Telehealth Therapy 2027: Run a Hybrid Schedule

For therapy clinics, telehealth policy has felt like a series of short extensions. The latest proposal buys another year.

What's proposed for Medicare

Under CMS's proposed 2027 Physician Fee Schedule (AHCA/NCAL; OT Index):

Most telehealth flexibilities would continue through 31 December 2027
Geographic and originating-site restrictions would stay waived through 2027, so patients can keep receiving telehealth at home
Audio-only authority would run through 1 January 2028
Occupational therapists remain eligible distant-site practitioners through 2027
CMS proposed new telehealth billing modifiers, so billing teams should watch the final rule for details

This is a proposal, and the extension is time-limited. Commercial payers and Medicaid programs set their own rules, so check each one.

When telehealth works well in therapy

Telehealth isn't right for every session, but it often works well for:

Counselling and psychotherapy sessions
Speech and language therapy for many goals, especially with parent coaching
Follow-ups, home programme reviews and progress check-ins
Parent training in paediatric and developmental therapy
Clients who live far away, have transport problems, or are recovering and tire easily

In-person sessions are usually still needed for hands-on assessment, manual therapy, equipment fitting, and anything where safety requires a clinician in the room.

How to run a hybrid schedule without chaos

1. Make session type part of the booking. Every appointment should be clearly marked as in-person or video, with the right link, location and reminder for each.

2. Group video sessions into blocks. Switching between the clinic floor and a quiet video room every hour is tiring and wastes time. Blocks of video sessions, for example one afternoon a week, often work better.

3. Free up rooms. Video sessions don't need a treatment room. Use that to reduce room clashes or fit in more in-person sessions on busy days.

4. Send the right reminder. A video client needs a link and a quick tech check. An in-person client needs the address and parking information. Mixing them up is a common cause of no-shows.

5. Have a backup plan. Agree in advance what happens if video fails: switch to phone where allowed and appropriate, or rebook at no penalty.

6. Watch your outcomes. Track attendance and progress by session type. If video sessions have fewer no-shows for some clients, that's useful to know.

Compliance basics

Use a secure, privacy-compliant video platform.
Confirm where the client is physically located at each session. Licensure generally depends on where the client is, not where the clinician is.
Document that the session was delivered via telehealth, using the payer's required codes and modifiers.
Keep consent for telehealth on file.

Plan for 2028 now

The safest approach is to treat telehealth as a valuable option, not the foundation of your business model. Keep processes flexible enough that if rules change after 2027, you can move clients back to in-person care without disrupting their treatment.

This article is general information, not legal, billing or compliance advice. Check requirements with each payer and your regulator.