Medicare Telehealth Rules by Service Date: The Payment History Behind a Fraud Review

Telehealth Medicare rules in 2026 allow eligible Original Medicare services nationwide, including in patients’ homes, through December 31, 2027. Telehealth fraud can hide in a claim for a facility the patient never entered. The service date changes the question: where could the patient be, who could deliver the care, and what did the claim actually buy? An old expiration date can send the whole review in the wrong direction.

Did Congress Extend Telehealth in 2026?

Yes. The Consolidated Appropriations Act, 2026, enacted February 3, extended broad Medicare telehealth flexibility through the end of 2027. It covered patient locations, expanded practitioner eligibility, rural health clinics, federally qualified health centers and audio-only services. It also postponed the mental-health in-person prerequisite to January 1, 2028.

These are Original Medicare payment rules. Medicare Advantage plans must cover the telehealth benefits included in Original Medicare and can offer additional telehealth benefits. A plan’s additional benefit and a fee-for-service Medicare claim therefore need their own payment analysis.

Controlled-substance prescribing has a separate deadline. The general temporary prescribing extension runs through December 31, 2026. Medicare’s payment extension does not supply prescribing authority or state permission to practice. Those permissions follow the practitioner and the encounter, even when a platform handles the booking and billing.

The Medicare Telehealth Timeline: A Moving Payment Boundary

Congress repeatedly changed which remote services Medicare could pay for. Before the pandemic, Medicare generally required the patient to be in an eligible medical facility in specified rural geography. Eligible sites included professional offices, hospitals, rural health clinics, federally qualified health centers, certain dialysis facilities, skilled nursing facilities and community mental-health centers. A clinic could host the patient without qualifying to bill as the distant provider delivering care.

There were already exceptions. Beginning January 1, 2019, acute-stroke services and specified home-dialysis assessments had geographic or site exceptions. Beginning July 1, 2019, treatment for a substance use disorder, or a co-occurring mental-health disorder in a patient with that diagnosis, had a home and geographic exception. The pre-pandemic Medicare law matters to older claims just as much as the emergency expansion does.

Store-and-forward care also had a specific exception for federal demonstrations in Alaska and Hawaii. In that arrangement, the distant professional reviews information without the patient being present. It is a different delivery method from a live conversation, with its own statutory boundary.

The dates below are enactment dates. The last column shows what each law changed for care.

Is the Government Shut Down Affecting Telehealth?

The funding lapse did not end coverage for qualifying telehealth claims. In its February 26, 2026 FAQ, the Centers for Medicare & Medicaid Services says it will pay those claims as before October 1, 2025, applying the flexibilities retroactively. The service date and the date Congress restored an extension can fall on different sides of a funding interruption.

Where the Patient Is and Who May Furnish Care

The originating site is where the patient receives care. The distant site is where the treating professional delivers it. The platform’s headquarters answers neither question.

The permanent practitioner categories include physicians, physician assistants, nurse practitioners, clinical nurse specialists, nurse-midwives, clinical psychologists and clinical social workers. Registered dietitians or nutrition professionals and certified registered nurse anesthetists also qualify within the applicable benefit. Marriage and family therapists and mental health counselors joined the Medicare benefit beginning January 1, 2024.

The temporary expansion includes physical therapists, occupational therapists, speech-language pathologists and audiologists. Under the scheduled January 2028 change, those professions lose that expanded Medicare telehealth authority. For most nonbehavioral telehealth, the general rural and medical-facility restrictions also return. Permanent exceptions remain, including behavioral-health home access and special rules for qualifying accountable care organizations.

For an eligible Medicare Shared Savings Program accountable care organization, the beneficiary’s assignment and the participating organization’s billing identity matter. Medicare permits qualifying services at home without geographic restrictions for the applicable arrangements.

A clinician can also work from home. The agency distinguishes someone who maintains another physical practice location from a virtual-only practitioner whose sole practice location is home. That enrollment distinction concerns the clinician. The place-of-service field for home telehealth concerns the patient.

State authorization remains a separate question. California, for example, requires physicians treating patients located in California to be licensed there. A billing company’s nationwide reach does not supply the clinician’s permission to practice.

What Medicare Pays and How the Claim Identifies It

Medicare’s telehealth-services list identifies which services can use the telehealth benefit. The patient’s location, the practitioner’s eligibility and the actual service still determine whether a particular claim fits.

The Service List Changed Alongside the Extension

The 2026 Physician Fee Schedule final rule removed permanent and provisional designations from the service list and simplified the review. A service’s place on the list and Congress’s temporary expansion of patients, sites and practitioners are separate decisions.

Effective January 1, 2026, the agency also permanently removed telehealth frequency limits for subsequent inpatient visits, nursing-facility visits and critical-care consultations.

POS 02 and POS 10 Describe the Patient’s Location

POS 02 identifies telehealth outside the patient’s home. POS 10 identifies telehealth in the patient’s home. Since January 1, 2024, Medicare has paid home telehealth at the nonfacility professional rate, which includes practice expenses ordinarily borne by an office. POS 02 retains the facility professional rate.

The place-of-service code update took effect January 1, 2022, with implementation on April 4. Those dates preceded the home-payment change. During the public health emergency, Medicare instead permitted the place of service that would have applied in person, with modifier 95. Comparing claims across these periods requires the coding instruction that applied then.

Q3014 Pays the Originating Facility

Q3014 is the originating-site facility fee, separate from the professional’s payment. Medicare reserves it for an eligible originating site. Allowing a patient to receive care at home does not turn that home into a billable medical facility.

Rural Health Clinics and Federally Qualified Health Centers

Rural health clinics and federally qualified health centers have separate behavioral and nonbehavioral payment pathways. Since January 1, 2022, behavioral-health services delivered through telecommunications have been paid under the rural clinic’s All Inclusive Rate or the health center’s Prospective Payment System.

The agency’s February 2026 FAQ described G2025 as the nonbehavioral distant-site code through the extended period. The CARES Act based that payment method on comparable Physician Fee Schedule telehealth services, with those costs kept outside the ordinary clinic payment calculation. A clinic’s own payment system therefore matters alongside the service code and patient location.

Hospitals have another pathway for staff-furnished outpatient therapy, diabetes self-management training and medical nutrition therapy delivered remotely to patients at home. Medicare continues that payment through the broad extension, with the scheduled change beginning in 2028. The hospital’s staff service and an independently billing professional’s visit need to be identified separately.

Audio-Only and Mental-Health Services

Audio-Only Billing: What Happened and What the Claim Represented

Medicare permits qualifying audio-only telehealth in patients’ homes through the broad extension. The technology rule requires a practitioner who can use video and a patient who cannot use it or does not consent to it. A telephone-first business model leaves that patient-specific question unanswered.

The 2025 audio-only rule expanded the technology definition for home telehealth where the home is an authorized site. Modifier 93 identifies audio-only care. Under the scheduled 2028 rules, the permanent home behavioral-health pathway continues to permit audio-only for new and established patients, with the video-capability and patient conditions.

The telephone evaluation-and-management codes 99441, 99442 and 99443 were deleted for 2025. Medicare retained its established office and outpatient visit approach instead of adopting codes 98000 through 98015 as separately payable replacements. Code 98016 addresses a brief check-in.

A telehealth audio-only billing fraud review compares the actual conversation with the modality, location and service represented on the claim, under the rules for that date. A telephone call can occur even when the claim describes a different kind of encounter.

In the CPC Associates settlement announced in July 2016, the Justice Department alleged improper Medicare claims for psychiatric care delivered by telephone from January 1, 2009 through June 1, 2015. The allegations concerned patients outside qualifying rural areas and calls without the interactive audio-and-video system required for those claims. The issue was the payment sought for the calls, rather than whether the calls occurred.

The Office of Inspector General’s February 2024 audit found a different result for Medicare evaluation-and-management services during March 1 through November 30, 2020. Some providers documented telephone care but billed audiovisual service codes. The audit said that mismatch did not affect payment during its review period, although it could impair the reliability of claims data. The same difference between a call and a video claim has to be read against the payment rules in force when the care occurred.

Mental-Health In-Person Timing

Mental-health payment has a separate in-person sequence. The agency’s FAQ describes an in-person service within six months before the first home mental-health telehealth service once the prerequisite takes effect. Patients who began home mental-health telehealth by the end of 2027 are treated as established, without that initial prerequisite. It describes their subsequent in-person requirement as at least once every 12 months, with limited exceptions.

Older rule text still gives conflicting follow-up intervals: six months in one provision, 12 months in another. The law postpones when the requirement starts, while the agency’s February 2026 FAQ describes the annual follow-up.

Remote Monitoring Has Its Own Payment Rules

Remote patient monitoring pays for device setup, device supply and data transmission, and treatment management. Medicare treats it separately from services that substitute for an in-person encounter. Virtual check-ins and patient-portal e-visits also have separate payment pathways. The broad telehealth expiration date does not answer whether one of these services met its own requirements.

For 2026, the monitoring codes added shorter-duration alternatives for device supply and treatment management. Those changes have their own effective date, separate from the broad telehealth extension. Remote therapeutic monitoring also has a separate code family.

There was also a shorter monitoring-data period during the emergency for patients with suspected or confirmed COVID-19. That exception ended with the public health emergency. The shorter-duration codes introduced later have their own service-date boundary.

The Date a Fraud Review Starts With

A telehealth fraud review connects the service date to the rule then in force and the payment requested. We compare the claim’s patient location, modality and code with the encounter documentation and the billing instruction that applied that day. For a platform operation, we also examine who set those instructions and what the business knew about claims that diverged from the care.

The next claim-identifier deadline also concerns platform arrangements. The February 2026 law requires the agency to establish claim identifiers by January 1, 2027 for specified virtual-platform arrangements and services furnished incident to a professional service. The July 2026 proposed rule names BB and BC and points to separate implementation guidance.

The useful starting evidence is the connection between what happened in the health care business and what it asked Medicare to pay. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

When You Know What the Claim Leaves Out

If you work in telehealth billing, clinical care or platform operations and know where the claims diverge from the care, speak to our whistleblower experts about the dates and decisions behind those claims. We build the case with you and bring in healthcare whistleblower lawyers who understand Medicare telehealth and remote-monitoring payment. We stay beside you as the evidence becomes a case against the business responsible.