TS Medicare Reimbursement Changes Information Center

Nov 14: Medicare Telehealth Flexibilities Reinstated After Government Shutdown:

The recent continuing resolution (CR) will extend payment for telehealth services that expired during the government shutdown.

The legislation retroactively reinstates Medicare telehealth flexibilities from October 1, 2025, through January 30, 2026, and ensures that claims put on hold will be paid.

• Retroactive payments: The CR provides for retroactive payment of telehealth claims that were suspended during the shutdown.
• Reinstated flexibilities: The CR restores Medicare telehealth flexibilities that expired on September 30, 2025, including some geographic limitations and eligibility for certain providers like physical and occupational therapists.
• Future guidance: The Centers for Medicare & Medicaid Services (CMS) is expected to issue guidance on how providers can submit and process these retroactively paid claims.

For more information, please see: Congress Ends Government Shutdown

Oct 15: TeleSpecialists’ Chief Strategy and Growth Officer Molly Reyna releases position paper, titled “Preserving Access to Life-Impacting Care: Why Congress Must Act on Medicare Digital Healthcare Reimbursement.”

Overview: On September 30, 2025, key Medicare telemedicine flexibilities expired, and the following day’s federal shutdown deepened a nationwide care crisis, leaving hospitals, providers, and patients in uncertainty. TeleSpecialists’ position paper outlines the urgent need for Congressional action as Medicare beneficiaries now face new barriers to essential neurology, psychiatry, and specialty consultations—except for stroke care, which remains protected. The analysis reveals that outdated geographic restrictions deny care based on ZIP code rather than medical need, despite evidence showing that digital consultations save $7,500–$12,000 per patient by preventing unnecessary transfers and improving outcomes.

Oct 15: Reimbursement Fact Sheet Released

Oct 6: TeleSpecialists releases Medicare reimbursement guidance and FAQs to its partner hospitals.

Oct 2: TeleSpecialists disseminated news release urging congressional action to preserve patient access to certain emergency neurology and behavioral services nationwide.

Overview: TeleSpecialists urges Congress to:

1. Extend telehealth reimbursement protections beyond rural carve-outs for all hospital-based emergency neurology and psychiatry services.
2. Refine the in-person visit requirement to reduce unnecessary barriers for behavioral health patients receiving care at home.
3. Ensure payment stability by authorizing retroactive reimbursement once the shutdown ends.

Oct 1: Government shuts down

Sept 30: Key pandemic-era Medicare telemedicine flexibilities expired.¹

1: https://www.cms.gov/files/document/mln901705-telehealth-remote-patient-monitoring.pdf