A family practice that sees about 60 Medicare patients a week by video asked us on Friday whether to keep the telehealth slots on the February schedule. It is the right question and, as of this writing on January 27, nobody can answer it with certainty. The Medicare telehealth flexibilities that have allowed those visits since 2020 are set to expire when January 30, 2026 ends. Congress has a bill that would extend them, there is broad support for it, and it has not passed. We have been here before, twice in the last four months, and both times the outcome was a lapse followed by a retroactive fix.
The background. The pandemic-era telehealth waivers were extended by a series of laws, most recently the Consolidated Appropriations Act of 2023, which carried them through September 30, 2025. When the federal government shut down on October 1, 2025, the flexibilities lapsed. The continuing resolution that ended the shutdown, H.R. 5371, was signed on November 12, 2025 and restored them retroactively, but only through January 30, 2026. That date was chosen because it was the end of the funding period, not for any healthcare reason. A longer extension, reportedly two years, has been proposed and has not been enacted as we write.
So the practice has to plan for two outcomes. This article lays out what actually expires on January 31 if nothing passes, what continues regardless, how the October lapse was handled and what it taught us, and a schedule and billing plan for February that works whether or not the extension arrives on time.
Key takeaways
- Unless Congress acts, on January 31, 2026 Medicare telehealth reverts to the pre-2020 statute: originating site restrictions return, most patients cannot receive telehealth at home, and audio-only visits are no longer covered for most services.
- Behavioral and mental health telehealth at home continues permanently, though the in-person visit requirement that was delayed until January 30 would take effect.
- Medicare Advantage plans set their own telehealth benefits and are not affected by the statutory lapse; commercial and Medicaid policies are separate too.
- In October 2025 CMS told providers to hold claims during the lapse, and the November law paid them retroactively; the same pattern is possible but not guaranteed.
- Schedule February Medicare telehealth visits as tentative, get a documented patient choice on each, and be ready to hold claims rather than bill them incorrectly.
What expires on January 31 if nothing passes
The Medicare telehealth statute, section 1834(m) of the Social Security Act, was written in 2000 for a rural world. Without the flexibilities, it requires the patient to be physically located at an eligible originating site (a physician office, hospital, rural health clinic and a few others) in a rural health professional shortage area or a county outside a metropolitan statistical area. The patient's home is not an eligible originating site except for specific carve-outs. The service must be delivered by real-time audio and video; audio-only is not telehealth under the statute. And the list of practitioners who may furnish telehealth is narrower: physical therapists, occupational therapists, speech-language pathologists and audiologists were added only by the flexibilities.
The flexibilities that expire January 30 are the ones that override each of those. The geographic restriction is waived, so a patient in a city qualifies. The home is an eligible originating site for any service, not just behavioral health. Audio-only is permitted for many services when the patient cannot or will not use video. Federally qualified health centers and rural health clinics can serve as distant sites. The expanded practitioner list applies. And the requirement for an in-person visit within six months before starting behavioral health telehealth at home, and periodically thereafter, is delayed.
| Flexibility | Status through January 30, 2026 | Status from January 31 if no extension |
|---|---|---|
| Patient's home as originating site, non-behavioral | Allowed | Not allowed; patient must be at an eligible site in a qualifying area |
| Geographic (rural) restriction | Waived | Applies |
| Audio-only visits | Allowed for many services | Not covered except narrow behavioral health cases |
| Behavioral and mental health telehealth at home | Allowed, in-person requirement delayed | Still allowed permanently; in-person visit requirement takes effect |
| PT, OT, SLP and audiology as telehealth practitioners | Allowed | Not allowed |
| FQHC and RHC as distant site | Allowed | Not allowed for most services |
| Hospice recertification by telehealth | Allowed | Face-to-face required |
What continues no matter what
Several things do not depend on the January 30 date. Behavioral and mental health services furnished by telehealth to a patient at home were made permanent by the Consolidated Appropriations Act of 2021; only the in-person requirement is affected. Certain services for end-stage renal disease and acute stroke have their own permanent home and site provisions. Medicare Advantage plans may offer telehealth as a supplemental benefit under their own rules, and most do, so the lapse does not directly change what an MA plan covers, though some plans mirror Original Medicare policy and should be checked individually. Commercial payers and state Medicaid programs have their own telehealth policies that are unaffected by the federal statute. And services that were never "telehealth" under 1834(m), such as virtual check-ins, e-visits through the portal and remote physiologic monitoring, continue because they are communication technology-based services with their own coverage rules.
Separately, CMS in the CY 2026 Physician Fee Schedule final rule made permanent several of its own regulatory flexibilities: removing frequency limits on certain telehealth services and allowing direct supervision through real-time audio and video for many incident-to services. Those are regulatory, not statutory, and are not tied to January 30.
What happened in October and what it taught us
When the flexibilities lapsed on October 1, 2025, CMS instructed Medicare Administrative Contractors to hold claims for telehealth services that would not be payable under the statute, initially for ten business days and then longer, rather than deny them. Practices had three choices: keep seeing patients by telehealth and hold the claims, convert the visits to in-person, or cancel. Many held. When H.R. 5371 passed on November 12 with retroactive effect to October 1, the held claims were released and paid. Practices that had billed the visits anyway, and had them denied, had to resubmit. Practices that had told patients the visit would not be covered and collected from them had refunds to process.
The lesson was that a hold is a reasonable bet but not a certainty, and that the paperwork of a hold is easier than the paperwork of a denial. The second lesson was communication: patients who were told in advance that coverage was uncertain and given a choice were fine; patients who found out from a statement were not. CMS has not, as of today, issued instructions for a January 31 lapse. Watch the CMS telehealth page and your MAC's notices this week.
A February plan that works either way
Keep the Medicare telehealth slots on the schedule but mark them as tentative, and have the front desk call each patient scheduled between February 2 and February 13 this week with a short script: the visit is scheduled by video, Medicare coverage for video visits at home is set to expire January 30 unless Congress extends it, and the patient can choose to keep the video visit knowing that coverage may be delayed or uncertain, convert to an in-person visit, or reschedule to later in February. Document the choice in the chart. That conversation takes two minutes and it prevents the statement surprise.
For behavioral health telehealth patients, check whether each has had an in-person visit within the prior six months, because if the flexibilities lapse the in-person requirement applies and a patient who has not been seen in person may need one before the next telehealth visit is covered. For Medicare Advantage patients, ask the plan; do not assume the MA benefit follows the statute in either direction. For practices that use audio-only heavily, especially with older patients, February is a month to offer the video option and the in-person option rather than defaulting to the phone.
On the billing side, set up a hold in your practice management system for any Medicare claim with place of service 10 (telehealth in the patient's home) or modifier 93 (audio-only) with a date of service on or after January 31, and release it when either the extension passes or CMS issues instructions. If the extension passes retroactively, release everything. If the lapse is prolonged, you will have a clean list of the affected visits to decide on individually. Do not bill the visits as if they were in person; that is not a workaround, it is a false claim. Practices that would rather have someone monitor the rule change and manage the hold for them are describing what our medical billing team does for its clients this week.
Questions we hear
Will Congress pass the extension before January 30?
We do not know, and anyone who tells you they do is guessing. A two-year extension has been proposed and has broad support, and the two most recent extensions both passed after the deadline with retroactive effect. Plan for the hold, hope for the vote, and check the news on January 30 and 31.
If the flexibilities lapse, can we bill the patient for a telehealth visit Medicare will not cover?
In principle a beneficiary can be billed for a service Medicare does not cover if they were informed in advance and agreed, which is what the Advance Beneficiary Notice process is for, but the ABN rules have specific conditions and a non-covered telehealth visit under a statutory restriction is not a routine ABN situation. Ask counsel or your MAC before using that approach, and in our view, converting to in-person or holding is simpler and fairer than billing the patient.
Does this affect our commercial and Medicaid telehealth visits?
Not directly. Commercial payers and state Medicaid programs set their own telehealth coverage, and many states have parity laws requiring coverage of telehealth. Check each payer's policy, but the January 30 date is a Medicare fee-for-service date.
What to do this week
- Pull every Medicare fee-for-service telehealth visit scheduled February 2 through February 13 and call each patient with the choice script.
- Check each behavioral health telehealth patient for an in-person visit within the prior six months.
- Set a claim hold for Medicare claims with place of service 10 or modifier 93 and a date of service on or after January 31.
- Ask your top two Medicare Advantage plans in writing whether their telehealth benefit changes if the federal flexibilities lapse.
- Assign one person to check the CMS telehealth page and your MAC's notices on January 30 and February 2, and to release or extend the hold accordingly.
