Medicare Final Telehealth Rule Changes Take Effect April 1, 2025 – What You Need Know
Today, we’re diving into the Medicare final telehealth rule changes taking effect on April 1, 2025. If you’re a healthcare provider using telemedicine, you need to be aware of these upcoming shifts. Medicare’s pandemic-era telehealth flexibilities are ending, and many policies are reverting to pre-pandemic rules.
Key Takeaways
- April 1, 2025: Medicare telehealth rules revert to pre-pandemic policies.
- Location matters: Patients may need to be in an approved facility again.
- Provider restrictions: PTs, OTs, and SLPs may lose telehealth eligibility.
- Supervision rules: Virtual oversight of medical residents ends in metro areas.
- Billing compliance: Providers must report home addresses for telehealth claims.
- DEA updates: In-person evaluations return for prescribing controlled substances.
Finding the Final Rule – Where’s the Clarity?
Let’s be honest—finding a clear, final Medicare ruling on telehealth changes is like searching for a needle in a haystack. There’s no neatly wrapped, final document detailing every change. But what we do have is Medicare’s website bulletin, which outlined extensions through March 31, 2025.
Translation? If those pandemic-era extensions only run until the end of March, it’s a strong indicator that Medicare telehealth regulations will revert to pre-pandemic rules on April 1, 2025. So, unless something changes last-minute, expect a return to the old system.
Who Should Pay Attention?
If you’re a provider who doesn’t specialize in behavioral health, these Medicare final telehealth rule changes taking effect on April 1, 2025, are crucial for you. Even if you’re in behavioral health, a few changes are coming your way—especially regarding in-person visit requirements.
The Originating & Distant Site Rules Are Back
The terms “originating site” and “distant site” are about to become very important again.
- Originating site = Where the patient is located at the time of the telehealth visit.
- Distant site = Where the provider is located while delivering telehealth services.
Before the pandemic, patients had to be in specific locations, like a doctor’s office, to receive Medicare-covered telehealth services. During the pandemic, that requirement was waived, allowing telehealth from anywhere, including home. But after April 1, 2025, it looks like we’re going back to the old rules.
What’s Changing? Let’s Break It Down
I printed off a great comparison grid from the American Hospital Association showing what was allowed pre-pandemic vs. what is likely to be reinstated on April 1, 2025. Here’s a quick summary:
| Category | Pre-Pandemic Rules | Pandemic-Era Waivers | What’s Likely to Happen April 1, 2025? |
|---|---|---|---|
| Eligible Geographic & Originating Sites | Only rural areas or health provider shortage areas. Patients had to be in a doctor’s office. | No geographic restrictions. Patients could be at home. | Reverting back to rural areas & doctor’s office requirements. |
| Audio-Only Services | Video + audio required for telehealth visits. | Audio-only visits allowed for E&M services. | Going back to video/audio requirement. |
| Eligible Provider Types | Only specific provider types (not PT, OT, etc.). | Allowed PTs, OTs, SLPs, audiologists to provide telehealth. | Reverting back—these providers may lose telehealth privileges. |
| Behavioral Health | Required in-person visit 6 months before starting telehealth. | Waived the in-person requirement. | Requiring in-person visit again. |
More Medicare Final Telehealth Rule Changes Taking Effect April 1, 2025
Let’s keep going because these changes don’t stop at originating sites and provider types. There are more Medicare final telehealth rule changes taking effect on April 1, 2025, and some even extending through the end of 2025.
Virtual Supervision—Say Goodbye to Remote Oversight
During the pandemic, providers could supervise diagnostic tests, physician services, and even outpatient hospital services virtually—meaning the supervising physician didn’t have to be physically present.
But as of December 31, 2025, we’re going back to requiring in-person supervision.
That means if you supervise residents, oversee cardiac rehab, or handle outpatient therapy, you need to be present on-site.
| Supervision Type | Pre-Pandemic | Pandemic-Era Waiver | Reverting at End of 2025? |
|---|---|---|---|
| General Clinical Supervision | Supervising provider must be in-person. | Allowed virtual presence for supervision. | Going back to in-person supervision. |
| Resident Supervision in Teaching Settings | Only allowed virtual supervision for non-metro areas (non-MSA). | Allowed virtual supervision in metro & non-metro areas. | Metro areas lose virtual supervision. |
| Cardiac & Pulmonary Rehab | Supervising provider had to be on-site. | Allowed virtual supervision via video. | Going back to requiring in-person supervision. |
Telehealth Billing & Provider Address Reporting
Another huge change coming back—if you provide telehealth from your home, Medicare will require you to report your home address again for enrollment, billing, and claims.
This requirement was waived during the pandemic, but it’s returning at the end of 2025. If you’re billing for telehealth services from home, start preparing now to submit your information properly—or risk claim denials.
DEA & Controlled Substances – In-Person Visit Requirements Are Back
If you prescribe controlled substances via telehealth, pay attention.
Pre-pandemic, an in-person visit was required before a provider could prescribe controlled substances. During the pandemic, that requirement was temporarily waived, allowing providers to prescribe medications without ever seeing the patient in person.
That waiver expires at the end of 2025, meaning:
- Providers will need to see patients in person before prescribing controlled substances via telehealth.
- DEA is supposed to finalize a “special registration process” for exceptions—but no clear rule exists yet.
- If you rely on telehealth for prescribing, you need to monitor DEA updates closely.
FAQ: Medicare Final Telehealth Rule Changes Taking Effect April 1, 2025
What are the Medicare final telehealth rule changes taking effect on April 1, 2025?
Starting April 1, 2025, Medicare telehealth policies will revert to pre-pandemic rules, restricting who can provide telehealth, where patients must be located, and supervision requirements. Audio-only visits, at-home telehealth, and expanded provider eligibility may no longer be allowed unless new extensions are announced. Stay updated to avoid billing issues.
Will Medicare still cover telehealth visits at home after April 1, 2025?
Most likely not. Before the pandemic, Medicare required patients to be in a rural area and at an approved facility (not at home) to qualify for telehealth services. The pandemic waived this rule, but April 1, 2025, changes will likely require patients to be in an approved medical facility again.
Can physical therapists, occupational therapists, and speech therapists still provide telehealth services?
Not after April 1, 2025. Medicare temporarily allowed PTs, OTs, speech therapists, and audiologists to provide telehealth, but this waiver expires on March 31, 2025. Unless new policies are introduced, these professionals will no longer be eligible to provide telehealth under Medicare rules. Check for updates regularly.
Will Medicare still allow audio-only telehealth visits?
No. Audio-only telehealth visits were temporarily permitted during the pandemic, but before that, Medicare required both audio and video for most telehealth services. Starting April 1, 2025, providers will likely need real-time video and audio connections to qualify for Medicare reimbursement.
What is the originating site rule, and how is it changing?
An originating site is where the patient is physically located during a telehealth visit. Before the pandemic, patients had to be in a rural area and at an approved medical facility. The waiver allowed home visits, but starting April 1, 2025, patients may have to return to an approved facility.
What is a distant site, and how does it affect telehealth providers?
A distant site is where the provider is located when delivering telehealth services. Before the pandemic, Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) couldn’t provide telehealth. The pandemic changed that, but these facilities may lose telehealth privileges when rules revert on April 1, 2025.
Will behavioral health telehealth visits still be covered?
Yes, but with more restrictions. Medicare previously required an in-person visit within six months before starting telehealth behavioral health services. The pandemic waived this, but it’s expected to return on April 1, 2025. Additionally, patients may have to complete an in-person check-in annually.
Will virtual supervision of medical residents still be allowed?
Not in metro areas. During the pandemic, Medicare allowed teaching physicians to supervise medical residents virtually in both metro and non-metro areas. After December 31, 2025, only non-metro areas will qualify for virtual supervision. If you’re supervising in a metro area, you’ll need to be physically present again.
Will providers have to report their home address if they work remotely?
Yes. Before the pandemic, Medicare required telehealth providers working from home to report their home address for billing and enrollment. This requirement was waived temporarily, but after December 31, 2025, providers must list their home address again when submitting claims.
How will DEA rules for prescribing controlled substances change?
Before the pandemic, providers needed an in-person evaluation before prescribing controlled substances via telehealth. That rule was waived, but unless the DEA finalizes a special registration process, the in-person requirement will return at the end of 2025. If you prescribe controlled substances, monitor DEA updates carefully.
What happens if I continue billing telehealth services incorrectly after April 1, 2025?
If you bill for telehealth services without following the new (or rather, old) rules, your claims will be denied, and you won’t get paid. Medicare audits could also flag non-compliance, leading to fines or penalties. Double-check your specialty’s eligibility and update your billing practices before April 1.
Will Medicare announce any last-minute extensions to telehealth rules?
We don’t know yet. Congress previously extended telehealth flexibilities into early 2025, but there’s no confirmation that it will happen again. To be safe, assume that these changes will take effect on April 1, 2025, and prepare now rather than waiting on uncertain extensions.
Final Thoughts – Be Prepared for April 1, 2025
These Medicare final telehealth rule changes taking effect on April 1, 2025, are major and will impact providers across multiple specialties. If you’re offering telehealth services, it’s time to review your billing practices, supervision rules, and originating site policies.
If you don’t adjust by April 1, you risk denied claims, compliance issues, and major disruptions to patient care.
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