Medicare’s In-Person Visit Rule for Telehealth Therapy Now Starts Jan. 1, 2028

Reviewed by Roey Hine

Key Takeaways

• Medicare’s in-person visit requirement for home-based mental health telehealth does not apply to services through Dec. 31, 2027.
• Starting Jan. 1, 2028, a new patient needs an in-person visit within six months before the first mental health telehealth service and at least one in-person visit every 12 months after that.
• Patients who began receiving mental health services on or before Dec. 31, 2027, are considered established and skip the six-month visit, but they still need the annual in-person visit.
• The requirement does not apply to telehealth for substance use disorders or co-occurring mental health disorders.
• Patients can keep receiving mental health telehealth at home after 2027, a permanent Medicare policy, while most other telehealth services return to rural and facility-based limits.

CMS released the CY 2027 Medicare Physician Fee Schedule final rule on Nov. 4, 2026, bringing Medicare regulations in line with the latest congressional extension of telehealth flexibilities. For behavioral health practices, the practical result is a fixed start date for the in-person visit requirement: Jan. 1, 2028, unless Congress extends it again.

What Is Medicare’s In-Person Requirement for Mental Health Telehealth?

Medicare’s in-person requirement is a condition of payment for mental health services furnished by telehealth while the patient is at home. According to CMS’s telehealth FAQs, the billing practitioner must have furnished an in-person, non-telehealth service to the patient within six months before the first mental health telehealth service, and the patient must then have an in-person service within 12 months of each mental health telehealth service.

Congress created the requirement in the Consolidated Appropriations Act, 2021, the same law that permanently allowed Medicare patients to receive mental health telehealth at home regardless of where they live. It has been postponed repeatedly since then.

When Does the In-Person Requirement Take Effect?

The requirement takes effect for services furnished on or after Jan. 1, 2028. The current date is the result of three actions since 2025:

• Lapse and short-term extension. Medicare’s telehealth flexibilities expired on Sept. 30, 2025, during the federal government shutdown. A funding law enacted in November 2025 extended them through Jan. 30, 2026.
• Consolidated Appropriations Act, 2026. Signed on Feb. 3, 2026, according to PYA’s summary of the law, it extended Medicare’s telehealth flexibilities, including the delay of the in-person requirement, through Dec. 31, 2027.
• CY 2027 Physician Fee Schedule final rule. CMS’s final rule fact sheet states that the rule finalizes conforming changes so that in-person visit requirements for mental health visits do not apply to services furnished through Dec. 31, 2027.

Which Patients and Services Does the In-Person Requirement Apply To?

The requirement applies to mental health telehealth services billed under the Medicare Physician Fee Schedule when the patient is at home. Several groups fall outside it or follow different rules:

• Established patients. CMS considers patients who began receiving mental health services on or before Dec. 31, 2027, established. They are not subject to the six-month visit before telehealth, but CMS states they must have at least one in-person visit every 12 months starting in 2028.
• Substance use disorder treatment. The requirement does not apply to telehealth for a diagnosed substance use disorder or a co-occurring mental health disorder, which falls under separate SUPPORT Act telehealth rules, as Foley & Lardner’s analysis of CMS’s guidance.
• Patients at a clinical originating site. When the patient is at an originating site that qualifies under Medicare’s standard geographic rules, such as a practitioner’s office in a rural area, the in-person requirement does not apply.
• Rural health clinics and FQHCs. CMS states that in-person visit requirements for behavioral health visits furnished by RHCs and FQHCs with the patient present virtually will not apply until at least Jan. 1, 2028.

What Exceptions Does the In-Person Rule Allow?

Medicare’s in-person requirement includes one exception to the annual visit and one option for who furnishes the visit. Neither removes the in-person visit a new patient needs before the first mental health telehealth service.

The annual in-person visit can be skipped for a 12-month period when the practitioner and patient agree that the risks and burdens of an in-person visit outweigh the benefits, according to Foley & Lardner’s summary of the requirement. The basis for that decision must be documented in the patient’s medical record.

If the practitioner who furnishes the telehealth service is not available, CMS allows a practitioner of the same specialty in the same group practice to furnish the in-person visit.

Can Audio-Only Telehealth Still Be Used for Mental Health?

Yes. Through Dec. 31, 2027, CMS states that beneficiaries can continue to receive audio-only telehealth services in their homes. Starting Jan. 1, 2028, CMS permits two-way, real-time audio-only communication for behavioral health services in the patient’s home when the practitioner can use audio-video technology and the patient is not capable of using it or does not consent to it. Audio-only claims carry their own modifier and place-of-service requirements, which are covered in PGM’s post on the billing gap between telehealth and in-office mental health visits.

What Changes for Other Medicare Telehealth Services in 2028?

Home-based mental health telehealth is a permanent Medicare benefit, while most other telehealth flexibilities end after 2027. CMS states that through Dec. 31, 2027, beneficiaries can receive Medicare telehealth services anywhere in the United States and its territories. Starting Jan. 1, 2028, beneficiaries receiving telehealth services other than behavioral health will generally need to be in a medical facility in a rural area. For practices that offer both behavioral health and medical services by telehealth, the two sets of visits follow different rules after 2027.

How Should Behavioral Health Practices Prepare for 2028?

Practices have until the end of 2027, and the work is mostly scheduling and documentation:

1. Identify Medicare patients seen only by telehealth. Run a report of Medicare patients with home-based mental health telehealth visits and no in-person visit in the past 12 months.
2. Record in-person visit dates where staff can see them. A field in the practice management system or EHR that shows each patient’s last in-person visit makes the 12-month deadline visible before the next telehealth session is scheduled.
3. Plan in-person capacity. Practices that converted to all-telehealth schedules will need office time, or an arrangement with a same-specialty colleague in the group, for annual visits.
4. Build a documentation template for the risks-and-burdens exception. The record has to state the basis for the decision, so a consistent template keeps the exception defensible.
5. Separate substance use disorder telehealth. Patients treated for a substance use disorder or a co-occurring disorder are outside the requirement, and scheduling rules should reflect that.
6. Watch for further legislation. Congress has moved the date several times, and a new extension before 2028 would change the timeline again.

How PGM Supports Behavioral Health Telehealth Billing

PGM has provided independent medical billing and revenue cycle management since 1981, with dedicated support for mental and behavioral health practices. Services include eligibility and benefits verification, prior authorization support, coding review, claims submission, denial management and appeals, and payment posting and reporting across commercial, Medicare, and Medicaid payers.

If your practice bills Medicare telehealth and wants to be ready for 2028, talk to PGM’s behavioral health billing team. For what to expect from a specialized partner, see how to choose a behavioral health billing company.

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Frequently Asked Questions About the Medicare In-Person Requirement

Does the in-person visit have to be a mental health service?

No. The qualifying visit can be any Medicare-covered item or service furnished in person, without telehealth, by the telehealth practitioner or, if that practitioner is unavailable, a same-specialty colleague in the same group. It does not have to be a psychotherapy or other mental health service.

Does the in-person requirement apply to commercial insurance or Medicaid?

No. The requirement is a Medicare rule. Commercial plans and state Medicaid programs set their own telehealth policies. Check each payer’s telehealth policy for in-person or originating site conditions. When a plan carves out behavioral health benefits to a separate behavioral health administrator, the administrator’s policy is the one to check, and PGM’s post on behavioral health carve-outs and wrong-payer denials explains how to identify the correct payer.

What happens to a claim if the in-person requirement is not met after 2027?

Medicare payment for home-based mental health telehealth depends on meeting the requirement, so a claim without a qualifying in-person visit in the required window, or a documented exception for the annual visit, does not meet Medicare’s conditions of payment. A claim paid without meeting those conditions can be recovered if it is later reviewed.