For three years, Medicare telehealth has lived on short extensions. The flexibilities that began in 2020 were extended through 2024, then through March 2025, then through September 2025, then lapsed during the fall shutdown, came back through January 30, 2026, and lapsed again for a few days at the end of January. On February 3, 2026, the President signed H.R. 7148, the Consolidated Appropriations Act, 2026, which extends the main flexibilities through December 31, 2027 and covers the brief gap retroactively.
Twenty-two months of certainty is the longest runway telehealth billing has had since the pandemic. It is also long enough that practices stop paying attention to the details, and the details are where the denials are. We spent the spring cleaning up telehealth claims for practices that turned services off in late January, turned them back on in February, and never checked what their systems were sending.
Key takeaways
- The geographic and originating site waivers, home as an eligible site, audio-only coverage, the expanded practitioner list and the FQHC and RHC distant-site rules now run through December 31, 2027.
- Place of service still drives the rate: POS 10 (patient at home) pays the non-facility rate, POS 02 pays the facility rate.
- Modifier 95 for audio-video and modifier 93 for audio-only, and the note must say which one happened and where the patient was.
- Claims for January 31 to February 3, 2026 are payable; find any still sitting in denial and resubmit.
- Every rule here is a Medicare rule. Commercial and Medicare Advantage plans changed their own policies in January.
What was extended, and what was not
The law extends, through December 31, 2027: the waiver of geographic restrictions and originating site rules, which means a Medicare patient can receive telehealth at home anywhere in the country; the ability of federally qualified health centers and rural health clinics to serve as distant site providers; the expanded list of eligible practitioner types, including physical therapists, occupational therapists, speech-language pathologists and audiologists; coverage of audio-only services where appropriate; the delay of the in-person visit requirement for mental health telehealth; and telehealth face-to-face encounters for hospice recertification. Separately, the Acute Hospital Care at Home program was extended through September 30, 2030.
What did not change: telehealth services must still be on the Medicare Telehealth Services List, documentation requirements are unchanged, and the payment rules that tie the rate to the place of service remain in force. The January 30 expiration date is gone, but the rules that produce denials are the same ones that produced them in 2025.
The five-point check
| Check | What to look for | Why it matters |
|---|---|---|
| Place of service | POS 10 when the patient is at home; POS 02 when the patient is elsewhere | POS 10 pays at the non-facility rate; POS 02 pays at the facility rate, which is lower for most E/M codes |
| Modifier 95 | Appended to real-time audio-video telehealth | Required by Medicare for most telehealth claims; many commercial payers also want it |
| Modifier 93 | Appended to audio-only services | Medicare pays audio-only only for eligible services and situations; the modifier tells the payer which one this was |
| Service on the telehealth list | Compare your top telehealth CPT codes to the current Medicare list | A code that is not on the list is not payable as telehealth regardless of modifier |
| Documentation of modality and location | Note states audio-video or audio-only, patient location, provider location | This is the first thing an auditor asks for |
A worked example: what the POS error costs
Take a three-physician internal medicine practice that delivers about 220 Medicare telehealth visits a month, nearly all to patients at home. Its system was configured in 2024 to send POS 02 for every telehealth encounter, and nobody changed it when POS 10 became the correct code for home visits. We see this configuration more often than any other telehealth error. For an established patient visit at the 99214 level, the facility rate is roughly $25 to $30 less than the non-facility rate in most localities, because the practice expense portion of the payment is reduced. Multiply a $27 difference by 220 visits and the practice was leaving about $6,000 a month on the table, correctly documented and correctly coded except for two digits.
The fix took ten minutes in the system settings. The recovery took longer: corrected claims for the past 12 months, payer by payer, because the place of service is a claim-level correction, not an appeal. Medicare accepted the corrected claims within its timely filing window. Two Medicare Advantage plans did not, because their filing limits for corrections were shorter. Check your POS logic before you need to do this.
The gap claims
Services furnished between January 31 and February 3, 2026 were in a lapse when they happened. The law covered them retroactively. If your practice held telehealth claims from those days, release them. If you billed them and they were denied for telehealth eligibility, they can be resubmitted; the Medicare Administrative Contractors reprocessed some automatically, but not all, and the practices we work with found a handful still sitting in denial queues in April. Pull anything with a date of service in that window and a telehealth denial and check its current status.
Some practices converted telehealth visits in that window to in-person visits, or cancelled them. There is nothing to recover there; just make sure any visit that was actually delivered by video was billed as telehealth and not as an office visit with POS 11. That is a false claim, not a workaround.
Audio-only is where the errors concentrate
Audio-only telehealth is allowed when the patient is at home and either cannot use video or does not consent to it, and the practitioner is capable of video. The documentation must say so. In audits we see two patterns: the note says nothing about modality and the claim carries modifier 95, or the note says "phone call" and the claim carries nothing. Both fail. Teach providers a single sentence for the note ("Visit conducted by audio only at patient request; patient at home; provider in office and capable of video") and teach the coder to look for it.
Behavioral health is a special case. The in-person visit requirement for mental health telehealth (a visit within six months before the first telehealth service and every twelve months after) remains delayed through 2027. It is delayed, not repealed. Practices should keep track of which patients have had an in-person visit anyway, because when the delay ends, the requirement will apply to existing patients. A simple flag in the chart, "last in-person visit," costs nothing now and saves a scramble later.
Commercial payers are not Medicare
Every rule above is a Medicare rule. Commercial and Medicare Advantage payers set their own telehealth policies, and many of them changed in January 2026 without regard to what Congress did. Some require POS 02 for all telehealth regardless of patient location; some pay parity with in-person; some have shortened their covered code lists. Pull your telehealth denials by payer for the first quarter and read the remark codes. A pattern at a single payer is a policy you have not read yet.
Build a one-page grid: payer, POS rule, modifier rule, audio-only rule, covered code list date. Five payers usually cover 80 percent of a practice's telehealth volume, and the grid takes an hour. Give it to the coder and the front desk, because the front desk decides whether the visit is scheduled as video or phone, and that decision determines the claim.
If telehealth is a meaningful share of your visits and you want the claim logic checked once and then monitored, our medical billing service includes a telehealth edit set, and the training courses cover telehealth coding for front-desk and billing staff.
Questions we hear
Do we still need patient consent for telehealth?
Medicare requires that the patient consent to telehealth, and many states have their own consent rules. Verbal consent documented in the note is common practice; check your state's requirement, and ask counsel if you are unsure.
Our provider is at home. Does that change the claim?
The distant site is where the provider is. Medicare continues to allow practitioners to furnish telehealth from home without listing the home address on enrollment through the extension period; check the current CMS guidance for your circumstances. The place of service on the claim reflects the patient's location, not the provider's.
Should we plan for the flexibilities to end in December 2027?
Plan as if they will, and be pleasantly surprised if they do not. Congress has extended these rules again and again; it may do so once more, but recent extensions have come within days of the deadline, and the January 2026 lapse shows what a near miss looks like. Put the date in the compliance calendar with a reminder in September 2027.
What to do this month
- Run a claim report for POS 02 and POS 10 for dates of service January 1 through April 30, 2026. Check that every line has modifier 95 or 93 and that the POS matches the documented patient location.
- Find any telehealth claims from January 31 to February 3 that are still denied and resubmit them.
- Review your top ten telehealth CPT codes against the current Medicare Telehealth Services List.
- Read ten audio-only notes for the modality and location sentence. If fewer than eight have it, schedule the provider huddle.
- Build the five-payer telehealth grid and give it to the front desk and the coder.
- Put December 31, 2027 in the compliance calendar with a September 2027 reminder.
