Medicare telehealth for physical therapy: the 2027 clock

The sentence that matters sits in a CMS telehealth FAQ updated February 26, 2026: “Starting January 1, 2028, physical therapists, occupational therapists, speech-language pathologists, and audiologists can no longer furnish Medicare Telehealth services.” Everything about PT telehealth between now and then is a countdown from that line.

CMS has written it before. In November 2025 the same FAQ said PTs would lose telehealth on January 31, 2026, per APTA’s report on the shutdown deal. Congress moved the date. It has done that, in the words of the CY 2027 fee schedule proposed rule, “numerous times” since the pandemic waivers were set to expire. The habit is real. So is the cliff at the end of each extension.

Does Medicare cover physical therapy telehealth in 2026?

Yes, through December 31, 2027, on the same terms your practice has worked under since 2020. The vehicle is H.R. 7148, the Consolidated Appropriations Act, 2026, which became Public Law 119-75 on February 3, 2026. Section 6209 does its work by surgery. In the parts of the Social Security Act that govern where a telehealth patient can be and which practitioners can bill, it strikes January 30, 2026 and inserts December 31, 2027. The audio-only allowance gets the same edit. APTA called the package a two-year extension of Medicare telehealth flexibilities.

Read the dates again. The prior authority ended January 30. The new law arrived February 3. For the second time since October, the flexibility ran out before Congress renewed it; the first lapse was the 43-day shutdown that began October 1, 2025. CMS’s FAQ covers that one in two sentences: it “will continue to pay telehealth claims in the same way they had been paid before October 1, 2025,” and the flexibilities “will apply retroactively as if there hadn’t been a temporary lapse.” The gaps get papered over. The practice with a telehealth schedule still holds claims, calls patients and waits on Congress every time the calendar turns.

How exposed are PT practices? More than before 2020, less than the headlines suggested. An ASPE issue brief from December 2024 counted Medicare fee-for-service beneficiaries receiving telerehabilitation PT and OT from therapist practices: 113 in 2019, 198,582 in 2020. In-person PT and OT from the same practices fell from 19 million beneficiaries to 14.6 million that year, then recovered slowly. The experts ASPE interviewed did not recommend a virtual clinic. They recommended “a hybrid approach to therapy that includes a mix of in-person and telerehabilitation sessions at the discretion of the clinician.” Telehealth, in other words, is a visit type on the schedule, not a business model.

Which PT codes are on the Medicare telehealth list?

The CY 2026 list of Medicare telehealth services carries the four PT evaluation and re-evaluation codes (97161 through 97164), therapeutic exercise (97110), neuromuscular re-education (97112), gait training (97116), therapeutic activities (97530), self-care and home management training (97535), group therapy (97150), physical performance testing (97750), and the orthotic and prosthetic management codes (97760, 97761 and 97763), among others. Manual therapy (97140) is not on it. No code in the 97010 to 97039 modality range is either.

That is the list telling you what a camera can carry. It also stopped being tentative. CMS’s December 2025 telehealth booklet says the agency “removed the distinction between provisional and permanent services” and now considers everything on the list permanent. For 2027, the proposed rule reports that CMS “did not receive any requests to add or remove services from the Medicare Telehealth Services List.” The codes you can bill today are the codes you will bill next year.

How do you bill a Medicare telehealth PT visit?

Bill the same CPT code you would bill in the clinic. The place of service tells Medicare where the patient was: POS 10 for telehealth in the patient’s home, POS 02 for telehealth anywhere else, per the FAQ. Since January 1, 2024, CMS pays POS 10 claims at the non-facility rate, and the booklet says the same thing from the other direction: “We pay for telehealth services you provide to patients in their homes at the non-facility PFS rate.” On the patient side, Medicare.gov says that for most telehealth services “you’ll pay the same amount that you would if you got the services in person,” so the 20% coinsurance conversation does not change. Hospital-employed therapists bill differently, with modifier 95 on the institutional claim, per the booklet.

Audio-only exists for PT, barely. The booklet’s rule since January 1, 2025: two-way audio-only is allowed when the practitioner is “technically capable of using an audio-video telehealth system and the patient is in their home but isn’t capable of, or doesn’t consent to, using video technology.” A phone call cannot watch a sit-to-stand. Treat it as the exception it is.

Two new modifiers are coming. Section 6209(g) of the law tells CMS to require a code or modifier by January 1, 2027 on two kinds of telehealth claims: services furnished through a virtual platform where the practitioner contracts with the platform’s owner or has a payment arrangement with an entity for its use, and services furnished incident to a practitioner’s service. The proposed rule creates modifiers BB and BC for those cases, says they “do not affect payment,” and adds that “guidance on use of these modifiers will be available on the CMS website.” Whether a practice paying for its own video platform falls under the first category is the question CMS has not answered. Comments on the rule close September 14; the rest of what it proposes for PT is in our piece on the 2027 fee schedule.

Can you treat a patient who is in another state?

Yes, if you are authorized to practice where the patient is sitting, and not otherwise. The FSBPT’s telehealth policy recommendations, updated September 2023, put it plainly. Providers “must be legally authorized to provide physical therapy in the jurisdiction in which the patient/client is physically located during the provider/client interaction,” and “most jurisdictions define physical therapy care as occurring in the jurisdiction in which the patient/client is located at the time the technology is used.” The same document settles the standards question: the standards, laws and regulations required for an in-person encounter “must also be followed for any encounter via telehealth.”

This is the snowbird problem. Medicare will pay for the January follow-up with the patient who winters in Florida, because through 2027 the home is a valid site anywhere in the country. Your state license may not reach Florida. The PT Compact pitches itself as the way to “work across state lines with ease,” and a therapist quoted on its homepage uses it for “PTs practicing across state lines, and expanding your reach through telehealth”; a compact privilege in the patient’s state is the clean answer where both states are members. Where they are not, the answer to “can we do this one by video?” is no. The front-desk fix is one question at booking: “Where will you be for this visit?” Record the state next to the appointment, the way you record the payer.

Does telehealth physical therapy work?

For musculoskeletal care, the evidence says it holds up against the clinic. A 2017 systematic review and meta-analysis in Clinical Rehabilitation pooled 13 studies and 1,520 participants. Treatment delivered solely by real-time telerehabilitation was “equivalent to face-to-face intervention” for physical function (standardized mean difference 0.14, 95% CI -0.10 to 0.37, with no statistical heterogeneity). Telerehabilitation added to usual care beat usual care alone, and pain outcomes were comparable between groups. The authors’ conclusion is the one to hand a skeptical referring physician: “effective and comparable to conventional methods of healthcare delivery for the improvement of physical function and pain in a variety of musculoskeletal conditions.”

The caveat belongs next to it. The review’s search ended in November 2015, and ASPE noted that the pre-pandemic literature “focuses on services for mental health conditions and PT, and for patients younger than 65.” For a Medicare caseload, the hybrid model is the evidence-aligned one: the eval and the manual work in the clinic, the home exercise progression and the re-check by video.

What happens on January 1, 2028?

Under current law, the pre-2020 rules come back. The FAQ says that except for behavioral health, beneficiaries “will generally need to be in a medical facility and in a rural area,” and PTs come off the list of practitioners who can bill. APTA has endorsed H.R. 1614, a bill “to expand practitioners eligible to furnish telehealth services under the Medicare program,” which it describes as bipartisan legislation to make PTs and PTAs permanent Medicare telehealth providers. Its line is that telehealth in physical therapy “shouldn’t be an emergency-only option.” Until something passes, the planning assumption is a 2028 cliff with a fair chance of another last-minute extension.

So build for both. Keep telehealth as a visit type inside the schedule you already run, on the same chart and the same claim, so an extension changes nothing and a lapse turns off one visit type. Know your exposure in one number: the share of Medicare visits delivered by video, by month. In Orion, telehealth is a visit type on both plans, same schedule, same note, same claim, so that report is a saved filter. And tell every Medicare telehealth patient at the first video visit that the benefit currently runs through December 31, 2027. A patient who hears that from you in 2026 is calmer than one who learns it from a denial in 2028.

CMS has already written the sentence that ends PT telehealth. Congress has erased it twice in a year. Your practice should be fine whichever of them wins.