Your clinician needs a license in the state where the patient’s body is, at the moment of the visit. Not where the clinician sits, not where your company is incorporated, and not where your servers are. That single rule decides which states your brand can sell into, and it is the constraint most online brands discover after they have already bought the ads.
Several states now say it in one sentence
This used to be an interpretation boards argued for. It is now statutory text in a growing number of states.
- North Dakota. “The practice of medicine is deemed to occur in the state the patient is located.” We wrote about that statute separately.
- Oregon. “The practice of medicine using telemedicine occurs where the patient is physically located.”
- Washington. “The provision of a telehealth service under this chapter occurs at the patient’s location at the time the service is provided.” That is the Uniform Telehealth Act, which Washington enacted in 2024 and other states are likely to copy.
- West Virginia. “The practice of the health care service occurs where the patient is located at the time the telehealth services are provided.”
- Florida. Any act delivering health care “is deemed to occur at the place where the patient is located at the time the act is performed.”
- North Carolina. The Board “deems the practice of medicine to occur in the state where the patient is located.” That is board policy rather than statute, which changes how it is enforced but not whether.
Texas arrives from the other direction. Someone physically in another jurisdiction who performs an act that is part of a patient care service initiated in Texas “is considered to be engaged in the practice of medicine in this state and is subject to appropriate regulation by the board.” Illinois says an out-of-state person treating an Illinois patient by telemedicine “submits himself or herself to the jurisdiction of the courts of this State.”
Federal guidance says it twice over: clinicians “must meet the licensure requirements of the state where they are located and be licensed or legally permitted to practice in the state where the patient is located.”
The registration pathway, and its two handcuffs
A minority of states let an out-of-state clinician register instead of holding a full license. This is the pathway that makes a fifty-state launch look cheap. Read the conditions first.
Florida is the model. A professional not licensed in Florida “may provide health care services to a patient located in this state using telehealth if the health care professional registers with the applicable board.” Then the catch, in the next breath: a registrant “may not open an office in this state and may not provide in-person health care services to patients located in this state.”
Every registration scheme we read carries those two handcuffs. Colorado’s, live since January 1, 2026, uses almost identical words. West Virginia’s “does not authorize a health care professional to practice from a physical location within this state without first obtaining appropriate licensure.”
Two have unusual limits. Vermont caps a telehealth license at “not more than 20 unique patients or clients located in Vermont during the two-year license term,” and its registration at ten patients over 120 days. Delaware’s registration is available only to a clinician “licensed in a state that has not adopted an interstate compact applicable to the health-care provider.”
| State | Out-of-state pathway | The catch |
|---|---|---|
| Florida | Telehealth registration | No office, no in-person care |
| Arizona | Telehealth registration | No office unless the group has an Arizona licensee; fewer than ten encounters a year needs no registration at all |
| Colorado | Telehealth registration, since January 1, 2026 | No office, no in-person care |
| West Virginia | Interstate telehealth registration | Does not authorize practice from a location in the state |
| Vermont | Telehealth license or registration | Hard patient caps: 20 per two years, or 10 per 120 days |
| Delaware | Interstate telehealth registration | Only if your state is not in an applicable compact |
| Minnesota | Annual registration | No office, no meeting patients, no calls in the state |
| Nevada | Telemedicine license | Requires specialty board certification |
| Kansas | Telemedicine waiver | Board-issued |
| Georgia | Telemedicine license | Telemedicine only. The Board notes the DEA treats it as a restricted license |
| Oregon | License to practice medicine across state lines | Separate statute restricts dispensing and some controlled substance use |
This route is shrinking, not growing
If your plan came from a list of registration states two years old, some of it is gone.
- Texas. The out-of-state telemedicine license is over. The current rule preserves it only for “those who held an out-of-state telemedicine license as of September 1, 2022.”
- Alabama. The Special Purpose License “will be abolished as of July 11, 2022. No new SP licenses may be issued nor existing SP licenses be renewed after this date.”
- Tennessee. “As of the effective date of this rule, the Board will no longer issue what was previously termed a ‘telemedicine license.'”
- Indiana. Telehealth certifications for out-of-state practitioners “will be terminated, permanently,” and all practitioners “must still be properly licensed in the state of Indiana in order to practice in the state of Indiana, even to provide telehealth services.”
- Louisiana. The telemedicine license statute was repealed effective January 1, 2024, and out-of-state authorization moved into board rulemaking.
California and New York never offered one. California’s Medical Board: physicians using telehealth to treat patients located in California “must be licensed in California,” though they “need not reside in California, as long as they have a valid, current California license.”
The exceptions that actually survive
Three hold up across most states we read. None is a business model.
- A genuine physician-to-physician consultation. California’s version is typical, and so is its limit: the consulting practitioner “shall not open an office, appoint a place to meet patients, receive calls from patients within the limits of this state, give orders, or have ultimate authority over the care or primary diagnosis of a patient who is located within this state.”
- Follow-up for an established patient who is temporarily in the state. Ohio allows follow-up “not later than one year after the last date services were provided in another state.” Illinois covers an existing patient “while the person licensed under this Act or patient is traveling,” and North Carolina’s policy covers a patient “attending college or vacationing in North Carolina.” Note the assumption: the relationship started somewhere you were already licensed.
- Low volume, in a few states. Arizona exempts a provider who “provides fewer than ten telehealth encounters in a calendar year.” Minnesota exempts service “less than once a month or provides the services to fewer than ten patients annually.” Both are built for the occasional patient, not a market entry.
What it costs to be wrong
Unlicensed practice is not a paperwork violation. In Florida it is “a felony of the third degree.” Texas makes it a third-degree felony too, and adds that “each day a violation continues constitutes a separate offense.” New York makes unauthorized practice “a class E felony.” California calls it a public offense.
We looked for a board order disciplining a clinician for cross-border telehealth in the last five years and found none we could verify from a primary source. Do not read that as comfort. What bites a brand arrives earlier and more quietly: a malpractice carrier declining a claim, a pharmacy or processor that stops working with you, and a diligence process that finds it before your buyer does.
What this means for you
Make a grid before you make a launch plan. Down one axis, every state you advertise into. Across the top, each prescriber on your panel. Fill in the license or registration that authorizes that clinician to treat a patient sitting in that state, with its expiration date. Empty cells are states you cannot sell into yet, which is a marketing instruction as much as a compliance one. Then test the registration cells against the two handcuffs: if your plan involves a location or an in-person visit in that state, the registration does not survive it. How we credential providers describes the file we keep per clinician, and a nationwide provider network covers the staffing side. Licensure is only the first gate: the good faith exam rules of the patient’s state apply on top of it, and so does the compact question if you are trying to license one physician broadly.
Related reading
Frequently asked questions
Do I need a license in the state where my telehealth patient is located?
Yes, in every state we checked, unless that state offers a registration and you hold it. Several states say in statute that the practice of medicine occurs where the patient is located at the time of the encounter. The clinician’s own location and your company’s location do not control.
Which states let an out-of-state clinician register instead of getting licensed?
We verified current pathways in Florida, Arizona, Colorado, West Virginia, Vermont, Delaware, Minnesota, Kansas, Nevada, Georgia and Oregon. Each one bars opening an office or seeing those patients in person, and some cap patient volume. Texas, Alabama, Tennessee, Indiana and Louisiana ended theirs between 2022 and 2024.
Can my physician treat a patient who is just traveling through a state?
In some states. Ohio allows follow-up within one year of the last service provided elsewhere, Illinois covers an existing patient while traveling, and Washington and North Carolina cover a patient temporarily in the state. The exception assumes the relationship began where your clinician was already licensed. It is not a way to open a new market.
What is the penalty for practicing telehealth without a license in that state?
Florida and Texas treat unlicensed practice as a third-degree felony, New York as a class E felony, and California as a public offense. Texas counts each day as a separate offense. The practical consequences usually arrive first, through insurance coverage, pharmacy relationships and acquisition diligence.
Does where my company is incorporated affect which states I can treat patients in?
No. Licensure attaches to the individual clinician and to the patient’s location during the encounter. Your entity’s state of formation, your office address and your server location do not change it. Corporate structure questions are real, but they are separate from the licensure question.
This is general information, not legal advice. Rules vary by state and change. Confirm your own facts with counsel.