FAQ: Update on Telehealth Flexibilities for SUD Treatment

ASAM has received member inquiries about certain federal telehealth flexibilities that were in place during the COVID-19 public health emergency but ended on September 30, 2025. Below are answers to commonly asked questions about the expiration of those flexibilities and the related impact on treating patients for a substance use disorder (SUD). Plus, download a flowchart here to help you determine eligibility for telehealth services. 

1. As of October 1, 2025, does Medicare require in-person visit(s) for patients receiving telehealth services to treat a SUD or a co-occurring mental health disorder?

NO. The SUPPORT Act of 2018 permanently eliminated geographic restrictions on where telehealth can be delivered in Medicare for the treatment of SUD or a co-occurring mental health disorder and included a patient’s home as an eligible originating site. It is important to note that practitioners rendering the service must be an eligible practitioner, the service must be listed on Medicare’s list of covered telehealth services, and the patient must be in an eligible originating site/location. 

(For purposes of Medicare telehealth coverage, federal regulations define “interactive telecommunications system” to include audio and video equipment, as well as audio-only communication technology for any telehealth service furnished to a patient in their home if the distant site practitioner is technically capable of using interactive audio and video equipment, but the patient is not capable of, or does not consent to, the use of video technology.) 

Note: Services permitted to be delivered via audio-video or audio-only technology at opioid treatment programs (OTPs) are not impacted by the Medicare telehealth waivers that expired on September 30, 2025. Clinicians serving in OTPs should continue to follow Medicare guidance for billing OTP telecommunications services - found here.  

2. As of October 1, 2025, does Medicare require in-person visit(s) for patients receiving telehealth services to treat a mental health disorder?

It depends.

If a Medicare patient is located at an eligible originating site (excluding their home) in a rural area or a rural health professional shortage area, then federal law allows Medicare coverage for mental health services without an in-person visit with the distant site physician/practitioner. Geographic eligibility can be determined here.  

Otherwise, beginning October 1, 2025 (absent future Congressional action), if the patient’s home is the originating site for the mental health visit, then Medicare requires: 

• An in-person visit within 6 months before the first telehealth-based mental health visit; and 
• An in-person visit at least every 12 months thereafter, unless the patient and clinician agree that the risks and burdens of an in-person visit outweigh the benefits.  

The in-person visits prior to and after the telehealth service may be rendered by a clinician in the same specialty or subspecialty as the clinician rendering the telehealth visit.  

It is important to note that regardless of the originating site, a physician/practitioner rendering the service must be an eligible physician/practitioner, and the service must be listed on Medicare’s list of covered telehealth services. 

3. What if I am using telehealth in a RHC or FQHC to treat Medicare patients?

According to HHS, “FQHCs and RHCs can permanently serve as a Medicare distant site provider for behavioral/mental telehealth services. Medicare patients can permanently receive telehealth services for behavioral/mental health care in their home. There are no geographic restrictions for originating sites for Medicare behavioral/mental telehealth services on a permanent basis. Behavioral/mental telehealth services in Medicare can permanently be delivered using audio-only communication platforms. For FQHCs and RHCs, the in-person visit requirement for mental health services furnished via communication technology to beneficiaries in their homes is not required until January 1, 2026.” 

For Medicare telehealth coverage for non-mental health reasons, as of October 1, 2025, FQHCs/RHCs may no longer serve as distant sites. However, they continue to have the ability to be reimbursed for those telehealth services under a special payment rule for RHCs/FQHCs through December 31, 2025.  Click here to learn more. 

4. What about Medicaid and commercial insurance policies?

Each state Medicaid program and commercial insurance carrier sets its own policies related to coverage of telehealth services. Clinicians should consult each about the status of coverage policies and whether those may change with the expiration of federal flexibilities for Medicare beneficiaries. 

5. What about current federal flexibilities allowing practitioners to initiate the prescribing of controlled substances via telemedicine?

Current federal flexibilities allowing prescribers to initiate the prescribing of controlled substances via telemedicine are in place through December 31, 2025. The Sept. 30th expiration of certain Medicare telehealth waivers did not affect this prescribing authority. However, prescribers should examine any applicable state limitations that may impact telemedicine prescribing authorities. 

Clinicians serving in OTPs should continue to follow SAMHSA regulations regarding their authority to use telehealth services for OTP patients. 

For additional information about Medicare’s telehealth coverage policies, click here. 

Disclaimer: The information contained in this document is meant for educational purposes only and should not be used as a substitute for the coverage policies of health insurers. Clinicians should consult each health plan they are contracted with for the latest updates on coverage of telehealth services. 

Questions? Contact advocacy@ASAM.org.