How Might Telehealth Policy Changes Affect Your Virtual Practice in 2026?
Get clarity on telehealth Medicare extensions and reimbursements for 2026.
Virtual care is now a staple in today’s healthcare market, but the policies governing it are still catching up. There have been multiple Medicare extensions, changing temporary flexibilities, and ongoing debates about what should become law. Together, these factors lead to uncertainty about telehealth reimbursements, especially for smaller practices.
As we head into 2026, small clinics and practices that rely on telehealth for some services need to understand what to expect from the telehealth policy 2025 - 26.
So let’s explore what you ought to know.
A Quick Backstory of Medicare Telehealth Flexibilities
In 2019, Medicare telehealth visits stood at around 840,000. However, during the 2020 COVID-19 pandemic, visits soared to over 52 million. This increase was the result of temporary telehealth flexibilities from CMS that enabled beneficiaries to access care during stay-at-home orders. Additionally, it permitted clinics to receive Medicare reimbursements at the same rates as in-person visits, making virtual care financially viable.
These flexibilities were tied to the Public Health Emergency (PHE) declaration and were only intended to last temporarily. But as virtual care became increasingly essential, Congress began extending it to avoid disrupting care for millions of individuals.
Subsequent Medicare extensions
2021 Consolidated Appropriations Act (CAA): Extended flexibilities through the end of PHE (May 11, 2023). Also made behavioral health telehealth permanently available from patients’ homes
2022 CAA: Extended telehealth flexibilities through December 31, 2024; a two-year extension beyond the PHE
2023 CAA: Maintained the December 31, 2024, expiration date
2025 American Relief Act: Extended through March 31, 2025, with a 90-day extension.
Full-Year Continuing Appropriations and Extensions Act, 2025 (H.R. 1968): Extended flexibilities through September 30, 2025 (six months beyond the March 31 deadline).
What is the Current State of Telehealth Medicare Extensions?
To understand what we should expect from telehealth policy 2025 - 2026, we must look to the Continuing Appropriations Act, 2026 (H.R. 5371).
In September 2025, Congress initially introduced this Act to extend telehealth flexibilities through November 21, 2025. However, lawmakers didn’t enact the bill before the September 30 deadline, triggering a lapse in coverage. A 43-day government shutdown occurred, during which flexibilities lapsed, and Medicare reverted to pre-pandemic restrictions.
During this timeframe, many clinics faced the choice of either stopping telehealth services or continuing without guaranteed Medicare reimbursement. But around November 11th, President Trump signed a revised version of the law that extended telehealth flexibilities through January 30, 2026. Additionally, the bill included retroactive coverage back to October 1, 2025, to address the gap period.
What’s Included in the Current Telehealth Policies?
Until January 30, 2026, the telehealth policies allow the following:
Telehealth access options
Medicare patients can receive telehealth services for non-behavioral/mental healthcare in their homes with no geographic restrictions for originating sites.
Healthcare services can be delivered using audio-only communication for non-behavioral/mental health services.
Audio-only is permanently available for any telehealth service if the patient isn’t capable of or doesn’t consent to video technology.
Provider eligibility
All eligible Medicare providers can provide telehealth services.
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as distant site providers.
Mental health services
In-person requirements are waived, meaning patients don’t require an initial in-person visit within six months of their first mental health telehealth service, nor annual in-person visits thereafter.
This waiver applies to both traditional providers and FQHCs/RHCs.
Payment provisions
FQHCs and RHCs that provide telehealth services receive payment at national average payment rates under the physician fee schedule through December 31, 2026.
The caveat: The authority for these clinics to serve as distant-site providers for non-behavioral telehealth expires January 30, 2026, which means the extended payment mechanism matters only if Congress extends the underlying authority to provide services.
How the State of Medicare Extensions Affects Small Clinics
If telehealth flexibilities are extended, then:
Patients can continue receiving care from home regardless of location.
Telehealth reimbursement will be at parity with in-person visits.
Practices experience lower overhead costs by offering virtual care options.
FQHCs and RHCs can continue assisting underserved communities.
If telehealth flexibilities are not extended, then:
Only rural patients in shortage areas qualify due to geographic restrictions.
Home-based care will be eliminated, requiring patients to travel to approved facilities to receive telehealth.
Practices may experience immediate revenue drops from lost telehealth visits.
Audio-only services end for non-behavioral health, cutting off patients without video capability.
Physical therapists, occupational therapists, speech-language pathologists, and audiologists lose Medicare telehealth eligibility.
Administrative complexity would increase for clinics offering behavioral and non-behavioral services as they’d have to:
Track which services fall under which rules
Verify patient eligibility differently depending on service type
Use different billing codes and documentation
Explain to patients why they can do mental health therapy from home, but not their diabetes follow-up
As you can see, extension and expiration present two different realities for smaller practices, but knowing what to expect can help leaders prepare.
Pending Telehealth Policy Legislation
With telehealth flexibilities on the verge of expiration at the end of January, Congress has introduced two viable bills:
Telehealth Modernization Act (H.R. 5081/S. 2709): A Medicare extension that would run through September 30, 2027.
CONNECT for Health Act of 2025 (S. 1261 / H.R. 4206): Would make Medicare telehealth flexibilities permanent.
Both bills have bipartisan support, but with Congress facing tight fiscal constraints and competing priorities, passage remains uncertain. Until then, smaller practices should prepare for both scenarios: plan for extension while being mindful of potential restrictions.
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*This content is intended for general informational purposes only and should not be construed as legal advice. For guidance on your specific situation, please consult a licensed attorney.