How to Document a Medicare Telehealth Exception for Behavioral Health Patients

For many behavioral health providers, rural distance and patient limitations can make in-person Medicare visits unrealistic. With the permanent expansion of telemental health, clinicians can continue caring for patients remotely, but beginning October 1, 2025, the Medicare in-person requirement is back in force.

If you serve patients who live hours away or have special needs, you can use the annual in-person exception, but only if your documentation is airtight. Here’s how to meet Medicare telehealth documentation expectations while protecting your practice’s compliance.

What Medicare Actually Requires

For behavioral and mental health services, patients can still be seen from home. Audio-only telehealth is permitted when video is offered but not feasible. In those cases, use modifier 93 and document why video was not possible.

The in-person cadence works like this:

• One in-person visit within six months before starting tele-behavioral health

• At least one in-person visit every 12 months thereafter

• The annual visit may be waived if the risks or burdens of travel outweigh the benefits, as long as that reasoning is clearly documented

• A same-specialty colleague in your group may complete the in-person portion if needed

In Nebraska, the controlling standard comes from CMS, not individual payors. Local guidance from WPS Medicare (Jurisdiction 5) can supplement your note, but the federal regulation governs.

How to Document the Exception

Use these core components in your note to meet behavioral health compliance requirements:

1. State the rule you are applying “Annual in-person visit requirement for Medicare telemental health considered for exception per 42 CFR 410.78(b)(3)(xiv)(B).”

2. Document a joint decision “Patient and clinician agreed that in-person risks and burdens outweigh the benefits for this 12-month period.”

3. List measurable, patient-specific burdens

   • Travel distance or lack of transportation

   • Mobility, sensory, or behavioral barriers

   • Caregiver availability or transfer risks

   • Environmental hazards such as weather or inaccessible routes

4. Confirm telehealth appropriateness “Telehealth supports safety planning, medication management, and monitoring outcomes effectively for this patient.”

5. Show that in-person care remains available “Patient may be seen in person by a same-specialty colleague at the local office if condition changes.”

6. Plan to reassess before 12 months elapse Include a note to revisit the exception in the next cycle.

Sample Template

We reviewed the Medicare telemental health in-person rule and, for this 12-month period, patient and clinician jointly determined that the risks and burdens of travel outweigh the benefits. Specific factors: [travel distance/time], [mobility or behavioral limitations], [caregiver constraints]. Telehealth remains clinically appropriate, and in-person care is available through a same-specialty colleague if needed. We will reassess the exception before the end of this cycle. (If audio-only, note modifier 93 and the reason.)

Why This Matters

Accurate Medicare telehealth documentation protects both your license and your reimbursement. Clear, specific reasoning demonstrates due diligence and keeps your practice audit-ready. The more measurable your details, the stronger your compliance record.

Partner for Smarter Documentation Support

At WiseMind Innovations, we help behavioral health providers navigate every part of behavioral health compliance, from chart templates to AI-supported documentation workflows. Our systems make Medicare updates and telehealth rules easier to follow without adding administrative chaos.

If you are updating your charting process for the new in-person rule, WiseMind can help you build compliant workflows that protect your time and your patients’ access to care. Learn more at wisemindinnovations.com