September 27, 2026 · AxonCPT Team · telehealth, billing, clinical practice

Medicare Telehealth In-Person Rule for Mental Health

Medicare’s in-person requirement for mental health telehealth is delayed until after December 31, 2027. Until then, Medicare patients can get mental health care by telehealth at home without a prior in-person visit. According to CMS, from January 1, 2028, new patients would need an in-person, non-telehealth visit within 6 months before their first mental health telehealth service. After that, patients would need an in-person visit every 12 months, with documented exceptions allowed. Patients who start mental health telehealth before January 1, 2028 are treated as established and face only the 12-month requirement [1].

Clinician holding a Medicare mental health telehealth visit with a patient over a laptop Photo by Vitaly Gariev on Unsplash

This guide is for PMHNPs and psychiatrists who see Medicare patients by telehealth, including older adults with ADHD. It is current as of September 27, 2026. Congress has moved these dates several times, so check the CMS source and your Medicare Administrative Contractor before relying on any date here, and verify Medicare Advantage and Medicaid rules with each plan. Remember that Medicare payment rules and DEA prescribing rules are separate systems. For how remote assessment fits into both, see objective ADHD testing with AxonCPT.

What is the Medicare telehealth in-person requirement for mental health?

The requirement comes from section 123 of the Consolidated Appropriations Act, 2021. That section amended section 1834(m) of the Social Security Act so the patient’s home could serve as the originating site for mental health telehealth, and it added an in-person visit condition [2]. CMS implemented it in the CY 2022 Physician Fee Schedule final rule, published November 19, 2021 [2]. CMS’s current summary, in its Telehealth FAQ updated February 26, 2026, reads [1]:

  • Before the first service: an in-person, non-telehealth item or service from the same physician or practitioner, paid by Medicare, “within 6 months prior to the initial telehealth service.”
  • After that: “an in-person, non-telehealth service within 12 months of each mental health telehealth service,” with limited exceptions.
  • Coverage within a group: the in-person visit “may be performed by a physician or practitioner of the same specialty within the same group practice” if the treating practitioner isn’t available.

When does it take effect?

CMS says the requirement is “effective after December 31, 2027” [1]. Congress set that date in the Consolidated Appropriations Act, 2026, which NASW reports was signed on February 3, 2026. The same law extended most Medicare telehealth flexibilities through the end of 2027 [3].

Period Rule for mental health telehealth to the home
Now through December 31, 2027 No in-person visit required [1]
From January 1, 2028: patients who started before then Treated as established. No 6-month requirement, but at least one in-person visit every 12 months [1]
From January 1, 2028: new patients In-person visit within 6 months before the first telehealth service, then every 12 months [1]
RHC and FQHC mental health visits In-person requirements don’t apply until at least January 1, 2028 [1]

What exceptions exist to the 12-month visit?

The CY 2022 final rule allows an exception to the 12-month requirement “if the patient and practitioner agree that the benefits of an in-person, non-telehealth service within 12 months of the mental health telehealth service are outweighed by risks and burdens associated with an in-person service, and the basis for that decision is documented in the patient’s medical record” [2].

For PMHNPs, the exception is only as strong as the note that supports it. Record the specific risks and burdens, such as distance, mobility, caregiving, or clinical risk from travel, and record that the patient agreed. A blanket template statement is weak support.

Does the rule cover audio-only visits and patients at home?

  • Home as originating site: For behavioral health, CMS says the Consolidated Appropriations Act, 2021 permanently removed geographic and place-of-service restrictions, so patients in rural and urban areas can receive behavioral health telehealth at home [1].
  • Audio-only: Allowed at home through December 31, 2027. From January 1, 2028, audio-only behavioral health care at home is allowed if the practitioner is technically capable of video and the patient can’t use video or doesn’t consent to it. It can be used for new and established patients [1].
  • Place of service: CMS directs POS 10 for telehealth in the patient’s home and POS 02 for other locations [1].

How is this different from the DEA rule?

This is the point that trips up the most prescribers:

Medicare in-person requirement DEA telemedicine rules
Governs Payment for mental health telehealth Prescribing of controlled substances
Authority Social Security Act §1834(m); CMS Ryan Haight Act; DEA/HHS
Current status Delayed until after Dec 31, 2027 [1] Temporary flexibilities through Dec 31, 2026 [4]
Applies to Medicare fee-for-service claims All patients, all payers

For a Medicare patient with ADHD in 2027, Medicare may pay for a video visit with no prior in-person visit, while DEA rules still decide whether you can prescribe a Schedule II stimulant remotely. Both have to be satisfied. See DEA telemedicine rules for 2027 and DEA special registration for telemedicine.

Try it with your next patient. AxonCPT gives you 2 free tests every month — no card required. Send a link, your patient finishes in ~16 minutes from home, and you get a norm-referenced report instantly. Create your free account →

How PMHNPs should prepare for 2028

  1. Flag start dates. In your EHR, mark the date each Medicare patient first received mental health telehealth from you. Patients who start before January 1, 2028 are grandfathered out of the 6-month requirement [1].
  2. Plan in-person capacity. Decide where in-person visits will happen: your office, a partner’s office, or a colleague of the same specialty in your group [1].
  3. Build an exception template that forces specifics. It should require the particular risks and burdens and the patient’s agreement [2].
  4. Separate billing from prescribing in your workflow. Track Medicare in-person status and DEA status as two different fields.
  5. Verify every year. These dates have been extended repeatedly. Check the CMS telehealth FAQ and your MAC’s guidance each fall.
  6. Check other payers. Medicare Advantage, Medicaid, and commercial plans set their own telehealth rules.

Where remote assessment fits

The in-person requirement is about the visit, not the assessment tools. A test the patient takes at home is not a telehealth visit and doesn’t satisfy an in-person requirement. But it can make each telehealth visit more informative. For older adults with ADHD, where attention complaints can overlap with mood, sleep, medication effects, or early cognitive change, objective and repeatable data helps you decide who needs closer in-person follow-up. Keep in mind that a CPT doesn’t screen for dementia and doesn’t diagnose ADHD by itself. If you’re asking whether PMHNPs can bill testing codes for this kind of work, see Can PMHNPs Bill Psychological Testing?

How this looks in practice

  1. Telehealth visit: confirm the patient’s location, note POS 10, and document the start date of telehealth care.
  2. Between visits: send an AxonCPT link. The patient takes the test in their browser on a tablet or computer, in about 16 minutes, with no app or login. For older patients, a family member can help set up the device, but the patient should take the test alone.
  3. Report: it’s ready as soon as the patient finishes, with five metrics compared against age- and sex-matched norms from a 20,000+ reference dataset and a Q1–Q4 vigilance breakdown. See what the report looks like.
  4. Follow-up: compare results across visits, alongside patient and caregiver reports. Use the trend to decide the timing of the annual in-person visit, and to support or rule out an exception.

Frequently asked questions

Do I need to see Medicare patients in person before telehealth in 2027? Not under Medicare payment rules. CMS says the 6-month in-person requirement is effective only after December 31, 2027 [1]. DEA and state rules may still require an in-person visit for controlled-substance prescribing.

My patient started telehealth with me in 2025. What happens in 2028? CMS says such patients are treated as established. They won’t need the 6-month pre-visit, but they will need at least one in-person visit every 12 months after December 31, 2027, unless a documented exception applies [1].

Can a colleague do the in-person visit? Yes, if they are of the same specialty in the same group practice and you aren’t available [1].

Does this apply to Medicare Advantage? Medicare Advantage plans can set their own telehealth policies. Check with each plan.

Start testing your patients with AxonCPT

Between now and 2028, Medicare mental health telehealth remains flexible. The practices that will handle the in-person rule best are the ones already tracking their patients with measurable data. AxonCPT gives PMHNPs a fast, home-administered attention measure that turns telehealth follow-up into documented, trackable care. Create your free AxonCPT account with 2 free tests every month and no card required, or learn more at axoncpt.com.

References

  1. Centers for Medicare & Medicaid Services. Telehealth FAQ, updated 2/26/26. February 26, 2026.
  2. Centers for Medicare & Medicaid Services. Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule (final rule). Federal Register, 86 FR 64996, November 19, 2021.
  3. National Association of Social Workers. Congress Passes Two-Year Extension of Medicare Telehealth Flexibilities. February 27, 2026.
  4. Drug Enforcement Administration & HHS. Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. Federal Register, 90 FR 61301, December 31, 2025.