Most denials in this series come from a stable rule applied to an imperfect claim — a missing modifier, a coverage criterion the notes did not meet, a prior authorization that was never obtained. Medicare telehealth is a different category. Here the claim can be coded correctly, for a covered service, delivered to a real patient — and still be denied, because the rule it was billed under had lapsed by the date of service. The instability is the defect.
The mechanism is a chain of expiration dates. Since 2020, the authority to bill Medicare for a telehealth visit to a patient at home has never been permanent law. It has been a temporary waiver, extended one funding bill at a time, each with its own hard expiration — and twice in the space of four months it simply ran out before Congress acted. What follows is that chain, reconstructed only from dated documents.
Every entry is a dated document. Red rules are the moments the authority to bill actually stopped.
- Mar 6, 2020Waiver
The 1135 waiver opens telehealth nationwide1
Under Section 1135, CMS waives the Section 1834(m) geographic and originating-site limits. For the first time Medicare pays for telehealth to a patient in any location, including the home — the flexibility everything after is built to preserve.
CMS — Medicare Telemedicine Health Care Provider Fact Sheet
- Mar 15, 2022Statute
CAA 2022 ties the waiver to the emergency, then adds a runway2
The Consolidated Appropriations Act, 2022 continues the flexibilities for 151 days after the COVID-19 public health emergency ends — the first time the authority is set to a countdown rather than a fixed date.
Consolidated Appropriations Act, 2022 — signed Mar 15, 2022
- Dec 29, 2022Statute
CAA 2023 sets the first calendar cliff3
Authority runs through Dec 31, 2024
Public Law 117-328 detaches the flexibilities from the emergency and pins them to a date. The waiver of geographic and originating-site limits now has a fixed expiration — the template for every extension that follows.
Consolidated Appropriations Act, 2023 (P.L. 117-328) — signed Dec 29, 2022
- May 11, 2023Statute
The public health emergency formally ends4
The event the earlier waivers were pegged to expires — but the flexibilities survive it, because CAA 2023 had already moved them onto a calendar deadline. The telehealth rule is now governed entirely by appropriations.
HHS — end of the COVID-19 public health emergency
- Dec 2024Extension
American Relief Act, 2025 buys three months5
Authority runs through Mar 31, 2025
With the Dec 31, 2024 cliff arriving, Congress extends the flexibilities — but only through the end of the first quarter, converting an annual deadline into a quarterly one.
American Relief Act, 2025 — enacted Dec 2024
- Mar 15, 2025Statute
The full-year CR extends through the fiscal year6
Authority runs through Sep 30, 2025
H.R. 1968, the Full-Year Continuing Appropriations and Extensions Act, 2025, carries the flexibilities to the end of the federal fiscal year in Section 2207.
H.R. 1968 (119th Congress), § 2207
- Oct 1, 2025Lapse
First lapse — the authority expires during a shutdown7
The Sep 30 deadline passes with no bill. The government shuts down and the telehealth flexibilities lapse with it. CMS directs Medicare Administrative Contractors to hold or return telehealth claims pending congressional action.
CMS guidance; telehealth.hhs.gov policy updates
- Nov 12, 2025Extension
H.R. 5371 restores the flexibilities, retroactively8
Authority runs through Jan 30, 2026
Six weeks into the lapse, the continuing appropriations act reopens the government and revives the flexibilities. CMS confirms the extension applies retroactively; claims held or paid out of pocket during the gap become payable on resubmission.
H.R. 5371 — signed Nov 12, 2025
- Jan 31, 2026Lapse
Second lapse — ninety days later, it happens again9
The Jan 30 extension expires and the flexibilities lapse a second time during another short shutdown. Providers are again instructed to hold telehealth claims while Congress negotiates.
CMS guidance; industry alerts, Jan–Feb 2026
- Feb 3, 2026Statute
A two-year extension finally clears — through 202710
Authority runs through Dec 31, 2027
After a four-day lapse, the Consolidated Appropriations Act for fiscal year 2026 is signed, extending the telehealth flexibilities for two years and treating the four-day gap as if it never occurred.
Consolidated Appropriations Act, FY2026 — signed Feb 3, 2026
The current state, precisely
As of July 2026 the flexibilities are in force and the next cliff is dated, not immediate. The distinction that matters for billing is between the flexibilities that are still on a clock and the ones that were made permanent — because a claim can only be manufactured into a denial by the parts that expire.
The billing mechanics that carry the risk
The instability lands on three fields a biller sets on every telehealth claim, and a lapse changes what each one means without changing how it is entered.
Place of service. POS 10 reports telehealth to a patient in the home; POS 02 reports telehealth to a patient anywhere else. The distinction is not cosmetic — it drives the payment rate, with POS 10 generally paying the non-facility rate and POS 02 the lower facility rate.11 During the flexibilities, POS 10 is a normal, payable code. The moment they lapse, home stops being a payable originating site for most services — and the exact same POS 10 claim that paid in December is the claim a contractor holds in the gap.
Modifier 95. The modifier attests that the service was furnished by real-time, interactive audio-video. It does not create coverage; it describes the encounter.11 Which is the trap — a claim can be perfectly modified and still fall outside the coverage window, because the modifier says how the visit happened, not whether the law allowed it on that date.
The date of service. Adjudication turns on the statute in force the day the service was furnished, not the day the claim was submitted. A visit on the wrong side of an expiration is billed against a rule that no longer exists. When a retroactive fix arrives weeks later, it restores payability — but only for work the practice must now identify, refund where a patient was charged, and resubmit.8
No coding error is required. The claim is denied because the rule it was billed under stopped existing on the date of service.
Step 1
The rule flips
A statutory deadline passes with no bill signed. On paper, the geographic and originating-site limits of Section 1834(m) snap back the next morning — home is no longer a payable originating site for most services.
Step 2
The clinician bills in good faith
The visit already happened, or happens during the gap. It is coded exactly as it was the week before — POS 10, the patient at home — because the practice has no way to know Congress will act, or when, or whether the fix reaches back.
Step 3
The claim meets a changed rule
The MAC adjudicates against the statute in force on the date of service. During a lapse, CMS directs contractors to hold or return telehealth claims; correct-in-February work is denied or suspended because it was furnished in a window when the authority had expired.
Adjudication turns on the date of service, not the billing date. A retroactive fix restores payability — but only after the claim has already denied, been held, or been returned, and only after the practice reworks it.
What this category is not
Two boundaries keep the picture honest. First, none of this touches Medicare Advantage or commercial payers, which set their own telehealth terms — the churn described here is specific to traditional Medicare fee-for-service. Second, the behavioral-health carve-out is genuinely durable: a telemental-health visit to a patient at home does not ride the extension clock, which is why behavioral-health telehealth denials usually turn on documentation or the in-person-visit timing rather than on whether coverage existed at all.
For everything else, the recurring failure is the same shape. A claim denies not because the work was wrong but because the rule under which it was billed had a hard expiration date — and denials produced by a lapse are the ones a retroactive fix is designed to reverse. That is a different appeal from a non-covered-charge denial on the merits: the argument is the calendar, and the calendar is on the record.
Sources
- 1CMS — Medicare Telemedicine Health Care Provider Fact Sheet (1135 waiver; telehealth paid nationwide, including the home, from Mar 6, 2020) · Mar 2020
- 2Consolidated Appropriations Act, 2022 — telehealth flexibilities continue 151 days after the PHE ends · signed Mar 15, 2022
- 3Consolidated Appropriations Act, 2023 (P.L. 117-328) — extends Medicare telehealth flexibilities through Dec 31, 2024 · signed Dec 29, 2022
- 4Telehealth.HHS.gov — telehealth policy updates (PHE ended May 11, 2023; flexibilities remain on statutory deadlines) · accessed Jul 2026
- 5McDermott Will & Emery — Congress extends certain telehealth flexibilities through March 31, 2025 (American Relief Act, 2025) · Dec 2024
- 6ASHA — Congress extends Medicare telehealth authority through September (H.R. 1968, § 2207, through Sep 30, 2025) · Mar 2025
- 7APTA — Government shutdown ended; telehealth flexibilities lapsed Oct 1, 2025 and extended to Jan 30, 2026 (MACs held/returned claims during the lapse) · Nov 17, 2025
- 8K&L Gates — Congress extends Medicare flexibilities through 30 January 2026 (H.R. 5371, signed Nov 12, 2025; retroactive payability confirmed by CMS) · Dec 9, 2025
- 9Mintz — Partial government shutdown ends with extension of Medicare telehealth provisions (second lapse Jan 31 – Feb 3, 2026; claims held; four-day gap treated as if it never occurred) · Feb 5, 2026
- 10American Bar Association — Congress extends Medicare telehealth flexibilities through 2027 (Consolidated Appropriations Act, FY2026, signed Feb 3, 2026; behavioral-health carve-out permanent) · Feb 2026
- 11Telehealth.HHS.gov — billing and coding Medicare fee-for-service claims (POS 02 vs POS 10; modifier 95 attests real-time audio-video; POS drives fee-schedule rate) · accessed Jul 2026