On February 3, 2026, the Consolidated Appropriations Act of 2026 was signed into law, and with it Medicare's telehealth flexibilities — home as an originating site, audio-only visits, therapist-furnished telehealth — were extended through December 31, 2027. After a fall in which those flexibilities actually lapsed for weeks during the government shutdown, practices finally have something they have not had since the pandemic began: a telehealth planning horizon measured in years rather than months.
This guide covers what the extension includes, what is now permanent regardless of it, and a clarification that matters to every practice running remote monitoring: RPM and RTM were never part of this drama.
What did the Consolidated Appropriations Act of 2026 change?
The Act extends the major pandemic-era Medicare telehealth flexibilities through December 31, 2027. The package includes:
- Home as an originating site. Beneficiaries can continue receiving telehealth at home rather than traveling to a qualifying facility.
- Audio-only telehealth. Visits conducted by telephone, without video, remain billable where permitted.
- Therapists as distant-site practitioners. Physical therapists, occupational therapists, and speech-language pathologists can continue furnishing telehealth services.
- FQHCs and RHCs as distant-site providers. Federally qualified health centers and rural health clinics keep their distant-site billing authority.
- The delayed in-person requirement for tele-behavioral health. The requirement for periodic in-person visits alongside tele-mental-health care remains postponed.
The practical effect: the telehealth service lines practices have been running since 2020 can continue, on the same basic terms, for nearly two more years.
What does the extension mean for behavioral health?
Tele-behavioral health receives two distinct protections in the package. The postponed in-person requirement means Medicare's mandate for periodic in-person visits alongside tele-mental-health care remains delayed through the extension window — patients receiving behavioral care remotely do not need to be brought into the office to keep that care billable. And the audio-only flexibility matters disproportionately in behavioral health, where a meaningful share of encounters happen by telephone for patients without reliable video access.
One caution for program design: postponed is not repealed. The in-person requirement remains on the books with a delayed effective date, so behavioral programs built for the long term should keep an eventual in-person touchpoint in their model rather than assuming the delay is permanent.
How did the flexibilities lapse in the first place?
The road to February 3 was not smooth, and the sequence is worth recording because it shaped how practices now think about telehealth risk.
The flexibilities had been extended in short legislative increments for years, each extension arriving near a deadline. On October 1, 2025, the pattern broke: the government shutdown began and the flexibilities lapsed outright. For weeks, the statutory authority behind home-based and audio-only Medicare telehealth simply was not there.
The November 2025 continuing resolution restored the flexibilities retroactively and carried them to January 30, 2026 — meaning services furnished during the lapse window became payable after the fact. The Consolidated Appropriations Act of 2026, signed February 3, then replaced the cycle of short-term patches with an extension through the end of 2027.
Two lessons survive the episode. First, telehealth authority tied to temporary statute can and did lapse — contingency planning is not paranoia. Second, the current extension, while long, is still finite: December 31, 2027 is now the date to watch.
What is permanent, regardless of the extension?
Separate from the statutory extension, the CY 2026 Physician Fee Schedule final rule — in effect since January 1, 2026 — made several telehealth-adjacent policies permanent:
- Direct supervision via real-time audio-video. A supervising practitioner can meet direct-supervision requirements through interactive audio-video rather than physical presence.
- Teaching-physician virtual presence. Teaching physicians can continue meeting presence requirements virtually for covered services.
- Removal of frequency limits. CMS eliminated frequency limitations that had capped how often certain telehealth services could be billed.
- The originating-site facility fee, set at $31.85 for 2026.
One more 2026 decision matters for billing teams: Medicare declined to separately pay the AMA's new telemedicine E/M code family (98000–98015). Practices bill telehealth visits using the established E/M codes with the applicable telehealth conventions, not the new code set.
The distinction between the two buckets is the strategic point. The permanent policies are load-bearing walls; the extended flexibilities are on a lease that runs through 2027. Practices building telemedicine programs should know which parts of their model rest on which.
Was remote patient monitoring ever at risk?
No — and this deserves to be stated as plainly as possible, because the confusion was widespread through the fall of 2025.
Remote patient monitoring and remote therapeutic monitoring are care-management services under the Physician Fee Schedule. They are not statutory "telehealth" services, so the expiration dates, the October lapse, and the retroactive restoration never applied to them. CMS reiterated the distinction in the CY 2026 final rule. While telehealth visits spent October in legal limbo, RPM device-supply and management billing continued exactly as before.
The same logic protects remote monitoring going forward: the December 31, 2027 sunset on the telehealth extension is not an RPM deadline. Practices weighing an investment in remote monitoring can plan on the fee schedule's ordinary annual rulemaking cycle, not on appropriations politics. The 2026 monitoring rules themselves — including the new short-duration billing codes that took effect January 1 — are covered in our guide to the 2026 RPM and RTM changes.
How do the 2026 payment updates fit into this picture?
The same CY 2026 final rule that made the supervision and teaching-physician policies permanent also set the year's payment parameters, and two of them are relevant to virtual care planning.
First, the conversion factor rose — and split in two for the first time: $33.5675 for qualifying APM participants (a 3.77% increase) and $33.4009 for everyone else (a 3.26% increase), both incorporating the 2.5% statutory update Congress enacted in 2025.
Second, the rule's new −2.5% "efficiency adjustment," applied broadly across the fee schedule, explicitly exempts evaluation and management services, care management, telehealth, and time-based codes. The services that make up a virtual care program — from telehealth visits to remote monitoring — were left out of that cut by design.
Neither change alters the telehealth statute's timeline. Together, though, they mean the payment ground under virtual care held steady, and modestly improved, heading into the two-year extension window.
What should practices do with a 2027 horizon?
Map your telehealth volume to its legal basis. Sort your virtual service lines into three buckets: permanent policy (supervision, teaching-physician rules), extended-through-2027 flexibility (home originating site, audio-only, therapist telehealth), and remote monitoring (unaffected by either). The middle bucket is the one with a sunset date.
Treat audio-only deliberately. Audio-only billing survives through 2027, but it is the flexibility most often questioned in policy debates. Practices with heavy audio-only volume should track their mix and be ready to shift toward video where clinically appropriate.
Use the runway to build, not to wait. Two years is long enough to justify investment in virtual care infrastructure — scheduling, documentation, and hybrid visit workflows — rather than another year of month-to-month caution.
Put December 31, 2027 on the compliance calendar now. If the pattern of the past few years holds, the next extension debate will run close to the deadline. Practices that documented their telehealth dependency in 2025 navigated the lapse better than those that discovered it in real time.
Keep remote monitoring in its own lane. Because RPM and RTM sit outside the telehealth statute, they can serve as the stable backbone of a virtual care strategy while the telehealth provisions cycle through Congress.
Verify the billing conventions, not just the authority. The extension preserves what can be furnished; it does not change how it is coded. With Medicare declining to pay the new 98000-series telemedicine codes separately, billing teams should confirm their claim conventions — established E/M codes, applicable modifiers, place-of-service rules — against current MAC guidance rather than assuming the new code set applies.
The bottom line
The Consolidated Appropriations Act of 2026 turned Medicare telehealth from a quarterly cliffhanger into a program with a two-year runway, and the CY 2026 fee schedule quietly made several of its supporting policies permanent. The flexibilities that practices rely on — home as originating site, audio-only, therapist telehealth, FQHC and RHC billing — are secure through December 31, 2027. Remote monitoring never needed the rescue. The practices best positioned for 2028 will be the ones that spent this runway building durable virtual care operations instead of watching the countdown clock.
This article is general billing information, not billing, legal, or medical advice. Verify current rates and payer policies against the CMS Physician Fee Schedule and your MAC before billing.
