Quick answer: On January 1, 2028, Medicare’s in-person visit requirement for mental health telehealth furnished to patients at home is scheduled to return. New patients will need an in-person, non-telehealth visit within the 6 months before their first mental health telehealth service; patients who started telehealth on or before December 31, 2027 are treated as established and need an in-person visit at least once every 12 months. Telehealth for a diagnosed substance use disorder (or a co-occurring mental health disorder) is exempt by statute. Mental health telehealth from home, with no geographic restriction, continues. Source: CMS Telehealth FAQ, updated February 26, 2026.
Behavioral health practices have been billing Medicare telehealth from the patient’s home for years without an in-person prerequisite, because Congress kept delaying the requirement it wrote into law in 2020. The current delay runs through December 31, 2027. Unless it is extended again, the rule arrives on January 1, 2028. Because it is measured in months before a visit, the preparation has to start in 2027, not in January 2028.
What changes on January 1, 2028
| Patient | Requirement from January 1, 2028 |
|---|---|
| New patient (first mental health telehealth service on or after 1/1/2028) | An in-person, non-telehealth visit within the 6 months before the first telehealth service, then an in-person visit at least every 12 months |
| Established patient (received mental health telehealth at home on or before 12/31/2027) | No 6-month pre-service visit; an in-person visit at least every 12 months after the rule takes effect |
| Any patient: exception | The 12-month visit can be skipped for a given period when the practitioner and patient agree that the risks and burdens of an in-person visit outweigh its benefits, with the reasoning documented in the record |
| Any patient: who can do the in-person visit | Another practitioner of the same specialty in the same group may furnish the in-person visit if the telehealth practitioner is unavailable |
| Substance use disorder treatment (incl. co-occurring mental health disorder) | Exempt from the in-person requirement under Social Security Act section 1834(m)(7) |
What does not change
- Mental health telehealth can still be furnished to the patient at home, anywhere in the United States, with no originating-site geographic restriction. That policy is permanent for behavioral health.
- Audio-only behavioral health visits from the patient’s home continue, but only when the practitioner is able to use audio-video and the patient cannot use or does not consent to video. Document why video was not used.
- The requirement is a condition of Medicare coverage and billing for telehealth services, not a rule that every session must be in person.
The 2027 modifiers arrive first
Before the in-person rule, two new telehealth modifiers take effect on January 1, 2027. Section 6209(g) of the Consolidated Appropriations Act, 2026 requires modifiers for telehealth services furnished through a virtual platform the practitioner contracts with or pays to use, and for telehealth services furnished incident to a practitioner’s service. CMS has said the modifiers do not affect payment and that guidance on their use will be posted on its website (CY 2027 Physician Fee Schedule proposed rule, Federal Register 2026-14327). Claim edits need updating when that guidance lands.
How to prepare: a practice checklist for 2027
- Build the patient list now. From your claims data, list every Medicare patient receiving mental health services by telehealth from home, with the date of their first telehealth service. That list decides who is “established” on December 31, 2027.
- Record each patient’s last in-person visit date. For established patients, the 12-month clock runs from the rule’s effective date; for anyone who first comes to you by telehealth in 2028, the 6-month pre-service visit must already have happened.
- Schedule the in-person visits into 2027. Patients who have never been seen in person are the ones to book first. A same-specialty colleague in the same group can furnish the visit.
- Decide how you will document the risk-and-burden exception: a template note in the chart, reviewed per patient, not a blanket policy.
- Separate SUD and co-occurring treatment in your tracking so exempt patients are not scheduled unnecessarily.
- Update telehealth claim edits for the 2027 modifiers as soon as CMS publishes its guidance, and keep audio-only documentation in the note.
- Re-check the law in late 2027. Congress has extended the delay repeatedly; the requirement applies only if it is not extended again.
Who can help a practice prepare
The work is administrative. Your Medicare Administrative Contractor publishes the billing rules; your billing company should be running the patient list, the visit-due dates and the claim edits. AMS Solutions does that for behavioral health clients from the claims data we already hold: we build the telehealth patient list, flag each patient’s in-person due date before it passes, apply the correct place-of-service codes and modifiers for each payer, and update claim edits when CMS guidance changes. Physician-founded in 1992; credentialing and billing under one roof. See our mental and behavioral health billing services, or start with a free billing assessment.
FAQs
Does Medicare mental health telehealth end in 2028?
No. Telehealth from the patient’s home for mental health continues without a geographic restriction. What returns on January 1, 2028 is the in-person visit requirement: within the 6 months before a new patient’s first telehealth service, and at least every 12 months thereafter.
Are my current telehealth patients grandfathered?
Patients who received mental health telehealth at home on or before December 31, 2027 are treated as established and do not need the 6-month pre-service visit, but they do need an in-person visit at least every 12 months after the rule takes effect, unless a documented risk-and-burden exception applies.
Does the in-person rule apply to substance use disorder treatment?
No. Telehealth for treatment of a diagnosed substance use disorder, or a co-occurring mental health disorder, is exempt by statute (Social Security Act section 1834(m)(7)).
Can a colleague do the in-person visit?
Yes. Another practitioner of the same specialty in the same group may furnish the in-person visit if the telehealth practitioner is unavailable.
Who can help a practice prepare?
Your Medicare Administrative Contractor for the billing rules, and your billing company for the patient tracking and claim edits. AMS Solutions builds the telehealth patient list and due-date tracking for its behavioral health clients.
Reviewed November 2, 2026.
Sources: CMS, Telehealth FAQ (updated February 26, 2026); Consolidated Appropriations Act, 2026, section 6209(g); CMS, CY 2027 Physician Fee Schedule proposed rule (Federal Register 2026-14327); Social Security Act section 1834(m)(7). This article describes Medicare coverage conditions as published; it is not legal advice, and items marked proposed may change in the final rule.
