What has changed due to the Government Shutdown?
It’s pandemic-era flexibilities that will come to an end:
- Geographic restrictions that only permitted telehealth in medically underserved areas
- Requiring the patient to go to an originating site (a health care facility) instead of being in their homes
- Allowing therapists (PTs, OTs, SLPS, audiologists) to perform services via telehealth
Behavioral health via telehealth will still be allowed after September 30th, because Congress passed a law allowing it permanently. It won’t be affected by a government shutdown, if one occurs. The Social Security Act references “mental health” as opposed to “behavioral”.
Quoting the MLN Matters Article on E/M services
MLN006764 September 2025
Telehealth Services
Section 2207 of the Full-Year Continuing Appropriations and Extensions Act, 2025, extended many of these flexibilities through September 30th, 2025. Starting October 1, 2025, the statutory limitations that were in place for Medicare telehealth services before the COVID-19 public health emergency (PHE) will retake effect for most telehealth services.
These include:
- Geographic restrictions
- Location restrictions on where you can provide services
- Limitations on the scope of practitioners who can provide telehealth services
That is, telehealth as we know it to anywhere in the country, in the patient’s home ends. How do you know if you are in an underserved area, and can continue to do telehealth? Quick and easy: could your practice do telehealth before the pandemic? Yes: in all likelihood, you can continue, but remember the patient must go to an originating site, not their homes. Are you in an underserved area? Check here.
At CodingIntel, we have a copy of the CMS telehealth fact sheet from prior to the pandemic. It isn’t up-to-date with the list below, but it will tell you the rules for most practices in the country if a shutdown occurs.
Still allowed are services that weren’t implemented as a result of the pandemic.
eCFR :: 42 CFR 410.78 — Telehealth services.
(iv) The geographic requirements specified in paragraph (b)(4) of this section do not apply to the following telehealth services:
(A) Home dialysis monthly ESRD-related clinical assessment services furnished on or after January 1st, 2019, at an originating site described in paragraphs (b)(3)(vi), (ix), or (x) of this section, in accordance with section 1881(b)(3)(B) of the Act; and
(B) Services furnished on or after January 1st, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.
(C) Services furnished on or after July 1st, 2019, to an individual with a substance use disorder diagnosis, for purposes of treatment of a substance use disorder or a co-occurring mental health disorder.
(D) Services furnished on or after January 1st, 2025, for the purposes of diagnosis, evaluation, and/or treatment of a mental health disorder. Payment will not be made for a telehealth service furnished under this paragraph unless the physician or practitioner has furnished an item or service in person, without the use of telehealth, for which Medicare payment was made (or would have been made if the patient were entitled to, or enrolled for, Medicare benefits at the time the item or service is furnished) within 6 months prior to the initial telehealth service and within 6 months of any subsequent telehealth service.
Betsy