patient with a bcbs employee plan that doesn’t allow it n

 

[Yo GabbaPentin]

Do all telehealth visits have to be video calls?

 

[callmeanesthesia]

Do all telehealth visits have to be video calls?

I think if you document that the patient was unable or unwilling to do video then it’s ok. I still try video call for every patient but seems like only half of them successfully connect.

 

[SpineandWine]

I think if you document that the patient was unable or unwilling to do video then it’s ok. I still try video call for every patient but seems like only half of them successfully connect.

My understanding is you can’t bill unless it’s video connection as well?
Otherwise, it’s a telephone encounter.

 

[Ducttape]

technically CMS is proposing "new" guidelines that suggest that audio only is acceptable, but buyer beware.

https://telehealth.hhs.gov/providers/billing-and-reimbursement/medicare-payment-policies

in the past, there were specific codes for audio only visit. those were cut. im not sure what codes are proposed for audio only visits.

one can peruse this site:

CMS-1848-P | CMS

CY 2027 Payment Policies under the Medicare Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies

www.cms.gov

of note for those using G2211 - there is a proposal to change that from a separate standalone code to an add on code (and, i suspect, its eventual degradation).

Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule

Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed RuleOn July 14, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS)...

www.cms.gov

this code is proposed to add 16% to the payment from the E/M code as opposed to flat wRVU and is a reduction that most are not noticing.

currently, we get 0.33 wRVU for G2211.

this would give 0.30 wRVU for level 4 visit, and 0.21 wRVU for level 3 visit.

 

[bubaghanush]

I think if you document that the patient was unable or unwilling to do video then it’s ok. I still try video call for every patient but seems like only half of them successfully connect.

Same

My understanding is you can’t bill unless it’s video connection as well?
Otherwise, it’s a telephone encounter.

Telephone Visits with Patients | ACP

For patients who do not want to utilize video visits, there is an option to telephone with patients. Find the applicable regulations and waivers you need.

www.acponline.org

Some patients may not have access to video visits because they cannot access interactive audio-video technology, do not have reliable broadband, may not be facile with technology, or may prefer not to use video technology. Practices can use audio-only telephone calls to provide care for their patients if the patient is unable or does not consent to the use of video

 

[Ducttape]

previously, we were required to use a different code for audio visit, not the standard level 3 or 4 E/M follow up codes, which were not going to be paid for by Medicare.


i cant find any documentation of whether we are supposed to still do that.

 

[painisfear]

Modifier 95 for audio with video
Modifier 93 for audio only

If audio only be sure to document that you were able to offer video capability but the patient was not able to support that or it wasn’t optimal for the patient for whatever reason.

Make sure you change your POS from 11 to 10 if patient is in their home.