Congress extended the Medicare telehealth waiver on February 3, 2026, pushing the in-person visit requirement deadline to December 31, 2027. CMS updated its telehealth FAQ on February 26, 2026 to confirm the new date. For therapists who built their Medicare practices entirely on telehealth — and who have never seen certain patients in person — that deadline is not a distant abstraction.
The APA and NASW both published urgent guidance in early 2026 flagging something practices have been missing: grandfathering protects established patients from the 6-month pre-visit requirement, but it does not exempt them from the annual in-person visit once the waiver expires. Knowing who is grandfathered and what that actually protects against is the work to do now, before 2028 arrives and the in-person requirement applies to new intakes who have never heard of it.
What Actually Changed — and What Did Not
The statutory language that created the in-person requirement has not changed. Section 1834(m) of the Social Security Act has required, since the end of the public health emergency, that Medicare beneficiaries receiving telehealth mental health services must complete an in-person, non-telehealth visit within 6 months before their first telehealth session, and then at least once every 12 months thereafter.
What has changed twice is the implementation date. Congress first delayed the requirement to January 1, 2025, then to December 31, 2026, and now — via the February 2026 spending bill — to December 31, 2027. Each extension was a one-time legislative fix responding to access concerns from patient advocates and mental health provider groups.
The extensions have been generous. But Section 1834(m) is still statute. The requirement exists, it is on the books, and the extension does not eliminate it — it postpones it. When the current waiver expires on December 31, 2027, the in-person requirement takes effect automatically unless Congress acts again.
Practices planning their Medicare telehealth operations for 2026 and 2027 should treat December 31, 2027 as a real operational date, not a soft deadline that will be extended again. Preparing now creates optionality. Waiting creates a scramble.
Who Is Grandfathered and What That Actually Protects
The APA and NASW guidance published in February 2026 clarified the grandfathering rules that took effect with the original delayed implementation. The key facts:
Patients who began receiving mental health telehealth services on or before December 31, 2027 are considered established patients under the in-person requirement. These patients do not need to complete the 6-month pre-visit before receiving telehealth services. They skip the pre-visit requirement entirely.
However, established patients are not exempt from the 12-month annual in-person visit rule. Once the waiver expires, grandfathered patients will need to complete an in-person visit at least once every 12 months to continue receiving telehealth mental health services. This requirement applies from 2028 forward.
New patients enrolled after December 31, 2027 face the full statutory requirement: in-person visit within 6 months before the first telehealth session, then annually.
The practical upshot: for existing patients, the near-term compliance action is planning for annual in-person visits beginning in 2028. For new patients you see in 2028 and beyond, the intake workflow changes significantly.
The Group Practice Exception — and How It Works
If you are in a group practice, the in-person visit requirement is more flexible than it looks for solo practitioners. Under Section 1834(m), the required in-person visit does not have to be with the therapist providing telehealth services. It can be completed by any Medicare-enrolled clinician within the same group practice.
This matters for practices that employ or contract with multiple providers. A new patient seen in person for an evaluation by a psychiatrist, primary care physician, or another licensed therapist in the same group can satisfy the in-person requirement before their telehealth sessions begin with a different clinician in the group.
Group practices operating across a network — including those using a centralized intake structure — should confirm with their billing staff and legal counsel whether their entity structure qualifies as a "group practice" under the applicable CMS definitions. The exception is substantive but requires the structural condition to actually be met.
Documenting the Access Barrier Exception
CMS has indicated that access barriers may justify exceptions to the in-person requirement, but the bar is documentation-specific. Accepted categories include:
- Mobility impairment — the patient's physical condition makes in-person travel to a clinical setting impossible or medically contraindicated
- Geographic barriers — the patient is located in an area where the nearest in-person provider is more than a defined distance away
- Transportation unavailability — the patient lacks reliable transportation and has no viable alternative
The exception requires explicit, contemporaneous chart documentation. A general note that the patient "lives far away" will not satisfy an audit. Documentation should name the specific barrier, explain why it prevents in-person care, and be updated at each treatment period review.
For practices serving rural, homebound, or medically complex Medicare patients, building a documentation protocol now — rather than trying to reconstruct chart notes in 2028 — is far cleaner. Build the field into your intake assessment and periodic review templates.
LMFTs, LPCs, and the New Cohort Who Have Not Navigated This Before
Licensed marriage and family therapists and licensed professional counselors became eligible to bill Medicare for outpatient mental health services on January 1, 2024 — a long-overdue expansion that brought a large cohort of clinicians into the Medicare system for the first time.
This cohort has existed as Medicare providers for two years, the entire duration of which has been under the extended waiver. Many LMFTs and LPCs credentialed with Medicare and started seeing patients without ever facing the in-person requirement because the waiver was already in place when they enrolled. They have not had to design around it, train staff on it, or explain it to patients.
That changes in 2028. LMFTs and LPCs seeing Medicare patients exclusively via telehealth — without any established in-person workflow — need to prepare as much as any other provider type. The provider eligibility expansion was a significant access win; the in-person requirement applies equally.
What Practices Should Be Doing Now
The 2027 deadline is long enough that it does not feel urgent. That framing is a compliance risk.
Audit your panel by grandfathering status. Pull every active Medicare telehealth patient and categorize them: established on or before December 31, 2027 (grandfathered from pre-visit, subject to annual in-person from 2028), or newer. Understand what each group needs when the waiver expires.
Design your annual in-person protocol. For grandfathered patients, the 12-month annual visit will be required beginning in 2028. What does that look like in your practice? Where do patients come in? How do you schedule it? Do you have adequate physical capacity? These questions are easier to answer in 2026 than in January 2028.
For new intakes, plan the pre-visit workflow. After December 31, 2027, new Medicare patients must complete an in-person visit before their first telehealth session. Where does that happen? With whom? If you are a solo telehealth-only practice, you may need to partner with a local provider to complete initial in-person evaluations, or reconsider your capacity to accept new Medicare intakes.
Check whether you qualify for the group practice exception. If your practice structure allows in-person visits to be completed by a colleague in the same group, confirm that arrangement is compliant and documented before you rely on it.
Monitor CMS guidance. CMS may release further rulemaking through 2026 and 2027 on documentation and enforcement details. Subscribe to your professional association's policy updates. Additional guidance is expected before 2028.
VibeCheck.luxury's documentation engine logs session types and generates compliant records — if you are using it for your Medicare documentation, ensure that in-person visit records, access barrier notations, and the relationship between telehealth and qualifying in-person visits are captured clearly in the chart structure.
FAQ
What is the current status of the Medicare telehealth in-person requirement?
The requirement exists in statute (Section 1834(m) of the Social Security Act) but is suspended until December 31, 2027, under the spending bill signed February 3, 2026. CMS confirmed this date in a FAQ update on February 26, 2026. When the suspension expires, new Medicare patients will require an in-person visit within 6 months before their first telehealth mental health service, and then annually.
Are patients I have been seeing via telehealth since 2024 grandfathered?
Patients who began receiving mental health telehealth services on or before December 31, 2027 are considered established patients and do not need to complete the 6-month pre-visit requirement. However, they will still need at least one in-person visit every 12 months after December 31, 2027 to continue receiving telehealth mental health services. Grandfathering eliminates the pre-visit requirement; it does not eliminate the annual in-person rule.
What if a patient cannot come in person due to mobility or location?
CMS recognizes access barrier exceptions, but they require specific chart documentation. Acceptable barriers include mobility impairment that makes travel medically contraindicated, geographic distance from any in-person provider, and transportation unavailability. The documentation must be explicit and contemporaneous — recorded at the time the barrier is identified, not reconstructed later. General notes about patient preference or distance alone are not sufficient.
Does the in-person visit have to be with me, or can another provider in my practice do it?
Under Section 1834(m), the qualifying in-person visit can be completed by any Medicare-enrolled clinician within the same group practice. If your practice structure qualifies as a group, a colleague can complete the initial in-person evaluation before a patient begins telehealth sessions with you. Confirm your entity structure meets the group practice definition under applicable CMS guidance.
What does this mean for LMFTs and LPCs who started billing Medicare in 2024?
LMFTs and LPCs became eligible to bill Medicare on January 1, 2024, and the waiver has been in place throughout their entire Medicare tenure. When the waiver expires on December 31, 2027, the requirement applies to them on the same terms as all other eligible providers. New patients seen after that date require the pre-visit; established patients require the annual in-person visit.