October 2, 2025
As of October 1, 2025, Congress has not yet passed an extension of the COVID-era telehealth flexibilities that expired on September 30, 2025. Due to the current impasse in Congress, these critical provisions have lapsed, and until a budget solution is passed, Medicare reimbursement for several types of telehealth visits that have become essential in PALTC settings are on hold until further notice. Congress has consistently included telehealth extensions in previous budget bills that passed Congress. PALTmed strongly advocates that an extension be included in the current budget bill.
What is not currently covered by Medicare telehealth:
- Visits with residents/patients in non-rural nursing homes
- Visits in assisted living communities
- PT/OT/SLP visits
What is still covered by telehealth:
- Patients enrolled in an ACO
- Mental health visits
- Visits with residents/patients in nursing homes in specified rural and underserved locations. Check the Medicare Telehealth Eligibility Analyzer here: https://data.hrsa.gov/tools/medicare/telehealth.
- Visits covered by commercial insurance
What this means for your practice:
If you are offering telehealth services that are currently not covered, you may need to consider:
- Substituting in-person visits for telehealth visits.
- Doing the telehealth visit and holding the claim until Congress restores coverage (likely, but not guaranteed).
- Doing the telehealth visit and submitting the claim now, knowing it may be denied if Congress does not take action. Per CMS’ October 1, 2025 memo, the agency encourages providers to submit claims during the temporary 10-day hold, even though payment will not be released until the hold is lifted and Congress reinstates Medicare telehealth flexibilities. Claims that are submitted beyond the 10-day hold period may need to be resubmitted if Congress includes retroactive payment in the telehealth extension. If there is no retroactive payment included in the bill – all claims submitted after October 1, 2025, would be denied, and begin to be reimbursed when Congress authorizes payment.
- Doing the telehealth visit and having the resident (or DPOA) pay out of pocket. Per CMS memo, the agency suggests: "Practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage.”
You can access the full Memo on the PALTmed website: Official CMS Memo on Impact of Government Shutdown on Medicare Policies
PALTmed’s Role:
This is a pivotal moment for PALTC medicine. Telehealth has proven to be a lifeline for residents in nursing homes and assisted living communities—improving access, reducing unnecessary hospital transfers, and supporting continuity of care. The abrupt loss of coverage risks harming our patients and destabilizing care delivery.
PALTmed is actively advocating with Congress and federal agencies to restore and preserve these critical telehealth provisions. We are making sure your voice, as frontline clinicians caring for the most medically complex and vulnerable patients, is heard.
PALTmed and our Public Policy Committee will continue to keep you apprised as this uncertain situation unfolds. We will also continue the discussion on PALTconnect, our online member’s only community, and invite you to bring your questions to our next PALTconnect Live Forum on Friday, October 3 at 1:00 PM ET. Click here to sign up.
We will continue to keep you informed and provide practical guidance as this situation evolves.