What started as an emergency workaround during the pandemic has become a permanent — but still evolving — part of how care gets delivered to patients. Exploring telehealth before and after COVID can help your practice identify how this delivery method fits into your revenue cycle and care strategy.
We already know the coronavirus pandemic altered all of our lives for better or worse. But of the many things that dramatically changed, how did telehealth fare?
When people were suddenly stuck at home, many patients sought alternative care options. Telehealth usage surged, increasing by more than 11,718% in just a month and a half, per CMS data reported by Healthcare Dive. In fact, 1.3 million Medicare members received telehealth services in the week ending April 18, 2020, compared to 11,000 members in the week ending March 7.
From April 2019 to April 2020, virtual care claim lines increased a whopping 8,336% nationally, per FAIR Health data.
Needless to say, telehealth wasn’t very widespread before the pandemic. The main reason? Reimbursement. Medicare only covered telehealth services under specific, limited circumstances, such as for patients in designated rural areas.
But that doesn’t mean the market wasn’t primed for a telehealth surge. Before the pandemic, telehealth usage was growing despite the restrictions and confines that barred a telehealth boom. For example, by March 2020, 19.5% of patients said they had, at some point, had a telehealth appointment, according to a Sykes patient survey. That’s already a huge increase from 2019, when only 8% of patients said they’d had a telehealth appointment at some point, per a 2019 American Well survey.
But in March 2020, the Centers for Medicare and Medicaid Services (CMS) broadened which telehealth services were covered during the public health emergency and removed geographic coverage restrictions.
Telehealth before and after COVID doesn’t tell the whole story of remote healthcare. While there was some limited usage before the pandemic, the numbers were quite low.
Telehealth usage today looks entirely different compared to that single-digit 2019 baseline. That’s because it stabilized at a meaningfully higher plateau than pre-2020 norms.
Only physicians and certain other practitioners were eligible to receive Medicare payment for telehealth.
CMS expanded which healthcare providers can get reimbursed for providing live, interactive telehealth services.
Providers had to have provided in-person medical care to the patient within the past three years.
Providers can treat new patients via telehealth.
CMS did not pay anyone outside of physicians and certain other practitioners.
CMS will pay any healthcare professional who is eligible to bill Medicare for professional services.
Only telehealth visits composed of audio and video components qualify for reimbursement.
Audio-only phone calls became eligible for reimbursement.
Patients must be in a medical facility to receive telehealth care.
Patients may be at home when receiving telehealth care.
Strict licensure requirements were in place. For example, patients and physicians must reside in the same state.
Licensure requirements for physicians relaxed. For example, a physician can reside in a different state than the patient they provide care for.
A telehealth visit was not considered the same level of care as that of a face-to-face visit; therefore, reimbursement would be less than an in-person visit.
CMS created payment parity, which means provider reimbursement is the same rate, no matter if patients receive in-person care or a telehealth consultation.
Lawmakers and healthcare providers never intended for this flexibility to be permanent, but it’s been very hard to walk it back.
Since the Public Health Emergency officially ended in May 2023, Congress has extended the key Medicare telehealth flexibility. It also removed originating site and geographic restrictions while expanding practitioner eligibility and allowing audio-only coverage.
Congress has extended these flexibilities multiple times. The most recent extension was made under the Continuing Appropriations Act, which keeps the flexibilities in place through December 31, 2027.
Even though the program has been extended, there have been a few interruptions along the way.
Coverage briefly lapsed during the government funding gap in October 2025 and again in early 2026. These issues sent billing teams scrambling to figure out if claims submitted during those windows would be covered. Visit the CMS’s telehealth billing and reimbursement guide for the latest.
Congress hasn’t loosened flexibility for behavioral telehealth services. Medicare still requires an in-person visit within six months of a patient’s first telehealth behavioral health visit and every 12 months afterward. Patients can request a waiver, but they must meet specific criteria. The in-person visit requirement is one of the more commonly missed compliance points.
As CMS policies changed, private payers followed suit and saw spikes in telehealth usage.
All of the national private payers who participated in a Center for Connected Health Policy analysis voluntarily expanded telehealth coverage for their commercial health plans during the worldwide health emergency.
Blue Cross Blue Shield of Massachusetts, for example, processed more than one million telehealth claims within nine weeks of changing its policy to expand coverage for telephone and virtual visits at no cost to members during the COVID-19 crisis. In February 2020, it received approximately 200 telehealth claims per day, but by May 2020, it was receiving 38,000 per day.
Unlike Medicare, private payer telehealth coverage has largely stayed in place regardless of federal funding status. Providers have enjoyed more predictable revenue streams on the commercial side, even when Medicare experiences funding gaps.
Trust and satisfaction with telehealth also grew substantially from 2020 to 2021 for both patients and physicians.
Approximately 61.78% of patients in the Sykes survey only tried telehealth because their doctor’s office moved their appointments to virtual visits, but trust and satisfaction in telemedicine still grew.
Pre-pandemic, 65.6% of patients felt hesitant or doubtful about telemedicine’s quality of care. Now, 87.82% want to continue using telemedicine for routine visits even after the pandemic.
Pre-pandemic, 56.4% didn’t think telehealth would provide the same level of care as in-person visits. Now, 79.95% believe telemedicine can deliver high-quality care, and 74.25% are willing to share health data from digital fitness trackers or smart devices with physicians.
The Harris Poll found that 35% of people would even replace primary care physicians with qualified and telehealth-enabled, on-demand physicians. About 50% of Gen Z and millennials agreed.
That early trust has held up, but it’s settled into a steadier pattern. According to Epic Research, telehealth has leveled off to roughly 6%–7% of primary care visits since mid-2023. While that’s well above pre-2020 levels, it’s nowhere near the pandemic peak. An estimated 33% of U.S. adults are expected to use telehealth at some point in 2026, which matches pandemic-era reach.
However, the total share of visits that figure represents is much smaller than during the pandemic. There are fewer visits per user, but a similarly-sized base of people is willing to use telehealth when the situation calls for it.
For the first several years after the pandemic, there was a lot of speculation about how Congress would handle the telehealth flexibilities. Since then, it has extended those flexibilities several times.
The latest extension gave providers and billing teams multi-year stability for the first time since the pandemic began. Now, they can focus on providing good faith estimates and meeting other compliance requirements.
One area that’s still in limbo is controlled substance prescribing via telehealth. The DEA flexibility that allows providers to prescribe controlled substances without a prior in-person exam remains valid through December 31, 2026. After that, permanent rules take effect, requiring new identity verification and reporting steps for telehealth providers.
The HHS’s telehealth policy updates page tracks changes as they’re finalized.
Although there are so many things that we can still do to improve access to care and reduce health disparities, telehealth has made it possible to improve healthcare system access for the nation’s most vulnerable demographics. And that’s just the beginning. We likely have only experienced a small portion of telehealth’s potential.
Even with more stable federal policy in place, there are still gaps in accessibility.
According to the Urban Institute, Medicare telehealth use in Q2 2025 ranged from 24.2% of eligible visits in California to just 5% in Iowa. States need the right infrastructure and broadband access to close this gap, and providers must adopt telehealth options.
Interested in learning more about telehealth? View a free webinar.
Telehealth before and after COVID presents a stark contrast.
During the shutdowns, providers rapidly rolled out or expanded telehealth offerings so they could stay connected to patients and do their best to continue managing chronic conditions. In the years since, telehealth has become more widely used and refined, resulting in better access and care experiences.
Telehealth seems to have stabilized at roughly 5.5%–7% of medical claim lines and visits, depending on which measurement is used. Mental health remains the most dominant use case, accounting for over 60% of telehealth claims. Adoption rates vary widely by age group. The 19-to-40-year-old group uses telehealth the most.
If your practice is already using telehealth or looking to add it to the mix, understanding these numbers is an important step.
The emergency-era spike in telehealth usage has passed, meaning your revenue cycle and staffing strategies should be built around steady growth. Patient cost estimate software and other RCM tools can help you take advantage of existing demand while capturing valuable revenue.
Rivet is a modern revenue cycle product suite that integrates with your EHR to allow you to see the big picture of what’s going on in your practice with payer contracts, fee schedules, denials, and underpayments. You can also check eligibility and provide accurate upfront patient cost estimates before services are rendered. The Rivet team will help you aggregate your fee schedules and input your claims data to enable you to increase revenue and decrease A/R days.
For more information about Rivet's modern product suite, schedule a Rivet demo.
Yes. Congress extended the major Medicare telehealth flexibilities, which included removing geographic restrictions and increasing practitioner eligibility. Audio-only visits are also covered now. These changes will remain in effect through December 31, 2027.
If flexibilities coverage lapses or expires, as they briefly did during the funding gaps in October 2025 and early 2026, Medicare reimbursements for many telehealth services will be paused or revert to pre-pandemic restrictions. Congress will have to act again to reinstate or fund these flexibilities.
Your practice should create a plan to promote billing continuity if there’s a funding gap.
Reimbursement rates are generally the same whether you deliver care in person or via telehealth. However, reimbursement rates can vary by payer and service type for commercial plans. Refer to your payer agreements for clarity when billing a patient with a commercial plan.
Telehealth can deliver comparable outcomes, particularly for behavioral health and routine follow-up visits. However, some services, including certain behavioral health visits, still require patients to come in for periodic in-person exams to maintain an acceptable standard of care.
Mental and behavioral health remain two of the dominant use cases for telehealth, representing the majority of telehealth claims. Primary care providers, dermatologists, and chronic condition management teams have also incorporated telehealth into their delivery models.
Not necessarily. Private payer telehealth coverage has generally stayed more stable than Medicare. That’s because Medicare coverage of telehealth is tied to a congressional funding and extension cycle. However, commercial coverage varies by plan and insurer.
