Do Medicare patients need an in-person visit before you treat them by telehealth for a mental health condition? Not through December 31, 2027. The Consolidated Appropriations Act, 2026 (H.R. 7148) pushed the statutory in-person requirement to January 1, 2028. CMS has proposed conforming changes in the 2027 Physician Fee Schedule.
That gives psychiatry practices fifteen months of runway. It also creates a new category that matters a great deal in 2028: patients who are already established in home-based tele-mental health before the deadline.
What is permanent for behavioral health
Several Medicare tele-mental health rules are permanent under current law, independent of the temporary extensions:
- The patient's home is an eligible originating site for diagnosis, evaluation, or treatment of a mental health disorder.
- No geographic restriction. Urban patients qualify the same as rural patients.
- Audio-only is allowed for behavioral health when the patient cannot use video or does not consent to it, and the practitioner is capable of video.
- FQHCs and RHCs can serve as distant sites for behavioral health.
- Marriage and family therapists and mental health counselors can bill Medicare telehealth.
What changes on January 1, 2028
Unless Congress acts again, the in-person requirement from the Consolidated Appropriations Act, 2021 takes effect for home-based tele-mental health:
- An in-person, non-telehealth visit within six months before the first mental health telehealth service.
- An in-person visit at least every 12 months after that, with exceptions when the patient and practitioner agree the risks of an in-person visit outweigh the benefits, documented in the record.
- The in-person visit may be furnished by a practitioner of the same specialty in the same group when the treating practitioner is unavailable.
CMS's February 2026 telehealth FAQ adds the detail that matters most for existing panels: patients who began receiving mental health telehealth in their homes on or before December 31, 2027 are treated as established. They skip the six-month pre-visit and only need the annual in-person visit after that date.
Why the established-patient rule is worth planning around
Every Medicare patient who starts home-based tele-mental health with your practice before 2028 enters the new rules under the lighter annual requirement. Patients who start in January 2028 need an in-person visit first.
For a telehealth-heavy practice, that suggests two concrete steps:
- Record the date of the first home-based tele-mental health visit for every Medicare patient as a structured field, so you can prove established status in an audit.
- Plan in-person capacity for 2028. Annual visits for every established Medicare telehealth patient add up. A practice with 300 such patients needs roughly 25 in-person slots a month to keep up.
Lessons from the 2025 lapse
When the federal government shut down on October 1, 2025, many temporary Medicare telehealth flexibilities lapsed until they were retroactively reinstated on November 12. Behavioral health in the home stayed covered because its core rules are permanent, but practices that also billed non-behavioral telehealth had claims to hold and resubmit.
Treat the December 31, 2027 date the same way: as a real deadline that may move. Keep a short list of which services depend on temporary authority, and a plan for holding those claims if authority lapses again.
Checklist
- Confirm your EHR captures patient location (home or other site) on every telehealth visit.
- Use the correct place-of-service and modifier for audio-only behavioral visits, and document why video was not used.
- Capture the first home-based tele-mental health date for each Medicare patient.
- Start reserving in-person clinic time for 2028.
- Watch the 2027 Physician Fee Schedule final rule, expected in early November 2026.