Medicare Telehealth Flexibilities Restored After Government Shutdown

The U.S. House of Representatives approved H.R. 5371, the Continuing Appropriations Act, 2026, on November 12, 2025, passing a Senate-approved bill that ends the 43-day government shutdown. President Trump signed the measure into law on November 12–13, 2025. This action restores Medicare telehealth flexibilities that expired on September 30, 2025, and extends them through January 30, 2026. For healthcare providers, this means they can continue billing for virtual services without the immediate threat of payment disruptions. It also helps patients, especially those in rural or hard-to-reach areas, maintain access to care without needing to travel to a clinic or hospital.

The shutdown stemmed from ongoing disputes between Congress and the White House over fiscal year 2026 spending priorities. It began at midnight on September 30 and dragged on, affecting federal agencies across the board. In healthcare, the timing could not have been worse, as it aligned exactly with the sunset of several temporary Medicare policies designed to support telehealth during and after the COVID-19 pandemic. These policies were first put in place under the CARES Act of 2020, which gave CMS broad authority to waive certain restrictions on remote services. Over the years, Congress extended them through short-term funding bills, but the latest lapse created real operational headaches for providers.

How the Shutdown Disrupted Telehealth Services

When the telehealth flexibilities expired on September 30, 2025, CMS had no choice but to revert to pre-pandemic rules for most services starting October 1. This meant halting reimbursements for non-mental health telehealth claims in traditional Medicare. According to reports from industry groups, telehealth utilization under Medicare Part B saw a noticeable drop in early October, with thousands of missed visits as providers scaled back to avoid non-payment risks.

Providers were caught in a bind. Under the old rules, telehealth was mostly limited to patients in rural health professional shortage areas or at specific sites like hospitals and clinics. Video was often required, and there were strict limits on how many visits could happen per month for certain conditions. For practices that had built their workflows around virtual options—especially smaller ones without extra staff for in-person surges—this reversal led to tough decisions. Some kept offering telehealth but issued notices to patients about potential non-coverage, risking denials later. Others scaled back entirely, which meant longer wait times for in-person slots and higher no-show rates as patients struggled with transportation.

The impact wasn’t uniform. Rural providers, who make up about 20% of Medicare-participating practices, felt it hardest because they had leaned heavily on home-based telehealth to bridge geographic gaps. Urban and suburban offices, while less dependent, still saw ripples in specialties like dermatology and endocrinology, where quick visual assessments or medication adjustments are common via video. Mental health services dodged the worst of it, as those flexibilities were handled separately and remained intact throughout the shutdown. But for everything else, the uncertainty led to a backlog of held claims—CMS instructed its Medicare Administrative Contractors (MACs) to pause processing rather than deny outright, but that only delayed payments, not eliminated the problem.

On top of that, the shutdown idled thousands of federal workers at CMS and HHS, slowing down routine tasks like claim reviews and policy updates. Providers reported delays in everything from prior authorizations to appeals, compounding the financial strain. Estimates from industry groups put the value of held telehealth claims in the billions for October alone, forcing some practices to dip into reserves or delay vendor payments.

Details of the Telehealth Extension in H.R. 5371

The new bill directly addresses these issues by reinstating the key flexibilities retroactively from October 1, 2025, all the way through January 30, 2026. This retroactive reinstatement means providers can now bill and expect payment for services delivered during the lapse period, once CMS issues specific guidance on reprocessing.

Breaking it down, the main changes include:

Patient Location Flexibility: Under the extension, Medicare beneficiaries can receive telehealth from virtually any spot, including their own homes. Before the pandemic, this was restricted to designated originating sites like physician offices in rural areas or mobile units. Removing that barrier opens up care for urban patients with disabilities or transportation issues, and it aligns with how many practices now operate hybrid models.
Communication Technology Options: The rules now allow both audio-video and audio-only interactions. This is a big deal for equity, since surveys show that around 20% of Medicare enrollees—often older adults or those in low-income households—lack reliable high-speed internet for video calls. Simple phone consultations can now qualify for reimbursement, making follow-ups for things like blood pressure checks or post-surgical instructions more feasible.
No Caps on Visit Frequency: For non-behavioral health services, providers aren’t limited to a set number of telehealth sessions per month anymore. This supports ongoing management of chronic conditions, where patients might need weekly or bi-weekly touchpoints. Eligible providers, from primary care physicians to nurse practitioners, physician assistants, and even some therapists, can use established billing codes. Examples include G2012 for brief virtual check-ins and the 99441 through 99443 series for longer telephone evaluations.

The extension also covers the Acute Hospital Care at Home program, which lets hospitals deliver inpatient-level monitoring and treatment remotely. This has been a game-changer for reducing readmissions in conditions like heart failure or COPD exacerbations. Overall, these provisions build on the momentum from 2024, when telehealth accounted for approximately 15-20% of all Medicare outpatient visits, according to CMS utilization reports.

While the bill focuses on telehealth, it ties into broader Medicare stabilizers, like extending the 1.0 work GPCI floor for rural physician payments and the ambulance super rural bonus. These aren’t directly telehealth-related but help maintain service viability in remote areas where virtual care often pairs with transport challenges.

Operational and Financial Impacts on Providers

For doctors and their teams, this extension eases a lot of the pressure built up over the past month. Practices that had to issue Advance Beneficiary Notices (ABNs) to patients—basically warnings that services might not be covered—can now pull those back and process claims normally. The retroactive reinstatement should help with payments for the lapse period, stabilizing cash flow at a time when many are still recovering from inflationary pressures on supplies and staffing.

From a revenue cycle standpoint, RCM teams need to act fast. Auditing October claims will be key to identifying any that were held or partially denied. With telehealth billing, accuracy matters—using the right modifiers, like GT for interactive telecommunications or 95 for synchronous audio-visual, ensures smooth processing. Larger health systems with dedicated telehealth platforms might see quicker rebounds, but independent practices could need extra time to ramp up patient outreach.

Patient-wise, the continuity prevents gaps in care that could lead to worse outcomes down the line. In cardiology, for instance, virtual EKGs or med tweaks keep things on track without ER visits. Similar benefits apply in oncology for symptom monitoring or endocrinology for insulin adjustments. Rural-urban divides show up here too: Data from the Federal Office of Rural Health Policy indicates rural telehealth use was 30% higher pre-lapse, so expect a sharper uptick there as word spreads.

CMS Guidance for Claims Reprocessing

CMS has already signaled its next moves. The agency expects MACs to reprocess affected claims, with some contractors planning to handle batches within about 30 business days of the bill’s signing. That timeline starts now, so payments could hit accounts by mid-December for eligible claims. Providers shouldn’t rush to resubmit everything—wait for the detailed instructions, which should land in the next MLN Connects newsletter or via provider alerts.

Practical steps include logging into the CMS Enterprise Portal to track individual claims or contacting your specific MAC for batch status. For telehealth documentation, keep records clear: Note the modality used, patient consent, and clinical necessity. Behavioral health claims, as mentioned, were never in jeopardy, so those pipelines remain clear.

If issues arise, CMS has set up a dedicated hotline for shutdown-related inquiries, separate from the usual 1-800-MEDICARE line. This setup aims to cut through the backlog without overwhelming standard support.

Pushing for Permanent Telehealth Reforms

This extension is a solid patch, but it’s not a fix. Come February 2026, the clock starts ticking again unless Congress acts. That’s why bills like the Telehealth Modernization Act (H.R. 5081) are gaining traction—they propose multi-year extensions or even permanent status, with built-in reviews every few years to adapt to tech advances and usage patterns.

Advocacy plays a role here. The American Medical Association, American Telemedicine Association, and specialty groups like the American College of Physicians are lobbying hard, often in tandem with rural health coalitions. They’re tying telehealth to bigger conversations, like the pending extension of enhanced ACA premium subsidies, which could expire at year’s end and affect Marketplace plans that overlap with Medicare.

Providers can get involved too—joining comment periods on CMS rules or testifying at congressional hearings. In the meantime, integrating telehealth deeper into electronic health records and training staff on hybrid workflows will pay off. Educating patients on how to access virtual visits, from app setup to coverage checks, builds buy-in.

In the end, H.R. 5371 doesn’t just close out a messy shutdown; it keeps telehealth as a practical tool in the Medicare toolkit. With careful planning, providers can use this window to strengthen their remote care strategies, setting up for whatever comes next in 2026.

Sources: