Home stays an originating site
- CAA, 2021 removed geographic and place-of-service limits for behavioral health telehealth [1]
Home / ASP Insights / Behavioral health
Insight · Medicare telehealth, behavioral health
The behavioral health telehealth in-person rule: a 2028 countdown
Short answer: CMS's October 2026 telehealth FAQ puts the in-person visit requirement for home mental health telehealth after December 31, 2027. Patients who start before then are grandfathered into an annual in-person cycle.
1834(m) · 6 months before, 12 after
95, 93, BB, BC
Start by Dec 31, 2027
Rule
Section 1834(m)
Effective
After Dec 31, 2027
Windows
6 / 12 months
POS
10 · 02
Modifiers
95 · 93 · BB · BC
Audience
MH group practices
Seven dates, 2022 to 2028 [1]
CMS's FAQ, updated October 8, 2026: the section 1834(m) in-person requirement is effective after December 31, 2027; until then a Medicare patient can start and continue at home without one [1].
- 1Jan 1, 2022RHC and FQHC behavioral health visits by telecommunications paid under the AIR and PPS
- 2Jan 1, 2024Home telehealth paid at the non-facility rate; POS 10 identifies the home
- 3Oct 1, 2025Shutdown lapse; CMS pays as before, flexibilities applied retroactively
- 4Oct 1, 2026FQHCs and RHCs bill the specific code with 93 or 95, not G2025, for non-behavioral telehealth [4]
- 5Jan 1, 2027Modifiers BB and BC required on telehealth claims; no payment effect
- 6Dec 31, 2027Last day without the in-person requirement for home mental health telehealth
- 7Jan 1, 2028In-person rule applies; geography and facility rules return for non-behavioral telehealth
Two halves, one grandfather clause
New patient: a paid in-person service within 6 months before the first home telehealth service, then within 12 months of each, limited exceptions. A same-specialty colleague may furnish it when the telehealth clinician is unavailable [1].
The windows, in months
Look-back before a first home servicenew patients from Jan 1, 2028
6 months43%
Maximum gap after any telehealth service
12 months86%
Left to onboard without a pre-visitto Dec 31, 2027
14 months100%
061214 months
Pre-visit look-backAnnual intervalGrandfather window
| Patient | Before the first telehealth service | After the first telehealth service, from Jan 1, 2028 |
|---|---|---|
| Started home mental health telehealth on or before Dec 31, 2027 | None; treated as established | One in-person visit every 12 months after Dec 31, 2027 |
| Starts home mental health telehealth on or after Jan 1, 2028 | In-person visit within the prior 6 months | In-person within 12 months of each telehealth service, limited exceptions |
| Seen through an FQHC or RHC while present virtually | Not applied until at least Jan 1, 2028 | Same |
| Seen remotely by hospital staff | Aligned with the PFS policy above | Same |
Takeaway
The grandfather clause is the operating lever. A first home telehealth session by December 31, 2027 skips the 6-month pre-visit and moves straight to the annual cycle.
What stays
Audio-only survives for behavioral health
- From January 1, 2028: when the practitioner can use video and the patient cannot or will not [1]
POS 02 and POS 10
- 10 at home, 02 anywhere else; home pays at the non-facility rate [1]
Modifiers 93 and 95
- 93 synchronous audio-only; 95 synchronous audio and video [4]
FQHC and RHC, proposedThe CY 2027 PFS proposed rule keeps in-person requirements off mental health visits through December 31, 2027 (CAA, 2026 section 6209(c)) [3].
By December 31, 2027: panel, plan, fields
The MLN booklet describes the visit within 6 months of the initial telehealth visit and annually after [2].
1
Count the home-telehealth panelQ4 2026
Every Medicare patient with a POS 10 psychotherapy or E/M claim in 12 months.
2
Fix the claim fieldsQ1 2027
POS 10 or 02, modifier 95 or 93, BB and BC from January 1, 2027; edit live before the first 2027 remittance [1].
3
Schedule the annual in-person visitQ2 to Q3 2027
The first 12-month window starts after December 31, 2027; book it inside 2028 Q1 so a missed visit never blocks a claim.
4
Onboard new patients before the deadlineQ4 2027
A first home session by December 31, 2027 avoids the pre-visit; intake should know the date [1].
5
Run the exception logJan 2028
Each limited exception and colleague-furnished visit, documented [1].
Four checks
Flag every Medicare telehealth patient established or newBy first home date.
Name an owner for each 12-month in-person windowA date inside each window.
Check POS 10 or 02, modifier 95 or 93, BB or BCThe POS and modifier map lays the payer rules side by side.
Keep Medicaid and commercial rules separateSee the behavioral health payer matrix; billing: mental health, psychiatry.
Frequently asked questions
Does Medicare require an in-person visit before mental health telehealth in 2027?
No. The FAQ updated October 8, 2026 says the section 1834(m) in-person requirement is effective after December 31, 2027; through that date a Medicare patient may start and continue at home without one.
What happens to patients who are already in telehealth care when 2028 arrives?
Patients who began home mental health telehealth by December 31, 2027 are established: no 6-month pre-visit, one in-person visit every 12 months after December 31, 2027.
Can another clinician in my group do the in-person visit?
Yes, by a physician or practitioner of the same specialty in the same group practice when the telehealth clinician is not available.
Will audio-only mental health telehealth still be paid after 2027?
Yes, for behavioral health at home: from January 1, 2028 when the practitioner can do audio-video and the patient cannot or does not consent, new and established.
Do FQHCs and RHCs face the same in-person rule?
Not yet. For RHC and FQHC behavioral health visits with the patient present virtually they do not apply until at least January 1, 2028; the CY 2027 PFS proposed rule proposes the same through December 31, 2027.
- CMS Telehealth FAQ, updated October 8, 2026 (posted October 9, 2026)
- CMS MLN901705, Telehealth and Remote Monitoring booklet (December 2025)
- CMS fact sheet: CY 2027 Medicare Physician Fee Schedule proposed rule (July 14, 2026), proposed
- CMS Transmittal 13776, Change Request 14468: distant site telehealth billing in RHCs and FQHCs (effective October 1, 2026)
Checked October 25, 2026. Confirm against the source; items marked proposed may change in the final rule.
Want your Medicare telehealth panel counted before the deadline?
We pull the POS 10 claims, flag patients who need an in-person plan, and check POS and modifier fields against the 2027 rules.