• Behavioral health via telehealth is allowed permanently, thanks to the Consolidated Appropriations Act signed in Dec. 2020 and effective January 2021. The Consolidated Appropriations Act of 2021 permanently removed geographic and originating site restrictions for behavioral health services in Medicare, allowing beneficiaries to receive mental health services from any location, including their homes, without rural-only geographic limits. It also authorized behavioral health visits to be conducted via audio-only technology when a patient either cannot access or declines a real-time video connection. [1], [2]
• The Consolidated Appropriations Act passed in Dec. 2022, effective Jan 1, 2023, allowed for Marriage and Family Therapists (MFT) and Mental Health Counselors (MHC) to be eligible to enroll in Medicare.

Behavioral Health Recap

• Patients may be in their homes, in any geographic ares of the country
• When using real time, audio visual technology, use modifier 95
• Services may be audio only (use modifier 93)
• RHCs and FQHCs can permanently provide behavioral health services via telehealth. If audio only in these settings, use modifier FQ
• MFT and MHCs may perform services via telehealth
• Both the patient and clinician must be in the U.S. (including U.S. territories) when the services are done
• CMS does not require a strict definition of home; they note that patients may not have access to private living space or may, for privacy reasons, prefer to talk from their car or “other private location.”

CMS discusses the requirement for an in person visit for audio only behavioral health.

• In-person behavioral health visit requirement.  This requirement was delay until until Jan 30, 2026 in the Continuing Resolution passed in Nov. 2025. An in-person visit within six months of an initial Medicare behavioral/mental telehealth service, and annually thereafter, is not required through September 30, 2025. For FQHCs and RHCs, the in-person visit requirement for mental health services furnished via communication technology to beneficiaries in their homes is not required until January 1, 2026.
• The above quote notes the difference for RHCs and FQHCs, which aren’t required to have the in person visit within 6 months of initiating telehealth for behavioral health. This is not for established patients receiving behavioral health via telehealth; notice CMS says “of an initial Medicare behavioral/mental telehealth service.”

Still allowed are telehealth services that weren’t put into effect as a result of the pandemic, including home dialysis, acute stroke, substance use disorders in SUD programs

CMS list of services on the telehealth list for 2025

• 90791, 90792 Psychiatric diagnostic evaluation
• 90832, 90833, 90834, 90836, 90837, 90838 Psychotherapy
• 90839, 90840 Psychotherapy for crisis
• 90785 Interactive complexity
• 90845 Psychoanalysis
• 90846 Family therapy (without the patient present)
• 90847 Family psychotherapy (conjoint psychotherapy) with patient present
• 90853 Group therapy
• E/M services for medication management, 99202—99215
• Inpatient initial and subsequent visits, discharge visits and observation services

Private payers and behavioral health telemedicine

Most commercial payers have added psychotherapy and behavioral health services to their lists of services that can be performed via telehealth during the public health emergency. As always with commercial carriers, individual practices must check the payer policies.

Place of service and modifiers

Use place of service 02 telehealth provided other than patient’s home or POS 10 telehealth provided in patient’s home.

• Modifier 93 Telemedicine audio only real-time interaction (abbreviated description)
• Modifier 95 Telemedicine audio-visual real-time communication (abbreviated description)
• Modifier FQ Telemedicine audio-only for behavioral health

For commercial payers, check each company’s guidance.

The Telemedicine in the time of COVID-19 article provides additional information about the changes that were effect during the public health emergency.

[1] This statement does not refer to cross-state licensure requirements.

[2] Final “draft” MPFS publication: https://public-inspection.federalregister.gov/2024-25382.pdf (PDF form), p.144: “§ 410.78(a)(3) to permanently change the regulatory definition of an interactive telecommunications system to include two-way, real-time audio-only communication technology for any telehealth services furnished to beneficiaries in their homes if the distant site physician or practitioner is technically capable of using an interactive telecommunications system that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner, but the patient is not capable of, or does not consent to, the use of video technology.”

Display copy MFS publication: https://public-inspection.federalregister.gov/2024-25382.pdf (PDF form), pp. 879-880.