On November 19, 2024, the DEA and HHS issued the Third Temporary Rule extending pandemic-era telemedicine flexibilities for prescribing controlled substances through December 31, 2025. DEA-registered practitioners can continue to prescribe Schedules II through V remotely without a prior in-person visit, under the same conditions in place since 2020.
For ASCs with pain management programs, surgical follow-up workflows that include controlled-substance refills, or co-managed anesthesia services, the extension buys time. It does not change the underlying direction: a permanent rule is coming, and it will almost certainly be narrower than the current flexibilities.
What the extension does and does not do
The Third Temporary Rule keeps four things in place through year-end:
- Remote prescribing of Schedule II-V controlled substances without a prior in-person evaluation.
- Out-of-state prescribing where state law allows.
- Continuity for practitioner-patient relationships established during the public health emergency.
- The same recordkeeping and state PDMP obligations that already applied.
What it does not do: change state-level rules, reduce documentation expectations, or signal that a permanent rule will look like the temporary one. In 2024, more than 7 million controlled-substance prescriptions were issued via telemedicine without a prior in-person visit, a volume that almost guarantees a stricter permanent framework.
Where ASCs actually have exposure
Most ASCs do not run dedicated telehealth lines, but several common workflows quietly depend on the flexibilities.
Pre-op and post-op encounters
If a pre-operative medication review or a post-op follow-up is conducted by video and includes a controlled-substance prescription or refill, that encounter is operating under the temporary rule. The documentation needs to make that explicit.
Pain management programs
Centers with embedded or affiliated pain programs frequently use telehealth for stable, established patients. When the flexibilities end, every one of those patients needs a documented in-person touchpoint within the new compliance window, whatever it turns out to be.
Anesthesia and pre-admission
Pre-admission anesthesia phone or video assessments rarely involve prescribing, but where they do, the same documentation discipline applies.
What to do in 2025
Three pieces of work hold up regardless of how the permanent rule lands.
Make telehealth visits visibly telehealth in the record
Modality, location of patient, location of provider, identity verification method, and consent should be discrete fields, not buried in a narrative. When a DEA investigator or surveyor pulls a chart, they should not have to infer.
Build a non-waiver-dependent medication workflow
Design the medication-management workflow as if the in-person requirement is back. Then layer the telehealth exception on top, with clear flags for which encounters relied on the flexibility. When the rule changes, you toggle, you do not rebuild.
Identify the patients who will need an in-person visit
Run the report now: every active patient on a controlled-substance regimen whose most recent qualifying encounter was telehealth. That list is your transition plan. Spreading those visits across the back half of 2025 is far easier than a December rush.
Quick win
Add a single required field to the controlled-substance prescribing workflow: Was the qualifying patient encounter in-person or via telehealth? That one field gives you the transition list you will eventually need.
The likely shape of the permanent rule
DEA has signaled a special-registration framework for some categories of telemedicine prescribing, with stricter requirements for Schedule II substances and more flexibility for buprenorphine and other treatments where access concerns are well documented. The exact contours remain unsettled. What is settled is that ASCs and pain clinics should not be designing 2026 workflows around the assumption that today rules persist.
How DocForms helps
Two modules carry the documentation and workflow load.
- Policies and Procedures version-controls the telehealth prescribing policy so the transition from temporary to permanent rule is a documented update, not a scramble.
- Compliance Logs track each controlled-substance encounter against the applicable rule in force at the time, so a future audit gets a clean answer instead of an explanation.