Key Takeaways
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Starting October 1, 2025, Medicare requires an in-person mental health visit at least once every 12 months to maintain eligibility for telehealth-based behavioral services.
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You can take steps now to prevent any disruption in your care, especially if you rely on virtual therapy sessions.
What Changed: Understanding the In-Person Visit Rule
Medicare has permanently expanded telehealth coverage for mental health services, but with a critical condition: as of October 1, 2025, you must see your provider in person at least once every 12 months to continue receiving mental health services via telehealth. This applies whether you’re getting care at home or another remote setting.
This in-person visit requirement was introduced to balance access with clinical oversight, but if you’re not prepared, it could affect your continuity of care.
Who This Rule Applies To
The rule applies to you if:
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You are receiving mental health services under Medicare Part B
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Your care includes services like psychotherapy, counseling, medication management, or psychiatric evaluations
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You are using telehealth to receive these services at home or outside of a medical facility
The rule does not apply if you’re getting care in a hospital or facility where telehealth rules are already governed differently.
What Counts as a Qualifying In-Person Visit
The in-person visit must:
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Be with the same provider (or a provider in the same practice) who offers you telehealth services
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Occur within 12 months of your first telehealth session and then every 12 months thereafter
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Include an actual face-to-face, in-office appointment (not via phone or video)
Missed or skipped visits could mean your telehealth coverage is suspended until a qualifying in-person visit is completed.
Exemptions and Special Circumstances
You may be exempt from the in-person requirement if you meet specific conditions:
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You have documented, persistent transportation challenges
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You live in a rural area with limited access to providers
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You’re receiving care from a provider who attests that an in-person visit would be detrimental to your condition
In these cases, Medicare may allow telehealth-only care on a case-by-case basis, but the exemption must be documented and approved by your provider.
How to Prepare Now
Here are steps you should take in 2025 to ensure your mental health care stays consistent:
1. Confirm Your Provider Is Medicare-Approved
Not every therapist or counselor accepts Medicare. Make sure your provider is enrolled in Medicare and authorized to deliver both in-person and telehealth mental health services.
If you’re unsure, ask your provider directly or search the official Medicare provider database.
2. Schedule Your In-Person Visit Before October 1, 2025
If your last mental health visit was remote and not followed by an in-person session, schedule a qualifying visit before the rule takes effect. This will reset your 12-month eligibility window and allow your telehealth services to continue uninterrupted.
3. Add Reminders for Future Visits
Since you’ll need an in-person session every 12 months, add recurring calendar reminders. Some providers also offer automatic alerts, so ask if they can notify you when you’re due.
4. Ask Your Provider to Document Exceptions
If attending in-person visits would be unsafe or impossible, talk to your provider about documenting an exception. Medicare accepts exceptions under specific conditions, but they must be justified in your medical record.
5. Coordinate With Transportation Services if Needed
If travel is your barrier, look into transportation options that work with Medicare-covered services. Some areas offer rideshare vouchers or senior transit programs you can explore.
Impact on Different Types of Mental Health Services
Not all services are affected in the same way. Here’s how the rule may impact specific types of care:
Psychotherapy and Counseling
Talk therapy via telehealth continues to be covered, but only if you’ve had an in-person session with the same provider (or their colleague) within the past year.
Medication Management
If your psychiatrist or prescribing provider manages your medications through telehealth, they must also meet the in-person rule to maintain that coverage.
Psychiatric Evaluations
Initial psychiatric evaluations can be done via telehealth, but a follow-up in-person session will be required to maintain the treatment plan.
Intensive Outpatient or Partial Hospitalization Programs
These programs are usually facility-based. The in-person rule doesn’t change their core structure but may affect any virtual components of aftercare or follow-up.
Preventive Screenings
Annual depression screenings and substance use assessments done via telehealth must be supported by an in-person visit every 12 months.
What Happens If You Miss the Deadline
If you fail to meet the in-person requirement:
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Medicare may suspend telehealth coverage for mental health services
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You could be responsible for 100% of the cost of virtual therapy until you complete the in-person visit
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Any future claims for telehealth sessions could be denied retroactively
To avoid this, don’t delay scheduling your next in-person session, especially if you haven’t had one since 2024.
How Telehealth Still Supports Mental Health Access
Despite this in-person requirement, telehealth continues to be a valuable option for many. It allows you to:
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Get therapy from home
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Meet with specialists outside your geographic area
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Maintain care during inclement weather, illness, or mobility limitations
But the rule emphasizes that at least some face-to-face contact is still necessary to ensure clinical safety and continuity.
Medicare Advantage and the In-Person Requirement
If you have a Medicare Advantage plan, the in-person visit requirement still applies because it is a federal mandate. However, some plans may offer:
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Reminders and tracking tools to help you stay compliant
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Additional virtual support between visits
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Transportation assistance to attend in-person appointments
Always check with your plan to confirm how they handle the 12-month rule.
The Role of Your Primary Care Provider
Your primary doctor can also help coordinate:
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Referrals to in-network mental health providers
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Documentation if you’re requesting an exception
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Updates to your care plan to ensure compliance with Medicare rules
Staying in touch with your primary care provider ensures all parts of your care remain in sync.
Medicare’s Long-Term Commitment to Telehealth
Medicare began expanding telehealth in 2020 and made many of those changes permanent. In 2025, you continue to benefit from:
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Permanent telehealth coverage for mental health services
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Audio-only services in select situations
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Broader provider eligibility including therapists, counselors, and psychologists
But the in-person visit rule is the trade-off for making virtual access a lasting part of Medicare’s mental health system.
Make This Rule Work for You
You don’t have to choose between convenience and compliance. With a little planning, the 12-month in-person rule won’t interrupt your care.
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Stay informed about timelines
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Keep your calendar up to date
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Communicate clearly with your provider
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Document any challenges early
These actions ensure you keep receiving the mental health care you need—without surprise gaps or denied claims.
Keep Your Coverage and Your Care Aligned
Mental health support through Medicare is evolving, and the in-person visit rule is part of that shift. It’s meant to create a balance between remote access and clinical accountability. If you rely on virtual therapy, don’t wait to plan your next face-to-face session. Taking proactive steps now helps you avoid care disruptions and lets you focus on what matters most: your mental well-being.
For help understanding your coverage or finding a Medicare-approved provider, get in touch with a licensed agent listed on this website.
