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Texas requires a prior relationship or initial video visit before telehealth

Texas requires an established provider-patient relationship or an initial video visit before telehealth services, a barrier to first-contact remote care for new patients.

Massachusetts sits outside the licensure compact, hindering cross-state telehealth

Massachusetts has not joined the Interstate Medical Licensure Compact, so clinicians licensed in other states must obtain full Massachusetts licensure to see Massachusetts patients by telehealth — a barrier to cross-state care.

California's non-membership in the licensure compact blocks cross-state telehealth

California has not joined the Interstate Medical Licensure Compact, so out-of-state physicians must obtain full California licensure to treat California patients by telehealth — a barrier to cross-state continuity of care.

New Jersey's telehealth payment parity is set to expire in 2026

New Jersey requires insurers to reimburse telehealth at in-person rates — but only through July 1, 2026. The scheduled sunset means telehealth access could narrow when parity lapses, an identified risk to durable coverage.

New York's non-membership in the licensure compact blocks cross-state telehealth

New York is one of the states outside the Interstate Medical Licensure Compact, so out-of-state physicians must obtain a full New York license to treat New York patients via telehealth — a significant barrier to cross-state care.

Texas private payers can reimburse telehealth below in-person rates

Texas requires private payers to cover telehealth but not to pay the same rate as in-person care. The reimbursement gap discourages providers from offering telehealth, narrowing access.

Out-of-state clinicians must register with Florida before any telehealth visit

Florida requires telehealth providers licensed elsewhere to register with the state before treating Florida patients, adding a regulatory step that delays or blocks cross-state telehealth care.

Specialty care in Monterrey doesn't connect back to Texas providers

Patients who travel to Monterrey's JCI-accredited specialty hospitals lack a coordinated link back to Texas providers. No shared record or referral channel exists, so specialty findings don't reach the home care team.

No care handoff after Americans get treatment in Tijuana hospitals

Americans treated at JCI-accredited hospitals in Tijuana have no coordinated handoff back to their California primary-care provider. Follow-up records and instructions rarely transfer, so post-procedure care is fragmented.

Clinical records don't follow patients across the Tamaulipas–Texas border

Patients crossing from Tamaulipas to Texas for care arrive without transferable clinical records. Mexico's records standard and Texas systems aren't interoperable, forcing duplicate workups and risking gaps in care.

Sonora-licensed physicians can't deliver telehealth to patients in Arizona

A physician licensed in Sonora has no pathway to provide telehealth to a patient who has crossed into Arizona. The U.S. interstate licensure compact is U.S.-only, so Mexican licensure doesn't bridge the border.

Patients lose mental-health continuity crossing the San Diego–Tijuana line

People who receive mental-health care on one side of the San Diego–Tijuana border cannot easily continue treatment on the other. State frameworks and provider licensing don't coordinate, so care effectively restarts on each crossing.

Wyoming requires out-of-state physicians to make periodic in-person visits to continue telehealth

Wyoming requires out-of-state physicians treating Wyoming patients via telehealth to have established care in person, and after six months of telehealth an in-person encounter is required before telehealth may resume.

Wyoming has no private-payer telehealth payment parity

Wyoming has no private-payer telehealth law, so insurers are not required to reimburse telehealth at the same rate as in-person care. Commercial telehealth coverage and payment are left to plan discretion.

Wyoming Medicaid excludes audio-only telephone visits from telehealth coverage

Wyoming Medicaid excludes audio-only telephone conversations from its telehealth definition. Telephone-only visits are therefore not reimbursable as telehealth.

Wisconsin has no private-payer telehealth law or payment parity

Wisconsin has no private-payer telehealth law, so commercial insurers face no telehealth coverage or payment-parity mandate. Plans are not required to cover telehealth or reimburse it at the in-person rate.

West Virginia requires out-of-state clinicians to register as interstate telehealth practitioners

West Virginia requires out-of-state providers to register as interstate telehealth practitioners with the appropriate WV licensing board before serving WV patients. They must be licensed and in good standing in their home state.

West Virginia Medicaid does not reimburse audio-only telehealth

West Virginia Medicaid does not reimburse audio-only telephone consultations. Coverage requires real-time interactive communication with both audio and video equipment.

Washington Medicaid requires an established relationship before audio-only telehealth

Washington covers audio-only telehealth only for established patients. The patient must have had an in-person or audio-video visit with the provider or medical group within the past three years before audio-only can be billed.

Virginia has no explicit private-payer telehealth payment parity

Virginia requires insurers to cover telehealth on par with in-person for eligibility, but has no explicit payment parity. Plans are not required to reimburse telehealth at the same rate as in-person and can deny technical fees.

Vermont requires out-of-state clinicians to obtain a telehealth registration or license

Vermont requires out-of-state providers to register before delivering telehealth to Vermont patients. They must obtain either an Interim Telehealth Registration or a permanent telehealth license/registration.

Utah Medicaid requires out-of-state telehealth providers to enroll and meet DOPL licensing

Non-resident providers serving Utah Medicaid patients via telehealth must meet Utah DOPL licensing requirements and enroll as Utah Medicaid providers. Temporary licenses exist only if full licensure takes longer than 15 days.

Utah has no general private-payer telehealth payment parity

Utah requires plans to reimburse network providers at a commercially reasonable rate, but does not mandate parity with in-person rates for general telemedicine. Only provider-to-provider telepsychiatric consults get an equivalence guarantee.

Texas requires out-of-state telehealth providers to maintain a physical office in the state

Out-of-state providers serving Texas patients via telehealth must be licensed or authorized in Texas and maintain a physical office in the state. This adds a presence requirement beyond licensure.

Texas Medicaid limits audio-only behavioral telehealth with an established-relationship rule

Texas Medicaid limits audio-only telehealth, requiring an established relationship for several services. Outpatient mental health and medication-assisted treatment via audio-only require an in-person or audiovisual visit within the prior six months.

Texas has no private-payer telehealth payment parity

Texas requires insurers to cover telemedicine but does not mandate paying it at the in-person rate. CCHP records no payment-parity reference, so commercial plans can reimburse telehealth below in-person care.

Tennessee has no private-payer telehealth payment parity

Tennessee insurers must cover telehealth but are not required to reimburse it at the in-person rate. State law specifies payers need not pay telemedicine encounters above the amount paid for the same in-person service.

Tennessee requires an in-person encounter before provider-based telemedicine

Tennessee requires evidence of a prior in-person encounter between the provider and patient before a provider-based telemedicine visit. Behavioral health initial evaluations are exempt, but most other services are not.

South Dakota Medicaid requires periodic in-person visits for ABA and therapy telehealth

South Dakota Medicaid requires periodic in-person, face-to-face visits for certain telehealth services. Applied Behavior Analysis and therapy services require an in-person visit within the first 30 days and every 90 days thereafter.

South Dakota has no private-payer telehealth payment parity

South Dakota law bars insurers from excluding a service just because it is delivered via telehealth, but it does not require them to pay telehealth at the same rate as in-person care. Private plans can reimburse telehealth below the in-person rate.

South Carolina requires out-of-state physicians to hold a full SC license for telemedicine

South Carolina requires physicians to hold a valid, current South Carolina medical license to treat patients in the state via telemedicine, with only narrow exceptions for care between in-person visits under an existing treatment plan.

South Carolina has no private-payer telehealth law (no coverage or payment parity)

South Carolina has no statute requiring commercial insurers to cover or pay for telehealth on par with in-person care. Private payers are free to decline telehealth coverage or reimburse it at lower rates.

Rhode Island prohibits prescribing controlled substances without an established in-person relationship

Rhode Island's Board of Medical Licensure and Discipline prohibits prescribing controlled substances via telemedicine without an established in-person physician-patient relationship. Patients seeking controlled-substance treatment generally cannot start care through telehealth alone.

Pennsylvania's telehealth insurance law provides coverage parity but no payment parity

Pennsylvania's Act 42 of 2024 requires insurers to cover in-network telemedicine but does not require payment parity, so reimbursement can vary by contract and plan. Private payers may pay less for telehealth than for equivalent in-person care.

Oregon is not a member of the Interstate Medical Licensure Compact

The Oregon Medical Board confirms that Oregon has not joined the Interstate Medical Licensure Compact or other physician licensure compacts. Out-of-state physicians generally must obtain full Oregon licensure to treat patients located in Oregon, with only narrow telemedicine exemptions for established patients.

Ohio law expressly does not require payment parity for telehealth

Ohio requires health plans to cover telehealth on the same basis as in-person care, but the statute expressly states it does not require reimbursement at the same rate as in-person services. Private payers can therefore pay providers less for telehealth than for equivalent in-person visits.

North Dakota requires an in-person-equivalent exam before initial telehealth diagnosis or treatment

North Dakota holds that an examination consisting only of a static online questionnaire or an audio-only conversation does not meet the standard of care for an initial diagnosis or treatment. This effectively limits which telehealth modalities can be used to establish care with a new patient.

North Dakota requires private insurers to cover telehealth but not at parity rates

North Dakota law requires commercial insurers to cover telehealth on the same basis as in-person care, but it explicitly leaves reimbursement rates to negotiation between insurer and provider. There is no payment parity, so private payers can reimburse telehealth at lower rates than in-person services.

North Carolina has no private-payer telehealth law (no coverage or payment parity)

North Carolina has no statute governing commercial insurer coverage of telehealth, meaning there is neither coverage parity nor payment parity for private payers. Private insurers are free to decline to cover telehealth services or to reimburse them at lower rates than in-person care.

New York is not a member of the Interstate Medical Licensure Compact

New York has not joined the Interstate Medical Licensure Compact, so there is no expedited pathway for out-of-state physicians to become licensed in New York. Clinicians must hold a full New York license to treat patients located in the state.

New York telehealth payment parity for private payers expires April 1, 2026

New York's law requiring commercial insurers to reimburse telehealth at the same rate as in-person care is temporary and sunsets on April 1, 2026. After that date, private payers can pay providers less for a telehealth visit than for the equivalent in-person visit, even though coverage parity remains.

New Mexico physicians not yet covered by the Interstate Medical Licensure Compact (operational ~2027)

New Mexico enacted the Interstate Medical Licensure Compact in February 2026, but the medical board is still writing rules and the expedited multistate pathway is not expected to launch until late 2026 or early 2027. Until then, out-of-state physicians must obtain full New Mexico licensure the traditional way.

New Jersey allows audio-only physical health telehealth to be reimbursed at only 50% of in-person rates

Under New Jersey's telehealth parity rules, audio-only physical health services are exempt from full payment parity and may be reimbursed at as little as 50% of the in-person rate. Audio-only visits for physical health care are therefore financially disadvantaged compared with in-person or video visits.

New Jersey requires telehealth organizations to register annually with the Department of Health

A telemedicine or telehealth organization operating in New Jersey must register annually with the state Department of Health before providing services. This registration requirement adds an administrative barrier for telehealth providers and out-of-state organizations serving New Jersey patients.

New Hampshire requires prior face-to-face contact before telehealth for primary care and remote patient monitoring

New Hampshire generally requires a prior in-person, face-to-face visit before delivering primary care or remote patient monitoring via telehealth, with limited exceptions for certain facility settings. This established-relationship requirement limits new-patient telehealth.

New Hampshire requires an in-person exam at least annually to continue prescribing controlled substances via telehealth

In New Hampshire, a clinician prescribing Schedule II-IV controlled substances by telehealth must conduct an in-person exam at intervals appropriate to the patient, but no less than annually. This in-person requirement limits fully remote controlled-substance prescribing.

Nebraska Medicaid covers audio-only telehealth only for established behavioral health patients

Nebraska Medicaid limits audio-only (telephone) telehealth to behavioral health and crisis services, and only for established patients. Phone-based visits for other services and for new patients are generally not covered, and store-and-forward telehealth is not covered at all.

Montana has no private-payer telehealth payment parity requirement

Montana law requires service parity (telehealth coverage equivalent to in-person) but explicitly does not require payment parity. Private payers may reimburse telehealth visits at lower rates than in-person care.

Missouri Medicaid requires out-of-state telehealth providers to be Missouri-licensed and MO HealthNet-enrolled

To deliver telehealth to Missouri Medicaid patients, out-of-state providers must be fully licensed to practice in Missouri and separately enrolled as a MO HealthNet provider. This dual requirement creates an administrative barrier for out-of-state clinicians.

Missouri has no private-payer telehealth payment parity requirement

Missouri requires carriers to cover telehealth on the same basis as in-person care but does not require them to reimburse at the same rate. Private payers may pay telehealth visits at lower rates and need not reimburse site origination fees.

Mississippi Medicaid requires an established patient relationship and limits audio-only telehealth

Mississippi Medicaid does not cover physician or practitioner telehealth visits for non-established patients, so a prior relationship is generally required. Audio-only services are not part of standard coverage and are allowed only during declared emergencies.

Mississippi has no private-payer telehealth payment parity requirement

Mississippi requires private insurers to cover telehealth to the same extent as in-person care but does not require equal payment rates. Insurers may reimburse telehealth visits at lower rates than in-person visits.

Minnesota Medicaid audio-only telehealth coverage is temporary and set to expire July 1, 2027

Minnesota's Medicaid program covers audio-only (telephone) telehealth only on a temporary basis through July 1, 2027. After that date, audio-only will no longer count as covered telehealth except for narrow emergency mental health and substance use exceptions.

Michigan has no private-payer telehealth payment parity requirement

Michigan law requires private insurers to cover telehealth services but does not require them to pay at the same rate as in-person care. Insurers can therefore reimburse telehealth visits at lower rates than equivalent in-office visits.

Massachusetts requires private-payer telehealth payment parity only for behavioral health, not all services

Massachusetts guarantees telehealth reimbursement at the in-person rate only for behavioral health services. For other services, private payers are not required to pay telehealth at parity, so medical and specialty telehealth visits can be reimbursed below in-person rates.

Massachusetts is not a member of the Interstate Medical Licensure Compact

Massachusetts has not joined the Interstate Medical Licensure Compact, so out-of-state physicians cannot use the compact's expedited pathway to get licensed in Massachusetts. They must instead apply through the standard, slower state process.

Maryland Medicaid requires providers to hold an active Maryland license to be reimbursed for telehealth

Maryland Medicaid requires telehealth providers to hold active Maryland licenses, aside from recognized interstate compacts and limited exceptions. This in-state licensure requirement is a cross-state barrier for out-of-state clinicians.

Maine requires telehealth providers to be licensed in the state where the patient is located

Maine requires providers to be appropriately licensed, certified, or registered in the state where the member is located during a telehealth service. A 2026 bulletin warns that noncompliance can lead to claim denials or recoupment.

Maine requires only telehealth coverage parity, not payment parity, so insurers may pay less than in-person rates

Maine bars insurers from denying coverage for telehealth that would be covered in person, but has no payment parity requirement. Carriers may reimburse telehealth below in-person rates and impose identical cost-sharing.

Louisiana caps originating-site telehealth physician reimbursement at no less than 75% of the in-person amount

Louisiana's private-payer telehealth law sets the originating-site physician reimbursement floor at no less than 75% of the reasonable and customary in-person amount. This allows reimbursement below the full in-person rate for those services.

Kentucky requires an in-person examination before certifying patients for medical cannabis

Kentucky requires an in-person examination for the initial medical cannabis certification, though follow-up visits may occur via telehealth. This limits fully remote access to the medical cannabis program.

Kentucky telehealth payment parity can be contractually waived, and audio-only is paid at the lower rate

Kentucky requires private insurers to reimburse telehealth equivalent to in-person care, but providers and plans may contractually agree to a lower telehealth rate. Audio-only encounters default to the lower of the two applicable rates.

Kansas has no telehealth payment parity, allowing insurers to reimburse telehealth below in-person rates

Kansas law expressly lets insurers set telehealth payment in the same manner as in-person services, with no parity guarantee. Commercial payers may reimburse telehealth at lower rates than equivalent in-person care.

Iowa generally requires an in-person interview/exam or established relationship before telehealth treatment

Iowa rules generally require physicians to conduct an in-person medical interview and physical examination, or otherwise establish a provider-patient relationship, before treating via telehealth. Exceptions exist for emergencies, institutional settings, and consultations.

Indiana requires out-of-state telehealth providers to obtain a telehealth provider certification

Out-of-state clinicians providing telehealth to Indiana patients must obtain an Indiana telehealth provider certification under IC 25-1-9.5-9. This registration step is an added administrative barrier for cross-state telehealth.

Indiana has no telehealth payment parity, so private insurers may reimburse telehealth below in-person rates

Indiana requires private insurers to cover telehealth using the same clinical criteria as in-person care, but imposes no payment parity. Insurers can reimburse telehealth services at lower rates than the equivalent in-person service.

Illinois private-payer telehealth payment parity sunsets January 1, 2028 (except mental health and substance use)

Illinois currently requires private insurers to reimburse telehealth at the same rate as in-person care, but this payment parity provision becomes inoperative on and after January 1, 2028. Only mental health and substance use disorder services retain parity after that date.

Idaho requires a provider-patient relationship to be established before delivering virtual care

Idaho's Virtual Care Access Act requires providers to first establish a provider-patient relationship meeting Idaho's community standard of care before delivering telehealth. Treatment based solely on a static online questionnaire is not acceptable.

Idaho has no private-payer telehealth law, so commercial insurers are not required to cover or pay parity for telehealth

Idaho has not enacted a private-payer telehealth statute. Commercial insurers are not required to cover telehealth, and there is no payment parity, so plans may reimburse telehealth below in-person rates or not at all.

Hawaii requires controlled-substance prescribers to be physically located in Hawaii and mandates an in-person consult first

Hawaii bars prescribing controlled substances via telehealth unless the prescriber is physically located in the state. An initial in-person consultation is also required before prescribing opioids or medical cannabis.

Hawaii Medicaid pays audio-only mental health at only 80% and requires a prior non-audio visit within 6 months

Hawaii Medicaid covers audio-only telehealth only for mental health, and only temporarily through 2027. Reimbursement is capped at 80% of the in-person rate and patients must have had an in-person or video visit within the prior six months.

Hawaii is an IMLC member but not a State of Principal Licensure, blocking expedited cross-state licensing via a Hawaii license

Hawaii participates in the Interstate Medical Licensure Compact but is not a 'State of Principal Licensure.' Physicians whose primary license is in Hawaii cannot use it to enter the compact and obtain expedited licenses in other states.

Georgia requires out-of-state telehealth physicians to arrange local coverage and a separate GA DEA registration for controlled substances

Georgia requires out-of-state physicians providing telehealth to have an arrangement with a local physician who has admitting privileges or a local hospitalist. To prescribe controlled substances, providers must also obtain a separate Georgia DEA registration.

Georgia bars private-payer reimbursement for audio-only telehealth outside mental/behavioral health

Georgia limits private-payer audio-only telehealth reimbursement to mental and behavioral health services. For all other services, insurers are not required to pay for audio-only (telephone) visits, disadvantaging patients without video access.

Florida private-payer telehealth law does not require payment parity

Florida's private-payer telehealth law does not mandate payment parity. Insurers and providers may agree to lower telehealth reimbursement than in-person rates, as long as the provider acknowledges the differential.

Florida requires out-of-state clinicians to register as telehealth providers (Fla. Stat. 456.47)

Under Florida Statute 456.47, a clinician not licensed in Florida may treat Florida patients via telehealth only after registering with the applicable board. Registrants must designate a Florida registered agent, carry liability coverage, and may not open an office or provide in-person care in the state.

Florida Medicaid does not cover audio-only telehealth

Florida Medicaid stopped covering audio-only telehealth after the federal public health emergency ended. Patients who rely on telephone-only visits because they lack video access cannot have those visits reimbursed by Florida Medicaid.

Delaware requires an interstate telehealth registration for out-of-state providers without a compact

Delaware requires out-of-state providers not covered by an applicable licensure compact to obtain an interstate telehealth registration from the Division of Professional Regulation before treating Delaware patients. This adds an administrative step despite strong coverage and parity rules.

California is not a member of the Interstate Medical Licensure Compact

California does not participate in the Interstate Medical Licensure Compact. Physicians licensed elsewhere cannot use the compact's expedited pathway and must complete California's full licensing process to treat California patients via telehealth.

Arkansas requires a professional relationship before telehealth and limits payment parity

Arkansas requires a professional relationship before telehealth, which can be established virtually only when the standard of care does not require an in-person encounter. Its private-payer law also does not require parity for services not comparable to in-person care.

Arkansas excludes audio-only communication from its telemedicine definition, limiting coverage

Arkansas law excludes audio-only communication from the definition of telemedicine. This limits reimbursement for telephone-only visits, disadvantaging patients without reliable video access.

Arizona requires out-of-state providers to register before delivering telehealth to Arizona patients

Even though Arizona mandates private-payer payment parity, out-of-state clinicians generally must register with the applicable Arizona licensing board before treating Arizona patients via telehealth. Narrow exemptions exist for emergencies, consultations, or infrequent care.

Alaska private-payer telehealth law has no payment parity requirement

Alaska requires private insurers to cover telehealth without prior in-person contact, but its law does not require payment parity. Insurers are not obligated to reimburse telehealth at the same rate as an equivalent in-person visit.

Alaska is not yet an operating member of the Interstate Medical Licensure Compact

As of mid-2026, Alaska is not a participating member of the Interstate Medical Licensure Compact. Legislation passed both chambers in May 2026 but was not yet operational, so physicians cannot use the compact's expedited pathway to obtain an Alaska license.

Alabama requires an established physician-patient relationship before telehealth treatment

Alabama generally requires an established physician-patient relationship (patient-initiated or by referral) before telehealth services. Repeated telehealth for the same unresolved condition also triggers an in-person visit requirement within 12 months.

Alabama has no private-payer telehealth law, so commercial plans face no parity requirement

Alabama has not enacted a private-payer telehealth statute. Commercial insurers are not required by state law to cover or reimburse telehealth at the same rate as in-person care, leaving coverage and payment to insurer discretion.