By, Connor Barnhart, MD

Starting October 1, 2025, psychiatrists who treat Medicare patients should be aware of important changes to telehealth coverage. The temporary waiver that allowed patients to begin and continue psychiatric care exclusively via telehealth is ending. Going forward, Medicare will once again require an in-person visit within six months before initiating telepsychiatry and at least once annually thereafter. While this shift is intended to align care standards, many psychiatrists worry it may limit access for patients in rural and underserved areas.

There are, however, limited exceptions. Patients already receiving behavioral health services by telehealth may continue without in-person care when it is clinically inappropriate or impractical, provided this is carefully documented. Additionally, if a practice lacks capacity, in-person visits may be completed by another clinician in the same group. Importantly, audio-only telehealth remains covered for mental health visits, and psychiatrists should continue to track CMS updates as geographic flexibilities could narrow further. The APA is actively advocating for permanent removal of the in-person requirement, citing access barriers.

Key points to keep in mind:

• Six-month in-person visit required before starting Medicare tele-psychiatry; annual follow-up in-person visit thereafter.
• Exceptions apply for established patients when in-person care is not appropriate, or when another group clinician provides the visit.
• Audio-only mental health telehealth remains reimbursable.
• Careful documentation is essential when relying on exceptions.