Telehealth billing changes 2026 are set to reshape how healthcare providers deliver and get paid for virtual care. If you’re a healthcare provider, the phrase billing changes might already send a shiver down your spine — and with good reason. Keeping up with evolving codes, regulations, and payer policies is practically a full-time job. But understanding the upcoming telehealth billing changes 2026 is essential to protecting your revenue and maintaining compliance.
With 2026 fast approaching, major updates to telehealth billing rules are on the horizon. These telehealth billing changes 2026 are largely driven by the expiration of Medicare telehealth flexibilities introduced during the public health emergency. As those temporary waivers end, providers will face new requirements for reimbursement, documentation, and patient eligibility.
Failing to prepare for the telehealth billing changes 2026 could result in denied claims, lost revenue, and costly compliance issues. But staying informed gives your practice a competitive advantage. This guide breaks down what’s changing, why it matters, and how to prepare your organization for success in the new telehealth billing landscape.
A Brief History of Telehealth Billing Changes 2026
Before we dive into the future, let’s take a quick look back. Before 2020, telehealth was a relatively niche service, often restricted to patients in rural areas or specific healthcare settings. The Centers for Medicare and Medicaid Services (CMS) had strict rules about where a patient had to be located (the “originating site”) and who could bill for these services.
Everything changed with the COVID-19 pandemic. To ensure Medicare beneficiaries could access care safely, Congress and CMS introduced sweeping waivers. These flexibilities enabled patients to receive care from the comfort of their homes, expanded the list of eligible providers, and increased reimbursement rates to match those of in-person visits. It was a game-changer for the industry.
Since then, legislation like the Consolidated Appropriations Act has extended these flexibilities temporarily. However, many of these temporary rules are set to expire by the end of 2024 or 2025, paving the way for a new, permanent set of regulations starting in 2026.
Key Changes Arriving in Telehealth Billing Changes 2026
The 2026 Medicare Physician Fee Schedule is expected to formalize the post-pandemic reality of virtual care. While the final rule hasn’t been written in stone yet, current legislative trends and CMS proposals point to several critical shifts you need to watch.
1. Shifts in Direct Supervision
One of the most significant changes involves virtual direct supervision. During the pandemic, supervising physicians didn’t need to be in the same room—or even the same building—as the resident or auxiliary personnel providing care, as long as they were immediately available via audio-video technology.
Unless new legislation is passed, this flexibility may expire or be significantly modified by Jan 30 2026. Providers may need to return to pre-pandemic rules requiring the physical presence of a supervising physician for certain services. This could heavily impact teaching physician workflows and clinics that rely on auxiliary staff for remote patient monitoring.
2. The “Originating Site” Requirement
Will patients still be able to hop on a call from their living room? That’s the big question. The waiver allowing the patient’s home to serve as an originating site is currently temporary. If this flexibility isn’t made permanent, Medicare patients might once again be required to travel to a designated healthcare facility to receive telehealth services, particularly if they don’t reside in designated rural areas.
3. Payment Parity and Rate Changes
For years, many telehealth claims have been reimbursed at the same rate as in-person visits (payment parity). As we move toward 2026, CMS is re-evaluating the cost differences between virtual and physical care. We may see a divergence in payment rates, where telehealth services are reimbursed at a lower rate than in-office visits, reflecting lower practice expenses.
4. Audio-Only Visits
Audio-only visits were a lifeline for patients without reliable internet access or smartphones. However, the future of reimbursement for these services is uncertain. Expect stricter requirements on when audio-only billing is permissible, likely limited to specific mental health scenarios or instances where video is technologically unavailable.
How These Changes Impact Providers
The ripple effects of these updates will be felt across the entire healthcare spectrum, but the impact varies by specialty.
Primary Care Physicians
For general practitioners, the potential loss of payment parity is a major concern. If reimbursement rates drop, high-volume telehealth practices may see a dip in revenue. Additionally, if the home is no longer a qualifying originating site, patient no-show rates could increase as the convenience factor disappears.
Mental Health Professionals
Behavioural health has been the biggest beneficiary of telehealth adoption. Fortunately, legislation has historically been more favourable to mental health services, often permanently allowing the patient’s home to serve as an originating site. However, providers must stay vigilant regarding virtual direct supervision rules and documentation standards for audio-only sessions.
Specialists
Specialists who serve rural areas—like those monitored by organizations such as ruralhealthinfo.org—will need to pay close attention to geographic restrictions. If rural exemptions are tightened, it could limit your ability to reach distant patients.
Practical Steps to Prepare for Telehealth Billing Changes 2026
Waiting until Jan 30, 2026, to update your processes is a recipe for disaster. Start preparing now to ensure a smooth transition.
Update Your Billing Systems For Telehealth Billing Changes 2026
Ensure your practice management software is ready to handle new place-of-service (POS) codes and modifiers. You’ll likely need to distinguish between telehealth provided in a patient’s home versus a medical facility more rigorously. Tools that integrate with updated Medicaid services and CMS guidelines can help automate this compliance.
Train Your Staff for Telehealth Billing Changes 2026
Your billing and coding team needs to be fluent in the new rules well before they go live. Invest in training sessions that cover the final rule once it is released. Resources from professional bodies like the NHMS or ACCMA can be invaluable for state-specific guidance.
Review Your Contracts for Telehealth Billing Changes 2026
Take a close look at your payer contracts. While Medicare sets the tone, private payers often follow suit. Negotiate where possible to maintain favourable telehealth reimbursement rates.
Audit Your Workflows for Telehealth Billing Changes 2026
If your clinic relies on virtual direct supervision, start planning for a potential return to physical presence requirements. This might mean adjusting schedules to ensure a teaching physician is on-site during specific procedures.
Stay Alert for Political Shifts
External factors, such as a potential government shutdown, can delay regulatory updates or payment processing. Keeping an eye on news from sources like KFF or Yahoo Finance can help you anticipate disruptions.
Helpful Resources
Staying educated is your best defense against billing errors. Bookmark these sites for reliable updates:
- Official Policy Updates: Centers for Medicare and Medicaid Services and Medicaid.gov are the primary sources for the 2026 Medicare Physician Fee Schedule.
- Rural Health: Visit ruralhealthinfo.org for data specific to rural populations.
- Billing & Coding News: Organizations like HFMA and AAPC offer deep dives into revenue cycle management.
- Telehealth Advocacy: The Center for Connected Health Policy (cchpca.org) tracks state and federal laws.
- Specialty Specifics: Check out LUGPA for urology-specific advocacy or IPTA for physical therapy updates.
- General Healthcare News: Sites like MDedge and Scope Forward provide broad industry analysis.
Conclusion
The landscape of telehealth services is shifting from emergency triage to sustainable, long-term care models. While the 2026 telehealth billing changes may seem daunting, they also represent a maturation of the industry. By understanding the shifts in virtual direct supervision, originating site requirements, and reimbursement rates, you can position your practice for stability.
Don’t let the final rule catch you off guard. Start reviewing your workflows, training your staff, and updating your technology today. The future of healthcare is hybrid—make sure your billing is ready to support it.
