The Centers for Medicare & Medicaid Services (CMS) has confirmed that several pandemic-era flexibilities for at-home telehealth services under Medicare will expire or be significantly scaled back effective January 1, 2026. The rollback requires many telehealth visits particularly those for non-mental health services to return to originating site requirements, potentially limiting access for rural, elderly, and mobility-impaired beneficiaries who relied on home-based virtual care.

Glimpse:

After multiple extensions, CMS will end the blanket waiver allowing most Medicare telehealth services to be delivered to patients at home without geographic or site restrictions. Starting January 2026, only mental health telehealth, certain chronic care management services, and a limited set of approved codes will retain full home-based eligibility. The decision reflects a return to pre-COVID policy while retaining some expansions made permanent or semi-permanent, creating a mixed impact on access, especially in rural and underserved communities.

The Centers for Medicare & Medicaid Services (CMS) has officially signalled the end of broad pandemic-era telehealth flexibilities for Medicare beneficiaries, with key at-home coverage provisions set to expire or revert on January 1, 2026. The rollback, detailed in the final 2026 Physician Fee Schedule rule released in late 2025, reverses temporary waivers that allowed most telehealth services to be furnished to patients in their homes regardless of geographic location or originating site requirements.

During the COVID-19 public health emergency, CMS temporarily removed restrictions that normally require Medicare telehealth patients to be located at a qualifying originating site (such as a physician office, hospital, or rural health clinic). This flexibility enabled millions of beneficiaries especially those in rural areas, with mobility limitations, or during lockdowns to access care from home via audio-video or, in many cases, audio-only modalities.

While some flexibilities were made permanent including coverage of telehealth for mental health services, certain chronic care management codes, and audio-only visits for established patients the majority of non-mental health telehealth services will revert to pre-2020 rules in 2026. This means patients will generally need to travel to a qualifying site (physician office, outpatient hospital, rural health clinic, etc.) for in-person telehealth encounters unless the service falls under an exception.

The decision has drawn mixed reactions. Patient advocacy groups and rural healthcare providers expressed disappointment, arguing that the rollback will disproportionately affect older adults, those with transportation barriers, and residents of medically underserved areas. Telehealth utilisation data from 2020–2024 showed that home-based visits significantly improved access, reduced no-show rates, and lowered emergency department use for certain chronic conditions.

On the other hand, CMS officials and some physician groups have supported a measured return to traditional rules, citing concerns over fraud risks, quality of care in fully remote settings, and the need to preserve in-person evaluation for complex cases. The agency has committed to ongoing evaluation of telehealth outcomes and has left open the possibility of future expansions if data continues to support safety and efficacy.

Key changes effective January 1, 2026 include:

Reversion to originating site requirements for most non-mental health telehealth services

Continued coverage of mental health telehealth (including audio-only) with no geographic restrictions

Permanent extension of certain chronic care management and virtual check-in codes

Retention of audio-only flexibility for established patients when video is not feasible

Ongoing coverage of telehealth for federally qualified health centres and rural health clinics serving rural patients

The rollback does not affect state Medicaid programmes or commercial insurance plans, many of which have independently extended or made permanent their own telehealth policies. However, for the roughly 65 million Medicare beneficiaries, the change will require many to resume in-person visits for routine specialist consultations previously conducted at home.

“While we recognise the value telehealth brought during the pandemic, we must balance access with safeguards that protect quality and program integrity. This measured approach preserves essential flexibilities while returning to foundational Medicare principles.”