Medicare's In-Person Requirement for Tele-Mental Health

Starting January 1, 2028, a Medicare practitioner treating a mental health disorder by telehealth at the patient's home will need to have seen that patient in person within the six months before the first telehealth visit, and then periodically, which CMS has set at least once every 12 months. The requirement is in section 1834(m)(7)(B) of the Social Security Act. Congress has delayed it repeatedly; the latest delay, in section 6209(d) of the Consolidated Appropriations Act, 2026, moved the date from January 31, 2026 to January 1, 2028.

What exactly does the statute require?

Payment "may not be made" for telehealth services furnished on or after January 1, 2028 for "diagnosis, evaluation, or treatment of a mental health disorder" unless the physician or practitioner furnishes an item or service in person, without telehealth, that Medicare pays for (or would have paid for, if the patient had been enrolled then):

• within the six months before the first time that practitioner furnishes such a telehealth service to the patient, and
• during later periods "at such times as the Secretary determines appropriate."

How has CMS filled in the details?

CMS's rule at 42 CFR 410.78(b)(3)(xiv) sets three conditions:

1. An in-person item or service within 6 months before the initial telehealth service.
2. An in-person item or service at least once within 12 months of each subsequent telehealth service, unless the practitioner and patient agree that the risks and burdens of an in-person service outweigh the benefits for that 12-month period, and the practitioner documents the reasons in the medical record.
3. Either visit may be furnished by another physician or practitioner of the same specialty and subspecialty in the same group, if the treating practitioner is not available.

The six-month initial visit has no risk-and-burden exception in the rule. The annual visit does. Rural health clinics and federally qualified health centers have parallel requirements for mental health visits by communication technology, delayed to the same date by sections 6209(d)(2) and (3).

Who is exempt?

The statute's clarification at section 1834(m)(7)(B)(ii) says the requirement does not apply:

• to telehealth services for a patient with a substance use disorder diagnosis, for treatment of that disorder or a co-occurring mental health disorder; or
• where payment would be allowed anyway, without the special mental health pathway. In practice, that means a patient at a qualifying originating site, such as a clinic in a rural health professional shortage area, under the ordinary telehealth rules.

Through December 31, 2027, the general extension in section 6209(a) also lets any Medicare patient be seen at home, which is why the in-person rule has had little bite so far. From 2028, unless Congress extends again, the home pathway for behavioral health runs through section 1834(m)(7) and carries this requirement with it.

Does a new patient who started in 2026 need an in-person visit?

The statute keys the six-month window to "the first time such physician or practitioner furnishes such a telehealth service." How CMS will treat relationships that began by telehealth before January 1, 2028 is something to watch in rulemaking and guidance. The cautious plan is to get every ongoing patient seen in person during 2027, so the 12-month clock is satisfied on January 1 whichever reading applies.

What does this mean for a virtual-only practice?

It means you need an in-person footprint, or a partner with one, by late 2027. Options practices are using:

• Clinicians who live near patient clusters holding a few clinic days a month in shared office space.
• Same-group, same-specialty colleagues covering in-person visits, which the rule allows when the treating practitioner is unavailable.
• Documented annual exceptions where the risks and burdens of travel outweigh the benefit, used honestly and case by case. It is not a blanket waiver for a whole panel, and it does not cover the initial visit.

How should you schedule for it?

1. Flag every Medicare patient receiving mental health telehealth at home, by treating practitioner.
2. Mark which ones have a substance use disorder diagnosis being treated, since they fall outside the requirement.
3. For the rest, record the date of the last in-person service by that practitioner or a same-specialty colleague in the group.
4. Book in-person visits in the second half of 2027 for everyone without one in the prior 12 months.
5. Build an EHR field for the annual exception and its reasons, so documentation is consistent.

This is one of the dates in our Medicare 2027 Cliff Plan ($1,450). The rest of the timeline is on the Medicare telehealth hub and in what the 2026 spending law extended. Behavioral health practices that also prescribe controlled substances have a separate DEA question; see what changes on January 1, 2027.