Minds → Telehealth → What in-person visit rules apply to mental health telehealth under Medicare? Answer in under 100 words. Cite only eCFR (www.ecfr.gov) sources.

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What in-person visit rules apply to mental health telehealth under Medicare? Answer in under 100 words. Cite only eCFR (www.ecfr.gov) sources.

For mental health telehealth furnished to a beneficiary in their home after the COVID-19 emergency period, Medicare Part B pays only if the distant-site physician or practitioner furnished an in-person item or service, without use of telehealth, for which Medicare payment was made within 6 months prior to the initial telehealth service and at least once within 12 months of each subsequent telehealth service, per 42 CFR § 410.78(b)(3)(xiv).

Last verified: 2026-08-28 · Sources checked: 1/1 resolving · Next scheduled review: 2026-11-26

Details / How it works

Under 42 CFR § 410.78(b)(3)(xiv), the home of a beneficiary is a permissible originating site for mental health disorder diagnosis, evaluation, and/or treatment during the period beginning the first day after the end of the emergency period defined at § 400.200 and ending December 31, 2024, with this geographic exception extended to mental health services furnished on or after January 1, 2025 under § 410.78(b)(4)(iv)(D).

Payment is conditioned on prior in-person care. The distant-site practitioner must have furnished an in-person, non-telehealth item or service for which Medicare payment was made (or would have been made) within 6 months before the initial telehealth service, and at least once within 12 months of each subsequent telehealth service, per § 410.78(b)(3)(xiv)(A)–(B).

Numbers & thresholds

Requirement	Timeframe	Citation
In-person service before initial mental health telehealth visit	Within 6 months prior	§ 410.78(b)(3)(xiv)(A)
In-person service before each subsequent visit	At least once within 12 months	§ 410.78(b)(3)(xiv)(B)
In-person service before initial and subsequent visits (post-Jan. 1, 2025)	Within 6 months prior to each	§ 410.78(b)(4)(iv)(D)

Exceptions & edge cases

The 6- and 12-month in-person requirements of § 410.78(b)(3)(xiv)(A) and (B) may be met by another physician or practitioner of the same specialty and subspecialty in the same group, if the furnishing practitioner is unavailable, under § 410.78(b)(3)(xiv)(C). The 12-month requirement may be skipped for a particular 12-month period when the practitioner and patient agree the risks and burdens of an in-person service outweigh the benefits, provided the practitioner documents the reason in the patient's medical record.

Sources

[1]U.S. Government Publishing Office / Centers for Medicare & Medicaid Services — 42 CFR 410.78 — Medicare telehealth services — conditions for payment · as of 2026-08-28

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