Telehealth

Telehealth 2025: The Final Rule

CMS is set to reinstate certain pre-pandemic telehealth policies if Congress doesn’t step in ASAP.

CMS issued the calendar year (CY) 2025 Medicare Physician Fee Schedule (MPFS) final rule on Nov. 1, 2024, publishing guidance that will have providers and coders scrambling to figure out how to handle their Telehealth patients in 2025, unless something is “fixed” or addressed immediately by Congress.

Absent Congressional action, the Final Rule for telehealth services effective Jan. 1, 2025, could leave 85% or more Medicare patients without access to virtual care.

I’ll start with the highlights of telehealth policy changes based in the 2025 MPFS final rule.

Telemedicine Flexibilities

Originating site location telehealth flexibilities that began during the COVID-19 public health emergency and were extended through 2024 by Congress, will end, as required by current law. Starting Jan. 1, 2025, telehealth originating site rules (where the patient is located at the time of service) will limit patient location to certain rural and underserved areas. Several Bills under consideration in Congress would extend or make telehealth flexibilities permanent but those Bills are pending and have not gotten past the Senate or House for approval as of yet.

  • Starting Jan. 1, 2025, two-way, real-time audio-only communication will satisfy the requirement for an interactive telecommunications system under specific circumstances when a patient cannot use or does not consent to using video technology. However, the distant site practitioner must still have audio-video capabilities. (Again, if the geographical site regulation is not changed from the pre-PHE rules by Congress, this is a moot point).
    • Again, pre-pandemic geographic and location restrictions for telehealth (before March 1, 2020) are being reinstated. This means that unless a Medicare patient lives or is located in a health professional shortage area, a rural census track, or a county outside of the metropolitan statistical area, at the time of service, they will not be covered for telehealth services in 2025.
  • Through calendar year 2025, CMS will continue to permit a distant site practitioner to use their currently enrolled practice location instead of their home address when providing telehealth services from their home. They will consider this issue further for future rulemaking.
  • CMS acknowledges the CPT® Editorial Panel’s decision to delete audio-only telephone services CPT® codes 99441-99443 for 2025. However, Medicare will not recognize 16 of the 17 telehealth CPT® codes (98000-98016) added for 2025; CPT® codes 98000-98015 will have an “I” Invalid status.
  • Medicare will pay separately for brief virtual check-in encounter CPT® code 98016 in lieu of HCPCS Level II code G2012, which CMS is deleting due to redundancy.
  • Direct supervision through real-time audio and visual interactive telecommunications (not audio only) will continue to be allowed on qualifying services.
  • Certain behavioral and mental health services will be permanently offered under telehealth for Medicare patients beginning Jan. 1, 2025. A link to CMS’s List of Telehealth Services is in the Resources section, which you should reference (once the list is updated on January 1st). (See the CAA – Consolidation Appropriations Act of 2021, Section 123 which outlines the BH permanent benefits under Medicare for 2025).
  • Place of service (POS) codes will continue to have two telehealth designations:
  • 02 Patient not in their home when telehealth services are rendered; or
  • 10 Patient in their home when telehealth services are rendered. POS 10 will continue to be paid at the non-facility rate.
  • CMS will continue to allow physicians to list their practice address, rather than their home address, when performing Medicare services via telehealth from their home.
  • Teaching physicians may continue to have a virtual presence in all teaching settings, but only for Medicare telehealth services. This was only extended 1-year through Dec. 31, 2025.
  • Both patient and any approved Telehealth provider must be in the U.S. (including U.S. territories) when the services are done. Out of country medical services are not covered by Medicare via telehealth or otherwise.

Authoritative references are provided in the resources section to allow you to source the information yourself.

Congress Could Change Everything

We still have until the end of 2024 for Congress to fix the geographical location issue for telehealth. But time is of the essence, or more than 85 percent of Medicare patients’ telehealth encounters occurring after Jan. 1, 2025, could be invalid for payment.

NAMAS urges you to contact your local representative to draw attention to this matter.

References and Resources

As first published on AAPC.com and NAMAS.co
This is a revision by the same author, Terry Fletcher, to this original article.