Yes, in the states that matter most, with conditions. Florida, Texas and California each let a licensed prescriber establish the relationship and evaluate a patient by telehealth if the standard of care is met. What none of them lets you do is skip the evaluation, hand it to someone unlicensed, or use video to satisfy a rule that requires a physician physically present. And for anything on a controlled-substance schedule, the federal clock runs out on 31 December 2026.
The three big states say yes, on the record
Florida. A telehealth provider must practice within their scope and the prevailing professional standard of practice, and may evaluate a patient by telehealth; if that evaluation is sufficient for diagnosis and treatment, no prior physical examination is required (Fla. Stat. 456.47). Schedule II drugs may not be prescribed by telehealth except for listed exceptions that do not include aesthetics or weight management. Out-of-state providers may register to deliver telehealth to Florida patients but may not open a physical office here.
Texas. A valid practitioner-patient relationship exists by telemedicine where the practitioner meets the standard of care and uses synchronous audiovisual interaction, or asynchronous store-and-forward technology combined with synchronous audio, or another audiovisual method that meets the standard of care (Tex. Occ. Code 111.005). The written-order rules in 22 TAC 169.27 still apply: the order is patient-specific and the physician is responsible for it.
California. Telehealth is a mode of delivering care, the professional standards that apply under the provider’s license apply while providing it, the patient must be informed and consent, and the statute does not require an in-person visit first (Bus. & Prof. Code 2290.5). The Medical Board’s expectation is the same as in person: an appropriate prior examination by someone authorized to perform it.
The common thread is “standard of care.” A video evaluation for a neurotoxin patient with a clean history meets it. A video evaluation for a filler patient with a vascular history the provider never asked about does not, and the fact that it was video will not be the defense.
Where a body must be in the room
Telehealth solves the evaluation. It does not solve presence rules written for the treatment.
| State | The rule telehealth does not satisfy | Authority |
|---|---|---|
| Louisiana | A physician or NP must be physically present on the premises and immediately available while an RN performs cosmetic procedures | LSBN Declaratory Statement |
| Ohio | Delegated light-based device procedures need on-site supervision: the physician in the same office suite | OAC 4731-18-01, 4731-18-03 |
| Mississippi | The collaborating physician must practice in-state 20 hours a week or 80 a month, and the rule states this does not include telemedicine | 30 Miss. Admin. Code Pt. 2630, Rule 1.3 |
| Texas | The delegating physician, PA or APRN must be present or immediately available for emergency consultation during treatment | 22 TAC 169 subch. E |
| Connecticut | The med spa’s own physician, PA or APRN performs the initial assessment; the statute requires an assessment, and whether it may be remote is not stated | Conn. Gen. Stat. 19a-903c |
Mississippi is the sharpest example. A physician can lawfully evaluate a Mississippi patient by video, and still fail the collaboration rule because video hours do not count toward the 20 a week. The evaluation and the collaboration are two different obligations.
Puerto Rico moved the other way
While mainland states layered on conditions, Puerto Rico loosened. Ley 8-2025, approved 11 April 2025, amended the telemedicine statute so that any physician or health professional holding a valid Puerto Rico license may practice telemedicine and telehealth without an additional certification. A Puerto Rico license is still required; a mainland license is not enough.
The controlled-substance clock
If the treatment involves a controlled substance, telehealth evaluation is governed by federal law on top of state law. The Ryan Haight Act’s in-person requirement was suspended by pandemic-era flexibilities that the DEA and HHS have extended four times, most recently in a rule published 31 December 2025 running through 31 December 2026. As of September 2026, a DEA-registered practitioner may still prescribe a controlled substance by telemedicine to a patient they have never seen in person. There is no fifth extension on the books. Testosterone is Schedule III, so telehealth TRT models sit directly on that date. Semaglutide and tirzepatide are not controlled, and neurotoxins and fillers are not either, so the ordinary aesthetic and GLP-1 menu is unaffected by the federal clock, only by state rules.
A telehealth exam that survives review
- Right license, right state. The evaluating provider is licensed where the patient is located, or registered under a scheme like Florida’s out-of-state telehealth registration.
- Right modality. Synchronous video by default. Texas permits store-and-forward plus synchronous audio; Florida and California key everything to the standard of care, which for aesthetics generally means seeing the treatment area.
- Right content. History, indication, contraindications, medications, prior reactions, and a decision, documented before the treatment with a timestamp that proves it.
- Right follow-through. Texas requires guidance on follow-up care and, with consent, notice to the primary care physician within 72 hours for relationships formed by telemedicine.
- Right presence. If the state requires a physician on site for the treatment itself, telehealth has not changed that. Staff the room accordingly.
What this means for you
Use telehealth for the evaluation where the state allows it and your provider network is licensed where your patients are; it is the only way a multi-site or online model gets forty documented evaluations done by a prescriber on a Saturday. Do not use it to paper over a presence rule: Louisiana’s premises requirement, Ohio’s same-suite rule for lasers and Mississippi’s in-state hours are staffing facts. Build the controlled-substance part of your menu on the assumption that the federal flexibility ends on 31 December 2026 and plan an in-person path for those patients now. See how good faith exams work, and the state pages for Florida, Texas and California.
Related reading
Frequently asked questions
Is a virtual good faith exam legal?
In Florida, Texas and California, yes, when performed by a licensed prescriber who meets the standard of care. Florida Statutes 456.47, Texas Occupations Code 111.005 and California Business and Professions Code 2290.5 each recognize a relationship formed and an evaluation performed by telehealth. Some states add presence rules for the treatment that video cannot satisfy.
Can a nurse do the telehealth good faith exam?
An RN cannot perform the evaluation in person or by video; the exam is a diagnosing-and-prescribing act reserved to a physician, NP or PA. Telehealth changes where the provider is, not who the provider must be.
Can controlled substances be prescribed after a telehealth good faith exam?
Under the DEA and HHS fourth temporary extension, yes, through 31 December 2026, subject to state law. Florida bars Schedule II prescribing by telehealth outside listed exceptions. Testosterone is Schedule III and depends on the federal extension; semaglutide, tirzepatide, neurotoxins and fillers are not controlled.
Does Texas allow store-and-forward for a good faith exam?
Texas Occupations Code 111.005 recognizes a relationship formed by asynchronous store-and-forward technology combined with synchronous audio, using clinically relevant images or records, provided the standard of care is met. Whether photographs plus a phone call meet the standard of care for a given aesthetic treatment is a clinical question the provider answers on the record.
Which states require the physician to be physically present in a med spa?
Louisiana requires a physician or NP physically on the premises while an RN performs cosmetic procedures. Ohio requires on-site supervision, in the same office suite, for delegated light-based devices. Texas requires the delegating physician, PA or APRN to be present or immediately available. Mississippi excludes telemedicine from the collaborating physician’s in-state hours.
This is general information, not legal advice. Rules vary by state and change. Confirm your own facts with counsel.