Telehealth billing spent the last few years on a roller coaster. Pandemic rules made almost everything billable, then those rules kept coming up for expiration, getting extended at the last minute, lapsing, and getting restored. Heading into 2026, a lot of practices were not sure what they could still bill. Here is where things actually landed, which payers still reimburse, and how to bill telehealth without guessing.
How We Got Here
During the public health emergency, Medicare and most payers loosened the rules on telehealth. Patients could be seen at home, geographic limits went away, more provider types could bill, and audio-only visits counted. Practices built telehealth into how they work.
Then those flexibilities were set to expire, and the last stretch got messy. The rules lapsed during a government funding gap, got restored with retroactive coverage, and came up against another deadline at the end of January 2026. For a while, no one could say for certain what 2026 would look like.
Where Medicare Landed for 2026
After all the back-and-forth, Congress extended the main Medicare telehealth flexibilities through December 31, 2027. So for now, most of what practices got used to billing is still billable.
What You Can Still Bill Through 2027
Under the extension, Medicare patients can still be seen by telehealth in their homes, without the old geographic restriction that limited telehealth to rural areas. The expanded list of provider types, including physical therapists, occupational therapists, speech-language pathologists, and audiologists, can still furnish and bill telehealth. Federally Qualified Health Centers and Rural Health Clinics can still serve as the distant site. Audio-only visits for non-behavioral care still count. These run through the end of 2027 unless Congress acts again.
What Became Permanent
A few things are locked in past the deadline. Behavioral and mental health telehealth no longer carries geographic or originating site limits, so those patients can be seen at home permanently. Audio-only is a permanent option for behavioral health in the home. Certain frequency limits on inpatient and nursing facility telehealth visits were removed for good. Virtual direct supervision and virtual teaching physician presence for telehealth services also became permanent.
The One Catch on Behavioral Health
There is an in-person rule attached to behavioral health telehealth that keeps getting pushed back. As it stands, the requirement for an in-person visit around the start of behavioral telehealth is set to apply after the end of 2027. So through 2027, that in-person visit is not required, but it is one to watch.
What Happens After 2027
The extension buys time, it does not settle the question. If Congress does not act again, on January 1, 2028 the temporary flexibilities fall away and Medicare telehealth reverts toward the pre-pandemic rules: geographic limits return, the home stops counting as an originating site for most care, and the provider list narrows. Practices building telehealth into their long-term plans should treat the end of 2027 as a real date, not a formality.
Commercial & Medicaid Payers Are Their Own Story
Medicare gets the headlines, but it is not the whole picture. Commercial insurers and state Medicaid programs set their own telehealth rules, and they do not all match Medicare.
Commercial Payers
Many commercial payers kept telehealth coverage after the pandemic, but the terms vary by plan. Some cover video and audio-only the same as an in-person visit. Others pay less for telehealth, cover only certain services, or require specific modifiers and place-of-service codes. The only way to know is to check each payer’s telehealth policy rather than assuming it follows Medicare.
Medicaid
Medicaid telehealth coverage is set state by state, and the differences are wide. Some states cover a broad range of telehealth services and audio-only visits. Others are more limited. A practice billing Medicaid across state lines has to know each state’s rules.
How to Bill Telehealth Cleanly in 2026
With the rules where they are, a few habits keep telehealth claims paid.
Use the Right Place-of-Service & Modifiers
Telehealth claims depend on the correct place-of-service code and modifiers to show the service was virtual and where the patient was. Getting these wrong is a common denial. Confirm what each payer wants, since they do not all agree.
Verify Coverage Before the Visit
Because commercial and Medicaid rules vary, checking a patient’s telehealth benefit before the visit prevents a denial after it. This is the same habit that protects any claim, applied to a service where the rules shift often.
Document Location & Consent
The record should show where the patient was, that the visit was by telehealth, and that the patient agreed to it. When audio-only is used, the note should reflect that too, since some payers treat it differently.
Watch the Dates
The 2027 deadline is real. Practices that track the expiration dates will not get caught billing a flexibility that lapsed. Keeping an eye on the rules is part of billing telehealth now.
The Takeaway
Telehealth billing in 2026 is more settled than it felt at the start of the year. Medicare extended its main flexibilities through the end of 2027, made a handful of behavioral health and supervision rules permanent, and left a 2028 cliff for Congress to deal with later. Commercial and Medicaid payers each set their own terms, so coverage still has to be checked plan by plan. Bill with the right codes, verify benefits before the visit, document the details, and watch the deadlines. Do that, and telehealth stays a paid service instead of a denied one.
