Medicare telehealth waivers will expire at midnight on January 30

On January 30 at midnight, Medicare waivers that allowed occupational therapy (OT) services via telehealth will expire after Congress failed to extend them as part of to-date unsuccessful budget negotiations. As a result, therapy providers, including occupational therapy practitioners (OTPs), will not be reimbursed by Medicare for OT telehealth services provided to beneficiaries unless Congress reinstates the waivers and makes coverage of these services retroactive as it did in November 2025.

Last-minute negotiations continue in the Senate where there are indications that a compromise is possible, although a House vote would also be required to finalize any deal. The House, however, is not scheduled to return to session until Monday, February 2, which means telehealth waivers will be allowed to expire for at least a few days. There is no guarantee that the House will accept any compromise reached in the Senate.

Therapy telehealth waivers and other Medicare telehealth policies have been tied to broader federal budget negotiations in the Senate this week, and they will expire even though the House passed legislation that included a 2-year telehealth waiver extension which is supported in the Senate. We do expect Congress to reinstate the waivers when it reaches a budget compromise.

As during the previous lapse in Medicare telehealth coverage, OTPs should consider the following:

• Review your current caseload to identify clients who receive occupational therapy services via telehealth and may be affected by the shift back to in-person care.
• Consult with your employer or facility partners to determine options for meeting affected clients' therapy needs
• CMS has not issued specific guidance for Medicare Part A. If your facility decides to provide telehealth services for Medicare Part A patients, you must accurately document the services you provide.
• During the last waiver interruption, CMS recommended that providers issue an Advance Beneficiary Notice of Non-coverage (ABN) to clients who request telehealth services under Medicare Part B. The ABN informs the client that the service may not be covered by Medicare and that they may be liable for payment for the service if Medicare denies the claim.

The House-passed extension which the Senate has so far failed to adopt includes language from the Telehealth Modernization Act which was introduced by Reps. Buddy Carter (R-GA) and Debbie Dingell (D-MI) and Senators Tim Scott (R-SC) and Brian Schatz (D-HI). Medicare telehealth waivers were first enacted by Congress in 2020, and they were periodically extended until September 2025 when telehealth policy became ensnared in the Congressional spending debate that resulted in a 42-day government shutdown and expiration of the waiver. Congress eventually acted to end the government shutdown in November and extended the telehealth waivers through January 30, 2026 and applied them retroactively. It is possible that when an agreement has been reached, Congress will authorize retroactive reimbursement for OT telehealth services provided during the lapse as they did in November; however, retroactive coverage is not guaranteed.

Please note that this situation is still evolving. AOTA will continue to monitor developments and share updates as new information becomes available—whether related to the waivers or CMS guidance on handling telehealth claims.