Briefing · November 12, 2026

Medicare's in-person rule for tele-mental-health waits until January 1, 2028

Medicare's in-person visit requirement for mental health telehealth now applies to services furnished on or after January 1, 2028. Section 6209(d) of the Consolidated Appropriations Act, 2026 (Public Law 119-75, February 3, 2026) moved the date from January 31, 2026, and the 2027 fee schedule final rule, CMS-1848-F, published November 9, 2026 and effective January 1, 2027, writes it into regulation.

The in-person requirement starts January 1, 2028

The final rule adds a paragraph to 42 CFR 410.78 stating that "in-person visit requirements for the purposes of diagnosis, evaluation, or treatment of a mental health disorder do not apply through December 31, 2027." The CMS telehealth FAQ, updated in October 2026, describes the requirement: an in-person visit within 6 months before the first mental health telehealth service at home, and one within 12 months of each later service, with limited exceptions.

CMS adds that "we do not believe this requirement applies to beneficiaries who began receiving mental health telehealth services in their homes prior to January 1, 2028." Under that reading, a patient who starts in 2027 would likely owe only the 12-month visit.

Audio-only and the home both continue

Under section 6209(e), the revised regulation allows audio-only technology "for any telehealth service furnished to a patient in their home on or before December 31, 2027." After that date, audio-only remains available at home when the clinician is technically capable of video and the patient "is not capable of, or does not consent to, the use of video technology."

Section 6209(a) extends the removal of geographic requirements and the expanded list of originating sites through December 31, 2027 for telehealth generally. For behavioral health, the FAQ states that the Consolidated Appropriations Act, 2021 "permanently removed geographic and place of service restrictions for behavioral health telehealth services." The final list of telehealth services keeps 90791, 90832, 90834, 90837 and the other psychotherapy codes.

Rural health clinics and FQHCs get the same delay

For mental health visits at rural health clinics (RHCs) and federally qualified health centers (FQHCs), the rule changes 42 CFR 405.2463(b)(3) from "Not before October 1, 2025" to "Not before January 1, 2028." The CMS fact sheet attributes the change to section 6209(c). The statute places it in section 6209(d), and the dates agree. Per the FAQ, these clinics' behavioral health telehealth is paid under the all-inclusive rate or the prospective payment system.

Supervision carries over, and two modifiers are new

The FAQ states that since January 1, 2026, the presence required for direct supervision "may include virtual presence through audio/video real-time communications technology (excluding audio-only)" for services that include most incident-to services. The 2027 rule repeats, in its discussion of advance care planning, that "direct supervision may be satisfied by use of audio-visual technology."

Section 6209(g) is new. Modifier BB marks telehealth furnished through a virtual platform when the clinician contracts with the entity that owns it or has a payment arrangement for its use. Modifier BC marks telehealth furnished incident to a clinician's service. Both "are required beginning January 1, 2027," and the rule states they "do not have payment implications." CMS said guidance will be posted online, and clinicians who work through a telehealth platform should watch for it.

Home telehealth pays the non-facility rate

The FAQ directs clinicians to use place of service 10 for telehealth in the patient's home and 02 for telehealth elsewhere, and states that home claims "are to be paid at the non-facility payment rate." The CY2024 final rule states that claims with place of service 02 "will continue to be paid at the facility rate." For 90837, the 2027 relative value file lists 5.62 non-facility and 4.50 facility RVUs. At the $32.6286 conversion factor, that is $183.37 against $146.83 nationally, a $36.54 difference by this site's arithmetic. The 2027 rates briefing and the Medicare guide give amounts by license.

How to read this briefing

This briefing has three limitations. First, the FAQ predates the final rule, and the supervision, home and transition statements rest on it alone. Second, the fact sheet and the statute cite different subsections for the clinic provision. Third, the facility rate for place of service 02 comes from the CY2024 rule, and nothing fetched restates it for 2027. Nevertheless, the statute, the regulation and the FAQ agree on the dates: the flexibilities run through December 31, 2027, and the in-person requirement begins January 1, 2028 unless Congress acts again.

Every regulatory statement cites Public Law 119-75, the Federal Register or CMS; § numbers refer to that law. Dollar calculations are this site's. Corrections via the form.