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The federal government shut down on October 1, 2025, after lawmakers failed to reach a funding agreement. The date also marked the end of the Medicare telehealth flexibilities that had been in place since the COVID-19 public health emergency (“PHE”) began. Even after the PHE, Congress passed several extensions that extended the telehealth flexibilities for Medicare beneficiaries. With the government shutdown, the telehealth extension expired for most. Here is what you need to know.
What does this mean? Is Medicare completely shut down?
No, as outlined in the CMS contingency plan, Medicare will continue to operate during the shutdown. Medicaid will also continue to operate, as it has funding through the first quarter of 2026.
Phew...how does this impact coverage for telehealth services?
The situation is evolving, and the future of the Medicare telehealth extension is unclear, but beginning on October 1, Medicare coverage for telehealth services reverts back to pre-COVID telehealth rules. The flexibilities that eliminated geographic and originating site restrictions, expanded the list of eligible practitioners, permitted audio-only telehealth visits, allowed telehealth hospice care recertifications, and delayed in-person requirements for mental health services are all gone. There are some exceptions for some mental health services, substance use disorder treatment and beneficiaries in certain Accountable Care Organizations.
Uhh...2020 was a long time ago what are the rules again?
Providers should start by determining which patients may actually still qualify for telehealth coverage. For patients with traditional Medicare, this will require asking about where they are located at the time of the visit. Patients are still covered if:
- Located in a rural health professional shortage area or outside a Metropolitan Statistical Area (MSA); AND
- Located in a proper originating site at the time of the visit:
- The office of a physician or practitioner.
- A critical access hospital
- A rural health clinic
- A federally qualified health center (FQHC)
- A hospital
- A hospital-based or critical access hospital-based renal dialysis center (including satellites).
- A skilled nursing facility
- A community mental health center
- A renal dialysis facility
- A rural emergency hospital
- The patients home ONLY in very limited circumstances related to substance use disorder or mental health diagnosis and treatment
**The list of MSAs can be found in OMB Bulletin 20-01. Here are the rural health professional shortage areas. Providers can check to see if an originating site is eligible for Medicare payment here.
Patients must meet BOTH locating requirements or the services will not be covered by Medicare
OK...what about Medicare Advantage and commercial plans?
Providers also need to check their other payor contracts. The government shutdown does not require Medicare Advantage or commercial plans to stop paying for telehealth services. In some cases, coverage will be unaffected. In other cases, payors may tie their reimbursement to Medicare policy, in which case that reimbursement may also be impacted.
What if telehealth providers want to keep seeing Medicare patients?
Telehealth providers can continue to submit claims, but payments will not be made. Current drafts of the continuing resolution extend the telehealth flexibilities, and the industry consensus is that any deal to fund the government will make the renewal of flexibilities retroactive to October 1, but nothing is guaranteed. Telehealth providers should assume they will not receive payment and hope for better. CMS has instructed the MACs to hold claims to avoid having to reprocess large volumes of claims should Congress reinstate the flexibilities in the near term, so it makes sense to submit claims for the time being.
If providers continue to see patients is there anything they can do to protect themselves from not getting paid?
Yes. Providers continuing to provide telehealth services to Medicare beneficiaries need to determine which patients are willing to pay in cash. Medicare patients willing to pay cash must be given a properly filled out Advance Beneficiary Notice (“ABN”) that provides them notice of likely non-Payment by Medicare. Note that providers can only charge beneficiaries up to the limiting charge, which is MCR + 15%, unless they have opted out of Medicare altogether.
How does this impact payments for remote patient monitoring (“RPM”) and remote therapeutic monitoring (“RTM”) services?
RPM and RTM services are not considered “telehealth” under federal law, so the expiration of telehealth flexibilities do not apply to those services.
Finally, some good news!
Yes, but if RTM and RPM companies or their customers are using telehealth to complete initiating visits, those visits may no longer be covered.
You had me for a second...what else should providers be thinking about?
Because we don't know how long this is likely to last, virtual providers can also consider partnering with providers at originating sites outside MSAs and in rural health shortage areas so that patients can meet originating site requirements that enable Medicare reimbursement for telehealth.
Let’s cut to the chase. What options do telehealth providers have?
Telehealth providers have a couple of choices.
- Keep providing the services (without expectation of payment from anyone), either indefinitely or for a transition period. The hope is that any deal ending the shutdown includes a retroactive extension to the telehealth flexibilities. If this happens, providers can then submit their claims for services provided during the shutdown.
- Keep current appointments but stop scheduling new ones (or only schedule cash appointments going forward). This limits the financial risk to telehealth providers but might pose a hardship to patients.
- Immediately cancel all appointments (unless the person is willing to pay cash). This eliminates the risk of not getting paid for services but impacts patients and hurts revenue. If patients are willing to pay cash, be sure to provide them with an ABN in advance and to get it signed.
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