August 1, 2025

By Laura Groshong, LICSW, CSWA Director of Policy and Practice

As many of you know, LCSWs have had several anxious moments in the last two years as Congress has, at the last minute, approved short term extensions of Medicare coverage of telemental health.

In the always-changing world of Medicare coverage of telemental health, there is a new wrinkle to the changes that will be coming on October 1, 2025.

First, the good news. It appears that CMS is now recommending permanent coverage of telemental health services if the patient is present in their home, which we interpret to mean place of residence. Here is the citation:

“Telehealth, defined as 2-way, interactive, audio-video technology, to diagnose, evaluate, or treat certain mental health or SUDs if the patient is in their home. Practitioners must be able to provide 2-way, real-time, audio-video technology services but may use audio-only technology given an individual patient’s technological limitations, abilities, or preferences. We cover telehealth for behavioral and mental health on a permanent basis.”

(https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf, p. 7)

The not-so-good news is that we still need to see patients in person with two exceptions. Here is the citation [bracketed italicized commentary is mine]:

“Starting October 1, 2025, in-person visit requirements will apply for mental health services provided by telehealth. This includes a required in-person visit within the 6 months before the initial telehealth treatment, as well as the required subsequent in-person visits at least every 12 months.

Telehealth also applies to mental health services provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). For RHCs and FQHCs, we don’t require the in-person visit for mental health services provided through telehealth to patients in their homes until January 1, 2026.”

The regulations at 42 CFR 410.78(b)(3)(xiv) describe 2 exceptions to the in-person requirements effective October 1, 2025:

”Patients who already get telehealth behavioral health services and have circumstances where in-person care may not be appropriate [no guidance on what the “circumstances” are].

Groups with limited availability for in-person behavioral health visits have the flexibility to arrange for practitioners to provide in-person and telehealth visits with different practitioners, based on availability [no definition of what “groups” are].

Exceptions to the in-person visit requirement require a clear justification documented in the patient’s medical record.” (https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf, p. 10)

There is still confusion about the in-person visit for NEW patients “six months prior to treatment” beginning, but patients who have ALREADY been seen through telemental health prior to October 1, 2025, can continue to be seen virtually without being seen in-person. Additionally, there is an exception to the in-person requirement every 12 months if there is “clear justification” for why it is not appropriate. This should include working with patients who are in another state; an LCSW not having an office where the patient can be seen in-person; and/or seeing patients who are in the LCSW’s state but too far away to be seen in-person. This remains to be clarified but is the best interpretation I can give at this time. As we have been for the past three years, CSWA is working with members of Congress and other mental health groups to eliminate the in-person requirement completely.

We realize this is complicated. Let us know if you have any questions by contacting Laura Groshong, LICSW, CSWA Director of Policy and Practice at lwgroshong@clinicalsocialworkassociation.org.