March, 2020: COVID-19 shut down the world. Normal functioning ceased. In response to the emergency, the Medicare decision was made to allow enrolled providers to conduct services via telehealth from their homes without having to add their home addresses to PECOS, the Medicare enrollment system.
It was a logical move. Medicare typically requires that all service locations be disclosed on a health care professional’s enrollment. But in March 2020, it would have been operationally impossible to process updates on everyone timely enough. This and many other COVID public health emergency “flexibilities” (I love that term; Medicare isn’t typically a “flexible” operation!) were continually in effect through the end of the public health emergency on May 11, 2023.
Many COVID-era waivers of Medicare’s statutory rules are still repeatedly renewed, creating a situation for the past 3 years in which the original rule is one thing, and then the waiver of it expires or comes close to expiring, and then everyone has to wait on CMS – and sometimes, Congress, for a Medicare decision. And then the waiver is usually renewed, again, creating endless cycles of Medicare uncertainty for both clinicians and clients. After 6.5 years of “flexibilities,” it seems more and more as if the “flexibilities,” are, in fact, the new rules.
So when will the Medicare decision be made to make all waivers permanent?
One waiver finally has been. On September 8, 2026, the Center for Connected Health Policy reported in its newsletter that a permanent Medicare decision has now been made that professionals who have an in-person office enrolled, will never have to enroll their home address as an additional location. As during the past 6.5 years, you can use your office address to bill for services conducted via telehealth from your home.
And, contrary to what many people online seem to think, you do NOT have to enroll in every state where you have a license – the only Medicare provider enrollments that need to be submitted are in states where you have a physical office location. Or, if you have no physical office, then you do have to enroll your home, and you’d enroll in Medicare in your home state only. Don’t believe me? In the link above, Medicare states the rules as follows:
- You are not required to enroll in the state(s) where the beneficiary resides.
- CMS defers to state law for telehealth licensure requirements. Ensure you comply with any additional state licensing rules.
So I can keep my home office?
Yes. If you also have an in-person office, this announcement is great news! You don’t have a date with PECOS until your next revalidation is due. (Or unless you go more than 180 days without billing Medicare, and you get administratively deactivated…) Gotta love Medicare!
If you only have a home office, you can keep it, and conduct all sessions over telehealth. Of course, if you don’t have any other practice locations, then your home does need to be enrolled in PECOS. Fortunately, Medicare eventually enacted safeguards to prevent your home address from being disclosed publicly.
You don’t need to rent or sublet a business office space unless you want to – but only for the next 15 months, until December 31, 2027, because of the in-person rule.
Hasn’t Medicare made a decision about the in-person rule yet?
That’s the critical Medicare decision that mental health clinicians are anxiously waiting for. The current waiver of the in-person rule is valid until December 31, 2027 – still 15 months down the road.
The Medicare in-person rule requires:
- An in-person visit must be conducted before any telehealth can begin. The in-person visit has to have been within the 6-month period prior to the start of telehealth treatment.
- At least one in-person visit every 365 days must occur thereafter.
(Unless you can document the existence of one of Medicare’s approved exceptions).
So while Medicare says “sure, you can enroll with just a home office via telehealth,” this is really only effectively true for the next 15 months. Then maybe it will continue to be true…and maybe it won’t.
The problem with the in-person rule (and most Medicare decisions) is that Medicare benefits and policies are written into federal law. Which means that only Congress, not CMS, gets to make significant changes. One need only look back to the fiasco last October, 2025, when the government shut down without having made a final decision to continue to extend the in-person rule waiver again, get rid of the rule altogether, or definitively state that the in-person rule was once again the law of the Medicare land.
The failure of Congress to make a timely Medicare decision meant that during what would become the longest shutdown in US government history to date, clinicians and clients were faced with the added anxiety of wondering whether their claims would eventually be paid.
No, I don’t know what will happen, or when, with respect to the in-person rule, or, for that matter, audio-only services, which are currently subject to the same waiver deadline (12/31/27).
The Medicare decision process is awfully slow…
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