Medicare Updates on Telehealth Services

Starting October 1, 2025: Medicare will only reimburse most telehealth services if the patient is physically located in a medical office or facility in a rural area at the time of the visit. 

While the service itself remains remote (i.e., the provider and patient are not in the same location), the patient must be in a Medicare-approved originating site in a rural area for the visit to qualify. 

This change limits the use of telehealth from home for most services, though exceptions remain for mental health, substance use disorder treatment, and certain other conditions. 

Exceptions: If members are not in a rural health care setting, they can still get certain Medicare telehealth services on or after October 1, including:  

• Monthly End-Stage Renal Disease (ESRD) visits for home dialysis  

• Services for the diagnosis, evaluation, or treatment of symptoms of an acute stroke, wherever they are, including in a mobile stroke unit  

• Services for the diagnosis, evaluation, or treatment of a mental and/or behavioral health disorder (including a substance use disorder) in their home  

How Does This Impact Quality?  

• The extension of telehealth flexibilities is crucial for managing chronic conditions and ensuring timely follow-up care, which directly affects HEDIS measures and overall Star Ratings.  
• Continued telehealth services contribute to higher beneficiary satisfaction by providing convenient and flexible care options. This positively impacts CAHPS measures (Getting Needed Care, Getting Appointments and Care Quickly).  
• Telehealth can play a significant role in closing care gaps, such as those related to chronic disease management and preventive services. Maintaining these services helps improve performance across multiple HEDIS measures.  

How Does This Impact Risk Adjustment?  

Currently, telehealth is an acceptable visit type for Risk Adjustment visits, per CMS’ April 19, 2020 memo.   

Please monitor CMS for updates or changes to telehealth visits applicable to Risk Adjustment.    

How can you help?  

• Actively promote the availability of telehealth services to members, emphasizing the convenience and accessibility of these options, if available.   
• Proactively reach out to members who have previously used telehealth services to inform them of their continued availability and encourage ongoing use.  
• Provide information on alternative care options, such as in-home visits or community-based services, for members who may face barriers to telehealth.