Key Takeaways

• Medicare covers teletherapy under specific conditions, but many restrictions still apply in 2025, especially related to provider types and settings.

• Independent licensed agents must clearly explain where teletherapy counts toward coverage and highlight the hidden situations where it does not to avoid client frustration.

Why Teletherapy Matters Now More Than Ever

Teletherapy is no longer just an emergency alternative; it has become a central mode of delivering mental health and behavioral services for older adults. Many clients now expect it as a permanent option. But as you know, Medicare rules do not always keep pace with client expectations. Your role is to set clear expectations about when teletherapy counts toward coverage and when it quietly does not.

The Foundations of Teletherapy Coverage Under Medicare

Medicare began allowing broader telehealth coverage during the public health emergency in 2020, but by 2025 the rules have been updated and narrowed in several areas. Clients often assume every teletherapy service is covered, but this is not the case.

Core Rules for Teletherapy Coverage

• The provider must be a Medicare-approved clinician such as a psychiatrist, psychologist, clinical social worker, or newly added categories like marriage and family therapists and mental health counselors.

• The service must use real-time, two-way interactive communication (video preferred; audio-only accepted in certain cases).

• The service must be considered medically necessary and billed under the appropriate Medicare-approved codes.

The Providers Who Count

Since 2024, Medicare has expanded coverage to include licensed marriage and family therapists and mental health counselors. This remains in place in 2025, which broadens access for clients. Still, you must remind them that not all types of providers can bill Medicare for teletherapy.

Covered Provider Types

• Psychiatrists

• Psychologists

• Clinical Social Workers

• Clinical Nurse Specialists

• Nurse Practitioners

• Physician Assistants

• Licensed Marriage and Family Therapists (since 2024)

• Licensed Mental Health Counselors (since 2024)

If a client’s therapist falls outside of these categories, Medicare does not cover their teletherapy sessions.

Technology and Communication Rules

Medicare requires secure, real-time audio and video connections for most teletherapy services. Audio-only sessions are allowed, but only under specific conditions, typically when the client cannot reasonably access video technology.

What Counts

• Video sessions conducted through a secure telehealth platform.

• Audio-only sessions in cases where the client has no video access and the service still meets clinical standards.

What Does Not Count

• Pre-recorded videos, email exchanges, or text message conversations.

• Group chat platforms without medical security safeguards.

The Geographic and Site Flexibility

In the past, Medicare had strict geographic restrictions, only covering telehealth for clients in rural areas or specific medical facilities. These restrictions were lifted during the pandemic and many changes became permanent. By 2025, clients can receive teletherapy from their own homes, regardless of geographic location.

However, this flexibility does not extend to every type of therapy or every provider specialty. It is important to clarify that the home-based option applies primarily to mental health teletherapy and not necessarily to all Medicare-covered services.

Billing and Coding Nuances

One of the most common points of confusion for clients is billing. Medicare only recognizes certain CPT and HCPCS codes for teletherapy. Services outside of these codes are not reimbursed.

As an agent, you do not have to master coding, but you should understand enough to explain that:

• Only Medicare-approved codes count.

• Incorrect coding can result in denial of coverage.

• Clients should verify that their provider bills with the correct telehealth codes.

The Hidden Situations Where Teletherapy Does Not Count

Many clients assume that because teletherapy is widely available, all sessions will be covered. You need to highlight the exceptions clearly.

1. Providers Not Enrolled in Medicare

If a therapist is not a Medicare-enrolled provider, teletherapy services will not be covered regardless of the therapist’s qualifications.

2. Services Outside of Clinical Necessity

Medicare does not cover teletherapy for general wellness, stress management coaching, or non-clinical counseling. Coverage applies only to medically necessary treatment for diagnosed conditions.

3. Platform Limitations

If the teletherapy is conducted over a non-compliant platform (such as an unsecured video chat app), Medicare may deny claims.

4. Frequency and Duration Restrictions

While there is more flexibility in 2025, Medicare still has limits on the frequency of certain therapy services. Excessive sessions may not be covered.

5. Out-of-Network or Non-Participating Providers

Even if the provider type qualifies, clients may face full costs if the provider does not accept Medicare assignment.

The Cost-Sharing Realities

Even when teletherapy is covered, clients are responsible for cost-sharing. In 2025, this typically includes:

• The Part B annual deductible ($257 in 2025).

• Coinsurance of 20% of the Medicare-approved amount for each session.

Clients often assume teletherapy is “free” because it is remote, but their cost-sharing responsibility remains the same as in-person visits.

How Agents Should Communicate These Limits

Your clients may feel overwhelmed by the complexity of teletherapy coverage. Here are ways you can simplify the conversation:

• Use clear, direct language. Avoid acronyms unless you explain them.

• Clarify that not all teletherapy is created equal under Medicare.

• Encourage clients to verify that their provider accepts Medicare and bills with approved telehealth codes.

• Remind clients that costs apply to teletherapy just as they do to office visits.

The Policy Timeline You Should Track

Medicare telehealth coverage has shifted multiple times in recent years. You should be aware of key changes:

• 2020: Broad telehealth expansion during the public health emergency.

• 2021–2023: Temporary extensions of telehealth coverage.

• 2024: Permanent expansion to cover licensed marriage and family therapists and mental health counselors.

• 2025: Current rules continue with emphasis on provider eligibility, medically necessary services, and secure platforms.

Anticipating Client Questions

When clients bring up teletherapy, they often have the same questions. Being prepared helps you maintain credibility and trust.

• “Can I do therapy sessions by phone only?” — Yes, but only if video access is not possible, and the provider is eligible.

• “Will Medicare cover my counselor?” — Only if the counselor is a Medicare-approved provider type.

• “Is there a limit to how many sessions I can have?” — Medicare covers as long as therapy is medically necessary, but excessive frequency can be denied.

• “Do I pay the same as in-person visits?” — Yes, deductibles and coinsurance apply equally.

Strengthening Your Role as a Trusted Advisor

Clients increasingly depend on you to interpret rules that are not obvious. By proactively explaining the hidden exceptions to teletherapy coverage, you build credibility and protect clients from unpleasant surprises.

Building Smarter Client Relationships Through Clarity

Teletherapy is here to stay in 2025, but Medicare coverage is far from universal. Your role is to set expectations clearly. By knowing which providers, platforms, and codes count toward coverage—and which do not—you help clients avoid costly mistakes and confusion.

We at BedrockMD are here to support you with tools, resources, and real-time updates. By joining our platform, you can access advanced client education materials, compliance support, and digital resources that make your work easier. Sign up today and see how we can help you serve your Medicare clients with confidence.