Telehealth Services Update for Medical Providers
Stay informed about the latest telehealth policies and guidelines that impact how medical services can be delivered remotely. This update highlights key changes from CMS and other payers to help providers remain compliant and optimize patient care.
Telehealth changes for HMSA Medicare Advantage plans effective 10/1/2025
Effective October 1, 2025, most flexibilities that were in place for Medicare telehealth during COVID-19 PHE had ended and will follow revised Original Medicare policies. Please refer to below references for Medicare guidelines. We continue to monitor CMS guidelines for Original Medicare and will adjust for future coverage changes.
HMSA Medicare Advantage plans follow Medicare guidelines but also provide coverage beyond Original Medicare through a supplemental benefit.
The below will continue (for 2025 and 2026):
a. cover all Medicare telehealth services for par providers at 100% of eligible charges
b. cover all Medicare telehealth services in a place other than the patient’s home for par providers at 100% of eligible charges
c. cover behavioral and mental health services for par providers using audio–only at 100% of eligible charges
References:
https://www.cms.gov/files/document/telehealth-faq-04-09-25.pdf
https://www.cms.gov/files/document/mln901705-telehealth-remote-patient-monitoring.pdf
Telehealth Services Update for Medical Providers
Telehealth enables healthcare providers to deliver certain services remotely using audio and video communication technologies, including phones and computers. In some cases, audio-only visits are also permitted.
Updated CMS Policy (Effective January 1, 2025)
For most telehealth services, patients must be located in an office or medical facility in a rural area within the U.S. However, exceptions apply to specific Medicare telehealth services, which may continue regardless of location:
- Monthly End-Stage Renal Disease (ESRD) Visits – For home dialysis patients
- Acute Stroke Services – Diagnosis, evaluation, or treatment of acute stroke symptoms, including in mobile stroke units
- Mental and Behavioral Health Services – Diagnosis, evaluation, or treatment of mental health disorders, including substance use disorders, provided in the patient’s home
Providers are encouraged to review these guidelines to ensure compliance and to inform patients appropriately.
Tricare West Telemedicine & CMS Telehealth
Reimbursement for audio-only visits will be paid at 80% of the standard in-person rate.o ensure compliance with the updated policies and inform patients accordingly.
For commercial plans and some self-insured plan members, audio-only visits are covered for the diagnosis, evaluation, and treatment of certain mental health conditions until December 31, 2025.