Q: Does Medicare make me see my therapist in person before online therapy?
A: No — not in 2026. The in-person requirement exists in statute, but its start date has been pushed repeatedly and now reads:
"Payment may not be made… for telehealth services furnished on or after January 1, 2028… unless such physician or practitioner furnishes an item or service in person… within the 6-month period prior to the first time the physician or practitioner furnishes such a telehealth service."¹
The date has been substituted five times by five separate public laws, most recently in February 2026.¹ Anyone telling you the requirement applies today is reading an older version — and, unusually, that includes one of Medicare's own booklets.
The trap: CMS contradicts itself
CMS's Telehealth & Remote Monitoring booklet (December 2025) states flatly: "You must conduct an in-person visit within 6 months of the initial telehealth visit and annually thereafter," with no effective date attached.² That sentence is on cms.gov today and it is wrong twice over — it omits the date, and the statute says prior to the first telehealth service, not of it.
CMS's own Telehealth FAQ, updated 26 February 2026, is later and specific: the requirement is "effective after December 31, 2027."³ Between a general booklet and the statute, follow the statute.
The part with a deadline on it, for you
Here is a real reason to act rather than wait. CMS says it "do[es] not believe this requirement applies to beneficiaries who began receiving mental health telehealth services in their homes prior to January 1, 2028" — those patients "will be considered established and will instead be required to have at least one in-person visit every 12 months after December 31, 2027."³
So starting home telehealth therapy before 1 January 2028 skips the six-month look-back entirely and leaves you on the lighter annual rule.
Two honest limits on that. It is CMS guidance, not statute — 42 U.S.C. §1395m(m)(7)(B) contains no grandfather clause. And grandfathered does not mean exempt: you still need one in-person visit every 12 months after the end of 2027.
What is permanent, and what is not
Mental health telehealth is permanent. CMS: "We cover telehealth for behavioral and mental health on a permanent basis."⁴ And critically for California's rural counties: "There are no geographic or place of service restrictions for behavioral health telehealth services. Beneficiaries, including those in both rural and urban areas, can receive behavioral health telehealth services in their homes."⁵
Audio-only counts where the practitioner can do video but you cannot use it or do not consent to it.⁶ That is the provision that makes this work without broadband.
Everything else is temporary. The general telehealth flexibilities run through 31 December 2027. From 1 January 2028, except for behavioral health, patients generally must be in a medical facility in a rural area, and physical therapists, occupational therapists, speech-language pathologists and audiologists lose telehealth billing.⁷ Mental health is the carve-out that survives.
One limit on your therapist: clinical psychologists, clinical social workers, MFTs and MHCs may bill for individual psychotherapy by telecommunications but "may not seek payment for medical evaluation and management services."⁸
Do this: if you use or want to use Medicare telehealth for therapy, start before 1 January 2028 — on CMS's stated position that puts you in the established-patient rule and skips the six-month in-person visit entirely. Then diarise one in-person visit a year from 2028 onward. If a plan or a provider tells you an in-person visit is required now, ask them to cite the effective date, and point at 42 U.S.C. §1395m(m)(7)(B). Does Medicare cover an MFT or LPCC? → · In person vs telehealth →
Sources
- 42 U.S.C. §1395m(m)(7)(B)(i) — ssa.gov. The 2028 date was substituted by Pub. L. 119-75, §6209(d)(1) (February 2026), the fifth such substitution; earlier substitutions were made by Pub. L. 117-328, 118-158, 119-4 and 119-37.
- CMS, Telehealth & Remote Monitoring, MLN901705, December 2025, p. 8 — cms.gov. We cite this to warn you off it, not to rely on it.
- CMS, Telehealth FAQ, updated 26 February 2026, Q5 — cms.gov. See also 42 CFR §410.78(b)(3)(xiv)(A)–(C) — ecfr.gov — which still carries superseded 2024–2025 dates; the statute controls.
- CMS, Medicare & Mental Health Coverage, MLN1986542, March 2026, p. 7 — cms.gov.
- CMS Telehealth FAQ (26 February 2026), Q11.
- CMS Telehealth FAQ (26 February 2026), Q6; MLN901705 (December 2025), p. 7.
- CMS Telehealth FAQ (26 February 2026), Q1–Q2.
- 42 CFR §410.78(e)(1) — ecfr.gov.
All sources read on 18 August 2026. This is a date Congress has moved five times; we will re-check it before each January and correct this page the same day if it moves again.