Audio-Only Telehealth: Medicare, Medicaid and State Rules

Audio-only care is where telehealth meets the patients video does not reach: older adults without smartphones, rural patients without broadband, people who will talk about their mental health on the phone but not on camera. It is also where the rules split most sharply. The same 20-minute phone call can be a covered Medicare telehealth visit, an invalid basis for a prescription in one state, and a visit that needs its own consent form in another.

How does Medicare define audio-only telehealth?

Through the definition of "interactive telecommunications system" in 42 CFR 410.78(a)(3). The default is audio and video equipment permitting two-way, real-time communication. The regulation then allows "two-way, real-time audio-only communication technology for any telehealth service furnished to a patient in their home if the distant site physician or practitioner is technically capable of using" video, "but the patient is not capable of, or does not consent to, the use of video technology." Claims for audio-only services must carry CPT modifier 93, or modifier FQ for rural health clinics and federally qualified health centers.

Two conditions do the work: the patient is at home, and the clinician could have used video. A practice that offers only phone visits, with no video capability, does not meet the definition.

How long does Medicare audio-only last?

The statutory flexibility runs through December 31, 2027. Section 6209(e) of the Consolidated Appropriations Act, 2026 (Pub. L. 119-75, signed February 3, 2026) extends audio-only telehealth to the period "ending on December 31, 2027." The home as an originating site and the removal of geographic limits run through the same date under § 6209(a). CMS, in the CY 2027 fee schedule proposal (91 FR 43842), describes the end point as January 1, 2028; the effect is the same. The tele-mental-health in-person requirement is a different provision, deferred to January 1, 2028 under § 6209(d).

After 2027, absent new legislation, the home stops being an originating site for most services, which makes the home-based audio-only definition largely moot outside mental health and substance use disorder care, where the home remains an originating site under Social Security Act § 1834(m)(7). Watch the CY 2028 rulemaking for how CMS handles that. Our Medicare through 2027 post and the Medicare telehealth hub track the dates; planning for the end of the flexibilities covers what to do about them.

Can a controlled substance be prescribed after a phone call?

Only in narrow cases. DEA's fourth temporary extension (90 FR 61301, through December 31, 2026) requires an interactive telecommunications system as defined in 42 CFR 410.78(a)(3), so audio-only qualifies only when that definition's conditions are met: patient at home, clinician capable of video, patient unable or unwilling to use it. The buprenorphine rule at 21 CFR 1306.51 expressly allows audio-only encounters for opioid use disorder treatment for up to six months. DEA's proposed special registration rule (90 FR 6541) would not authorize audio-only encounters for special registration prescribing, apart from OUD treatment. See buprenorphine by telemedicine and what changes on January 1, 2027.

State law can be stricter. Arizona allows Schedule II prescriptions only after an in-person or audio-visual exam (A.R.S. § 36-3602(E)), and Texas requires audio and video for chronic pain prescribing outside a narrow refill exception (22 Tex. Admin. Code § 175.3; see the Texas chronic pain rule).

How do states treat audio-only for licensing and practice?

From the statutes and rules we have verified:

• Audio-only excluded from telehealth: Maryland's definition excludes care delivered solely by audio-only calls (Md. Code, Health Occ. § 1-1001); New Jersey excludes audio-only calls used alone from telemedicine; Tennessee's medical board definition excludes audio-only.
• Allowed only when video is unavailable: Arizona counts audio-only as telehealth only if audio-visual is not reasonably available because of the patient's functional status or lack of technology or infrastructure (A.R.S. § 36-3601(4)(b)); Delaware includes audio-only in telemedicine only if the patient cannot access the broadband or technology needed for video (24 Del. C. § 6001(6)).
• Allowed where the standard of care is met: Florida, Kansas, Mississippi, Montana, Nevada and West Virginia, among others; Ohio only when every element of a bona fide visit is performed. Minnesota counts scheduled audio-only visits as telehealth through June 30, 2027 under current law (Minn. Stat. § 62A.673).
• Not enough to start a relationship: North Dakota says an audio conversation alone does not meet the standard of care; Iowa prohibits prescribing based solely on a telephone evaluation without a valid relationship.

Do any states require a separate consent for audio-only?

Yes. Vermont requires a separate audio-only consent covering billing and the patient's right to choose another modality (18 V.S.A. § 9362). Washington requires the patient's consent before a provider bills for an audio-only visit; it may be verbal or written, lasts up to 12 months and must be kept five years (RCW 48.43.735; WAC 284-170-433). See telehealth consent requirements.

Do commercial payers have to pay for audio-only?

It depends on the state, and parity laws often treat audio-only differently from video. Arizona's payment parity covers audio-only only for behavioral health and substance use disorder services. Georgia does not require insurers to pay for audio-only calls other than mental or behavioral health. New Jersey's extended parity does not reach audio-only physical health visits. Virginia's insurance definition of telemedicine excludes audio-only calls. Details are in telehealth payment parity laws.

And Medicaid?

Each state Medicaid program decides whether and how it pays for audio-only, and many did so during and after the pandemic, often limited to behavioral health or established patients. Check the current state Medicaid manual rather than the commercial statute. See Medicaid telehealth coverage.

How should a practice decide when a phone visit is allowed?

1. Offer video first, every time, and record why the visit went to audio-only: patient lacks the technology, cannot use it, or declines. That record is what Medicare's definition, DEA's rule and Arizona's and Delaware's statutes turn on.
2. Check the patient's state against the audio-only rule for that state and the purpose of the visit: a new relationship, a follow-up, a prescription.
3. Block controlled substance prescriptions after audio-only visits unless the DEA and state conditions are met and documented, with OUD treatment under 1306.51 handled separately.
4. Collect the audio-only consent where a state requires one.
5. Apply the right claim modifiers and confirm the payer covers audio-only for that service. Our billing sister, White Glove Medical Billing, handles code-level claim questions.
6. Put December 31, 2027 on the calendar for Medicare and June 30, 2027 for Minnesota.

Our Medicare 2027 Cliff Plan ($1,450) segments audio-only Medicare volume and plans for the end date, and the 50-State Telehealth Matrix ($2,950 for one service line) maps each state's audio-only rules for your counsel. Nothing here is legal advice.