Countdown to 2026: New Year Changes in Telehealth Impacting Medicare Providers

Newsletter

The manner in which services are provided via telehealth has the potential to look very different for healthcare providers—particularly those providing services to Medicare patients—in 2026. As 2025 draws to a close, the Quarles Health Law Team takes a look at these possible changes and what they could mean for healthcare providers that provide care via telehealth.

1. Time’s Almost Up (Maybe?) for DEA’s Temporary Telehealth Controlled Substance Prescribing Flexibilities

The U.S. Drug Enforcement Administration (DEA) COVID-19–era rules permitting practitioners to prescribe controlled substances via telehealth are set to expire on December 31, 2025. To date, the DEA has issued three temporary extensions, allowing these pandemic-era flexibilities to remain in effect for a limited period and shaping how telehealth practitioners may establish and maintain patient relationships.

The flexibilities currently in place allow all DEA-registered practitioners to prescribe Schedule II – V controlled substances via telehealth and remove the requirement for an initial in-person examination. While the current flexibilities are set to expire at the end of this month, a fourth extension appears imminent. On November 10, 2025, the Office of Management and Budget disclosed that it is reviewing a proposed rule entitled Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. While details of the proposed fourth extension have not yet been released, it seems likely that some version of the current flexibilities will be extended into 2026.

Quarles will continue to monitor the DEA’s telemedicine flexibilities and their impact on telehealth providers. If the DEA does not issue a fourth extension or permanently adopt these flexible controlled-substance prescribing rules, telehealth providers should be prepared to comply with the pre-COVID-19 requirements under the Ryan Haight Act, including the need for an in-person examination.

2. With an Uncertain Future, Medicare Telehealth Flexibilities Extended Through January 2026

The recent passage of the budget bill not only reopened the federal government but also extended several key Medicare telehealth flexibilities. These flexibilities, now extended through January 30, 2026, include the following:

  • Expanded list of eligible providers: Practitioners such as physical therapists, occupational therapists, speech-language pathologists, and audiologists may continue to provide and be reimbursed for telehealth services;
  • FQHC and RHC coverage: Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can continue to provide and be reimbursed for telehealth services;
  • Home as the “Originating Site”: Medicare beneficiaries can continue receiving telehealth services from any site at which they are located, including their home;
  • No geographic restrictions: Telehealth services remain available to patients in both urban and rural areas;
  • Coverage of audio-only services: Medicare will continue reimbursing audio-only telehealth visits for non-behavioral health visits;
  • Hospice Face-to-Face requirement: Hospice care providers can continue to meet the face-to-face recertification requirement when the meeting is conducted through the use of telehealth services; and
  • Delayed in-person meeting requirement: The delay in the six-month in-person meeting requirement for mental health services furnished through telehealth has been extended.

While the extension provides some reassurance for current telehealth providers, ensuring Medicare reimbursement through January 2026, the relief is only temporary. As the calendar turns to 2026, providers will once again face uncertainty as these flexibilities approach expiration. Four bills are currently pending in Congress, including both limited-term extensions of the aforementioned telehealth flexibilities to proposals that would make these flexibilities permanent.

3. Medicare Physician Fee Schedule Final Rule: Permanent Changes to Telehealth and Physician Supervision Requirements

On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Final Rule (CMS-1832-F). Effective January 1, 2026, the rule introduces a series of payment and program updates, including revisions to physician supervision requirements and telehealth policies that may affect physicians, health systems, academic medical centers, and digital health companies delivering virtual care services. Key changes include the following:

  • Direct Supervision

CMS finalized a permanent definition of “direct supervision” that does not require the supervising physician or practitioner to be physically present. Direct supervision may now be provided through real-time, two-way audio-visual telecommunications (excluding audio-only) for services that require direct supervision.

With the exception of services that have a global surgery indicator of 010 or 090, a physician or other supervising practitioner may provide virtual direct supervision for applicable incident-to services under § 410.26, diagnostic tests under § 410.32, pulmonary rehabilitation services under § 410.47, and cardiac rehabilitation and intensive cardiac rehabilitation services under § 410.49.

  • Teaching Physician Supervision

CMS did not initially propose extending the current policy that allows teaching physicians to be virtually present for purposes of billing services furnished involving residents in all teaching settings. The current policy was set to expire on December 31, 2025. However, in response to public comments underscoring the importance of this flexibility in modern clinical practice, CMS is finalizing a permanent policy permitting teaching physicians to be virtually present only when the underlying service itself is furnished virtually. A full overview of the changes published by CMS under the 2026 PFS Final Rule is available here.

The Quarles Health Law Team continues to monitor each of these issues and will provide further updates as these very fluid situations evolve. If you have any questions or would like guidance on government healthcare program compliance, reimbursement strategy, or telehealth program development, please contact your Quarles attorney or:

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