Audio-only telehealth remains billable to Medicare, but the coverage that survived the COVID-19 public health emergency is narrower, and more conditional, than many providers assume. Congress extended the pandemic-era flexibilities, including audio-only visits furnished in the patient's home, through December 31, 2027, in the appropriations package enacted in February 2026 after a brief government shutdown lapsed the program. That extension covers general medical audio-only billing. Mental health audio-only coverage runs on a separate, permanent track under different law. A telehealth practice billing the wrong theory, or without the record CMS actually requires, risks recoupment on every claim that followed the same pattern.
Medicare's Audio-Only Coverage Through 2027
Under current Medicare rules, a beneficiary may receive audio-only telehealth in their home anywhere in the United States through December 31, 2027, with no geographic or originating-site restriction. The distant-site practitioner must still be technically capable of two-way audio-video communication; audio-only is billable specifically because the patient is unable to use video or has not consented to it after being offered the option. Rural Health Clinics and Federally Qualified Health Centers bill non-behavioral telehealth, including audio-only visits, using HCPCS code G2025, through the same date. After December 31, 2027, the rule reverts: except for behavioral health, beneficiaries will generally need to be in a medical facility located in a rural area to receive a covered telehealth visit at all, and audio-only coverage outside behavioral health goes with it. CMS's own February 2026 guidance dates every one of those changes to that same day.
The Permanent Mental Health Carve-Out
Behavioral health telehealth runs on different law entirely. The Consolidated Appropriations Act, 2021 permanently removed the geographic and originating-site restrictions for behavioral health telehealth, including treatment for substance use disorder, and it permanently authorized two-way, interactive audio-only technology for those visits when the patient is in their home. Congress locked in that mental health audio-only rule without a renewal requirement in 2021, and none has been needed since, unlike the general Medicare audio-only extension above. The tradeoff is an in-person visit requirement: current CMS guidance requires an in-person, non-telehealth visit within six months before the first mental health telehealth service and at least once every twelve months after, with limited exceptions for group-practice coverage. For beneficiaries who began mental health telehealth before 2028, CMS has said the annual visit requirement, rather than the six-month rule, is what applies going forward.
The Documentation That Decides Whether the Claim Survives Audit
Coding an audio-only visit correctly starts with modifier 93, which identifies a claim as a real-time, audio-only synchronous service; Rural Health Clinics, Federally Qualified Health Centers, and opioid treatment programs also append modifier FQ. Neither modifier substitutes for the underlying record. CMS's rule requires the chart to reflect that the distant-site practitioner was capable of audio-video and that the patient was unable to use it or declined to consent, and post-payment reviewers ask for that record specifically, not just the claim line. A pattern of audio-only claims lacking consent or capability documentation is exactly the kind of billing pattern a Unified Program Integrity Contractor extrapolates across an entire claims sample, turning a documentation gap into a recoupment demand covering claims never individually reviewed, the same mechanism behind the telehealth billing audits Health Law Alliance defends.
The modifier tells Medicare a claim was audio-only. The chart note explaining why video was not used is what keeps the claim paid.
Why Early Legal Counsel Is Critical
It is critical that telehealth practices and providers billing Medicare for audio-only visits build this record before an auditor asks for it, not after. Early engagement of healthcare defense counsel, whether when a new audio-only billing pattern is adopted or after a payor audit notice arrives, can confirm the coding theory matches the visit actually furnished, correct a documentation gap before it recurs across an entire claims population, and preserve the practice's defenses if a post-payment review or extrapolated demand follows. Waiting until a Medicare Administrative Contractor or a UPIC opens a review turns a fixable documentation habit into a multi-year exposure, the same documentation pattern behind the telehealth fraud enforcement actions DOJ has pursued.
How Health Law Alliance Can Help
Health Law Alliance defends telehealth providers, platforms, and practices nationwide in Medicare and payor audits, including audits built on audio-only billing patterns, modifier use, and the consent and capability documentation behind them. The firm's bench includes a former federal prosecutor and a former senior PBM executive, background that shapes how a telehealth billing defense is built to withstand a Medicare Administrative Contractor's or a UPIC's extrapolation methodology. If your practice bills audio-only telehealth to Medicare and has questions about whether its current documentation would survive an audit, contact us today for a free consultation.
