Behavioral Health Telehealth In-Person Requirements

National Government Services has been receiving questions regarding the behavioral health telehealth requirement that the initial telehealth service include an in person visit within the previous 6 months, and a continuing in person visit every 12 months after the initiation of telehealth.

This policy was adopted by Medicare effective 1/1/2022 by CMS through legislative changes from the Consolidated Appropriations Act of 2021, and introduced in MLN Matters® MM12549 CY2022 Telehealth Update Medicare Physician Fee Schedule.

As part of this policy, the in-person visit requirement within six months prior to telehealth services for behavioral health and 12 months thereafter was to take affect 1/1/2022. However, these requirements were put on hold based on legislative action. The hold continued as indicated in the Consolidated Appropriations Act of 2023. This legislation continued the delay in implementing this requirement through 12/31/2024.

CMS posted in the CY 2024 Physician Fee Schedule Final Rule that the Act continued that legislation through the end of 2024. Legislation has not indicated any additional delay in the implementation of this requirement nor did the CY 2025 Physician Fee Schedule Rule indicate any such delay. As such, this requirement will go into effect 1/1/2025, for behavioral health telehealth services.

Posted 12/3/2024