The Big Impact of a Government Shutdown on Medicare Part B: Telehealth for Physicians

Reversion to Pre-Pandemic Telehealth Rules

The most significant effect on physicians is the expiration of the PHE-era Medicare telehealth waivers due to the lack of an extension by Congress, which often coincides with the shutdown. This has caused Medicare Part B coverage for telehealth services to largely revert to pre-pandemic statutory restrictions, creating immediate limitations for both physicians and beneficiaries.  

Key restrictions now in effect for most services include:

• Geographic and Originating Site Limits: Telehealth services are generally restricted to Medicare beneficiaries in rural areas and must be received at an eligible originating site (such as a clinic or hospital), rather than the patient's home.  

• Audio-Only Restriction: Coverage for audio-only telehealth services is significantly curtailed, with most no longer being reimbursable (an exception remains for certain behavioral and mental health services).  

• Limited Eligible Practitioners: The expanded list of practitioner types eligible to bill for telehealth services has been reduced.  

Exception for Mental and Behavioral Health: Telehealth for mental and behavioral health services retains some of the extended flexibilities and generally does not have the same geographic or originating site restrictions.  

Exception for ACOs: Clinicians in certain Medicare Shared Savings Program Accountable Care Organizations (ACOs) may continue to provide and be reimbursed for covered telehealth services to eligible beneficiaries in their homes, regardless of geographic restrictions, as this is authorized by pre-existing law.  

Physician Action: Due to the uncertainty of future retroactive coverage by Congress, physicians who continue to provide non-covered telehealth services are advised to consider issuing an Advance Beneficiary Notice of Noncoverage (ABN) to patients, informing them they may be responsible for the cost if Medicare denies the claim.