Medicare proposed rule includes changes to telehealth coverage

Editor's note: For more on the 2026 Physician Fee Schedule proposed rule, see this statement from the American Academy of Family Physicians. 

The Centers for Medicare & Medicaid Services (CMS) recently proposed a number of changes to its telehealth policies, including how it adds services to the list that Medicare covers via telemedicine.

Adding services to the Medicare Telehealth Services List is currently a five-step process that includes placing the service temporarily in a “provisional” status. The Medicare Physician Fee Schedule (PFS) proposed rule that CMS issued July 14 would remove the provisional status and allow for services to be added permanently if they meet three criteria:

• Is the service separately payable under the Medicare PFS?
• Is the service subject to geographic or originating site requirements under the Social Security Act’s section 1834(m)?
• Can all elements of the service be provided via synchronous audio-video communication?

Other proposed telehealth changes

The proposed rule also makes the following changes:

• Removes all limits on how frequently services for follow-up inpatient visits, nursing facility visits, and critical care can be provided via telehealth;
• Makes permanent COVID-19 era flexibilities that allow physicians to remotely supervise certain services (e.g., incident-to visits or diagnostic tests) via audio-video technology, with the exception of procedures with 10-day or 90-day global periods, which require the physician to be physically present;
• Returns to pre-pandemic policies requiring physical presence for physicians supervising medical students and residents in metro areas, but maintains flexibility for physicians in rural areas to supervise students and residents remotely audio-video technology;
• Adds to the Medicare Telehealth Services List multiple-family group psychotherapy (CPT 90849), group behavioral counseling for obesity (G0473), and infectious disease add-on code G0545 for the complexity of treating confirmed or suspected infectious disease in a hospital setting.

Proposed non-telehealth changes

The Medicare PFS also proposes to:

• Increase the conversion factor (what Medicare pays per relative value unit) by 3.8% for qualifying alternative payment model participants and by 3.6% for all other physicians,
• Broaden the use of G2211 and other add-on codes. 

The final rule is expected in November, with policy changes taking effect Jan. 1, 2026.

— Andy Marso, Senior Editor, FPM

Posted on July 18, 2025