Medicare Telehealth Through 2027: What the 2026 Spending Law Extended

The Medicare telehealth flexibilities now run through December 31, 2027. President Trump signed the Consolidated Appropriations Act, 2026 (H.R. 7148, Pub. L. 119-75) on February 3, 2026, and section 6209 of that law replaced "January 30, 2026" with "December 31, 2027" throughout the telehealth provisions of section 1834(m) of the Social Security Act. The in-person requirement for tele-mental health was pushed to January 1, 2028. This is a two-year extension with a fixed end date, not a change to the underlying law.

How did we get here?

The pandemic-era waivers became statutory extensions in 2022 and were renewed in short increments. The last one before this law ran through September 30, 2025, and when the government shut down on October 1 they lapsed. DEA, writing in the preamble to its December 2025 telemedicine rule (90 FR 61301), called it "the abrupt 41-day cessation of Medicare's telemedicine flexibilities." The Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026 (Pub. L. 119-37, signed November 12, 2025), restored them through January 30, 2026. The February 3 law then carried them to the end of 2027. A McGuireWoods client alert reported that CMS would pay claims for services furnished in the few days between January 30 and the signing, consistent with its approach after the fall shutdown.

What exactly did section 6209 extend?

• No geographic limits and the home as an originating site (6209(a)), through December 31, 2027. A Medicare patient can be seen at home, in any county.
• Expanded practitioner types (6209(b)), through December 31, 2027. Physical therapists, occupational therapists, speech-language pathologists and audiologists can bill telehealth services.
• FQHCs and RHCs as distant sites (6209(c)), through December 31, 2027.
• The in-person requirement for tele-mental health (6209(d)) now applies to services on or after January 1, 2028, for physicians, RHCs and FQHCs alike. See the tele-mental-health in-person requirement.
• Audio-only telehealth (6209(e)), through December 31, 2027. CMS, in the CY 2027 fee schedule proposal, describes the end point as January 1, 2028; the effect is the same. See audio-only telehealth rules.
• Hospice recertification face-to-face encounters by telehealth (6209(f)), through December 31, 2027, but no longer for patients in areas under a hospice enrollment moratorium, patients of hospices under enhanced oversight, or encounters by hospice physicians or NPs not enrolled in Medicare. From January 1, 2027, hospice claims must carry a modifier or code showing the encounter was by telehealth.

What is new in this extension?

Section 6209(g) adds paragraph (10) to section 1834(m): by January 1, 2027, CMS must require modifiers on two kinds of telehealth claims. The first is a service furnished through a telehealth virtual platform where the practitioner contracts with the entity that owns the platform, or has a payment arrangement with an entity for its use. The second is a telehealth service furnished incident to a practitioner's professional service. In the CY 2027 fee schedule proposal (91 FR 43842, July 16, 2026), CMS says it is creating modifiers BB and BC for these claims, that they do not affect payment, and that guidance will be posted on the CMS website. If your clinicians bill Medicare and your company owns the platform or pays for it, assume your claims will need a modifier from January 1. See the 2027 fee schedule proposals.

Section 6210 extends the Acute Hospital Care at Home waiver through September 30, 2030, a much longer runway than the telehealth provisions; see hospital at home after the 2026 extension. Section 6213 directs HHS to issue guidance within a year on telehealth for patients with limited English proficiency, including interpreter use and multilingual instructions.

What did the law not do?

• It did not end the flexibilities' expiration date. On January 1, 2028, absent new legislation, the geographic and originating-site limits return for most services. The CONNECT for Health Act (S. 1261 / H.R. 4206), which would make broader changes, is pending.
• It did not change the parts of section 1834(m) that already apply without an end date: mental health services and substance use disorder treatment to a patient at home under section 1834(m)(7), subject to the in-person requirement for mental health from 2028.
• It did not touch DEA rules. Medicare paying for a telehealth visit says nothing about whether a controlled substance can be prescribed in it. See DEA telemedicine rules.
• It did not touch state licensure. The patient's state still governs who may treat them.

What should a practice do with the extra time?

1. Put December 31, 2027 on the calendar now, with checkpoints in mid-2027 when Congress will be debating the next extender package.
2. Segment Medicare volume. Separate behavioral health visits (which keep a home pathway) from everything else (which does not). Separate audio-only from video.
3. Fix the modifier logic before January 1, 2027 if you use a contracted or company-owned platform or bill incident-to telehealth.
4. Start the in-person plan for tele-mental-health patients. January 1, 2028 is close for a practice with no physical sites.

Our Medicare 2027 Cliff Plan ($1,450) does that segmentation and builds the contingency plan; the Medicare telehealth hub tracks each date. For code-level claim questions, our billing sister, White Glove Medical Billing, handles claims. Planning for the end date is in planning for the end of Medicare's flexibilities.