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Telehealth Flexibilities: Attention Clinical Social Workers Who are Private Practitioners

By Mirean Coleman, LICSW, CT

Revised October 2, 2025

Effective September 30, 2025, several telehealth flexibilities that were put into place during the COVID-19 pandemic expired and now require congressional actions to be renewed. As of today, lawmakers have not addressed the expirations. Clinical social workers should be aware of two expirations that may impact the way they practice:the geographic waiver and in-person requirement.

Geographic Waiver

The geographic waiver has expired. However, it does not apply to behavioral and mental health services. Clinical social workers can continue to provide mental health services across state lines.

In-Person Requirement

Currently, Congress has not extended the in-person telehealth waiver. The telehealth in-person requirement is being implemented for Medicare patients who receive mental health services. New patients must receive an in-person visit within six months prior to the first telehealth mental health service, and then at least once every 12 months thereafter.

  • CMS has provided some flexibility by allowing the required in-person service to be furnished by another social worker within the same group practice if the original social worker is unavailable. 
  • The in-person service must be provided by a Medicare provider.
  • • Established patients who began treatment while the waiver was in effect and are currently receiving behavioral health services via telehealth are not required to have an in-person visit within six months of the September 30 expiration date.

Exceptions to In-Person

Exceptions to the in-person requirement include:

  • Patients located in a rural area and in an eligible originating site such as a rural health clinic
  • If the risks and burdens of travel outweigh the benefits of an in-person encounter.
  • Patients receiving treatment for a substance use disorder (SUD) or a co-occurring mental health condition.  

Clinical social workers should contact their Medicare Administrative Contractor and other third payer payers to learn what telehealth changes they will be implementing on October 1, 2025.

NASW is advocating for telehealth permanency and will keep members abreast of future congressional telehealth changes.