On July 14, 2025, the Centers for Medicare & Medicaid Services (“CMS”) released the CY 2026 Medicare Physician Fee Schedule (“PFS”) proposed rule. Several of the PFS proposals are related to telehealth, signaling a continued investment and interest in telehealth policies and use post the COVID-19 pandemic. The proposed rule does not address or discuss the continued coverage of telehealth services via the pandemic waiver flexibilities, as this coverage was established through legislation unrelated to CMS’s PFS rulemaking.
Telehealth Proposal Overview
The proposed rule aims to streamline the overall processes for receiving services through telehealth. Among the most significant proposals are the permanent removal of frequency limitations for subsequent inpatient visits, nursing facility visits and critical care consultations delivered via telehealth. CMS also proposes to eliminate the distinction between provisional and permanent additions to the Medicare Telehealth Services List and instead focus solely on whether the service can be delivered through two-way, real-time interactive audio-visual technology.
Another notable shift includes CMS’s proposal to permanently adopt a revised definition of “direct supervision” that permits virtual supervision through real-time audio-visual communication (i.e., audio-only supervision will not suffice). This definition would apply to certain services only, including applicable incident-to services, diagnostic tests, pulmonary rehabilitation services, cardiac rehabilitation and intensive cardiac rehabilitation services. The new “direct supervision” permissions would not extend to services that have a global surgery period of 10 or 90 days, and CMS is seeking input on whether to additionally exclude services with a 0-day global surgery period, citing concerns around quality and patient safety.
CMS additionally announced its intent to let the current policy allowing virtual supervision of residents by teaching physicians expire at the end of 2025. CMS proposes a return to pre-public health emergency requirements, which would mandate that services provided within Metropolitan Statistical Areas have in-person supervision of care. However, the proposed rule would allow virtual supervision of care to continue in rural areas, per the CY 2021 PFS Final Rule.
Importantly, telehealth stakeholders should be mindful that the proposed rule above is specific to Medicare reimbursement for telehealth services. The proposed rule and stated intentions do not alter state-specific professional practice rules for the provision of telehealth services. Telehealth providers, therefore, need to consider compliance with both the conditions for reimbursement and any applicable state-specific rules, requirements or limitations for virtual supervision, permitted telehealth technology, etc.
Practical Takeaways
- Stakeholders should consider submitting comments on these proposed changes.
- Consider which proposals would affect your current systems and formulate plans to adjust accordingly when the Final Rule is published.
- Legislation is needed to continue current telehealth coverage flexibilities beyond September 30, 2025.
- The proposed rule does not alter or replace state-specific professional practice rules for the provision of telehealth services.
If you have questions or would like additional information about the Physician Fee Schedule proposed rule or telehealth generally, please contact:
- Chris Eades at (317) 977-1460 or ceades@hallrender.com;
- Regan Tankersley at (317) 977-1445 or rtankersley@hallrender.com; or
- Your primary Hall Render contact.
Special thanks to Summer Associate Meredith Johnson-Monfort for her assistance in the preparation of this article.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot give legal advice outside of an attorney-client relationship.
