Recently, the Centers for Medicare & Medicaid Services (CMS) published the calendar year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule. The Proposed Rule includes significant changes to Medicare telehealth policies, among other proposals. Healthcare providers that utilize telehealth in their practices should understand the proposed changes and be prepared to comply with any shifts in Medicare policy if the proposed changes become final.
In the proposed rule, CMS proposes simplifying the current five-step process to determine if a service qualifies for the Medicare Telehealth Services List. Under the new process, CMS would only keep three criteria: the service must be separately payable under the PFS; fall within the scope of certain federal laws regulating telehealth services; and be deliverable through real-time, two-way interactive communication. This change aims to lower provider burden and speed up access to new telehealth services.
Based on the revised review process, CMS proposes adding five new services to the Medicare Telehealth Services List for CY 2026:
- Multiple-family group psychotherapy (CPT 90849)
- Group behavioral counseling for obesity (HCPCS G0473)
- An infectious disease consultation add-on for inpatient/observation visits (HCPCS G0545)
- Diagnostic analysis, programming, and verification of auditory osseointegrated devices (CPT 92622 and 92623)
Additionally, CMS proposes to permanently remove frequency limitations on certain telehealth services. Currently, there are restrictions on how often subsequent inpatient visits, nursing facility visits, and critical care consultations can be provided via telehealth. CMS cited claims data from 2020 to 2023 showing that less than 5 percent of beneficiaries received these services via telehealth. This shift would give clinicians more freedom to decide how and when to use telehealth in patient care, and possibly increase its utilization.
CMS also proposes to permanently remove the geographic restriction and originating site requirements for telehealth services, but only for a specific new Ambulatory Specialty Model (ASM). The new ASM applies to payments for services related to heart failure and low back pain. Notably, CMS declines to propose a permanent removal of these restrictions for other Medicare services that can be performed via telehealth, which have been allowed through repeated extensions of the COVID-19 public health emergency (PHE) waivers and flexibilities. Unless Congress extends or makes these flexibilities permanent, they will expire on September 30, 2025, and pre-PHE telehealth restrictions and requirements will be reinstated on October 1, 2025.
Lastly, CMS proposes to permanently adopt a definition of direct supervision that permits such supervision to be achieved via real-time audio/video communications technology (excluding audio-only). Traditionally, “direct supervision” required a physician to be physically present in the office and immediately available to provide assistance. However, during the COVID-19 PHE, CMS permitted supervising practitioners to be “immediately available” through real-time audio/video technology instead of being physically present. This proposed new definition is a further step toward flexibility and modernization. Providers should carefully review these proposed reforms and be prepared to take steps to comply with any changes that become final. Interested providers may consider submitting comments on the Proposed Rule before the September 12, 2025 deadline.
For over 40 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare law and regulation. If you or your healthcare entity has any questions pertaining to healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or [email protected].
