California Telemedicine Laws: Licensure, Prescribing, Parity

California is a full-licensure state with no compact shortcut, a broad and mature parity regime on both the commercial and Medicaid sides, and one genuinely unusual door: a 2024 exemption that lets out-of-state specialists treat Californians with immediately life-threatening conditions without a California license. If your patient is sitting in California, plan on a California license — and then plan on getting paid at the in-person rate.

Here is the quick reference, then the detail.

Licensure: full license, narrow exceptions

The Medical Board of California's position is plain: physicians using telehealth to treat patients located in California must hold a valid, current California license. The physician does not need to live in California, and the standard of care is the same as for an in-person visit.

California is not a member of the Interstate Medical Licensure Compact and has no IMLC bill moving, which puts it alongside New York among large states outside the compact. It is also not in the Physical Therapy Compact. The privilege-to-practice compacts do not reach California either: the state is outside the Nurse Licensure Compact and the Counseling Compact, and its PSYPACT bill was introduced but never enacted. There is no telehealth-specific registration pathway of the kind Florida offers.

The exemptions are limited. Under Bus. & Prof. Code § 2060, an out-of-state physician may act in actual consultation with a California-licensed practitioner, but may not open an office, receive calls from patients in the state, give orders, or hold ultimate authority over the patient's care. The newer one is § 2052.5, added by AB 1369, effective January 1, 2024. It allows an "eligible out-of-state physician and surgeon" — licensed in good standing in another state, no history of discipline, with expertise in the patient's illness — to practice medicine in California if the practice is limited to telehealth for an "eligible patient." The patient must have an immediately life-threatening disease or condition, provide written informed consent (personally or through a legally authorized representative) to the out-of-state physician's telehealth services and to release of certified records to the patient's California primary physician, either have not been accepted into the clinical trial nearest their home within one week of completing the application process or have their California primary physician judge trial participation unreasonable because of their current condition and stage of disease, and have documentation from that primary physician attesting to eligibility. The statute itself creates no Board registration step; verify current procedures with the Board before relying on it.

Behavioral health has its own small opening. Bus. & Prof. Code § 4980.11 lets an out-of-state marriage and family therapist treat an established client who is temporarily in California for up to 30 consecutive days in a calendar year, with advance notice to the Board of Behavioral Sciences and required disclosures to the client; CCHP reports parallel provisions for clinical social workers and professional clinical counselors. The MFT provision sunsets January 1, 2030. See our cross-state licensing tracker.

Prescribing: telehealth can be the exam

California does not require an in-person visit before prescribing by telehealth. Bus. & Prof. Code § 2242 makes prescribing dangerous drugs "without an appropriate prior examination and a medical indication" unprofessional conduct — and then states that the appropriate examination "does not require a synchronous interaction between the patient and the licensee and can be achieved through the use of telehealth," including a questionnaire or self-screening tool, provided the licensee meets the standard of care. That is a permissive baseline; the constraint is clinical judgment, not a procedural gate.

California has no telehealth-specific schedule restriction in the Medical Practice Act comparable to Florida's Schedule II rule. The state duties below apply to controlled substances regardless of modality:

• Registration. California has no separate state controlled substance registration. A practitioner authorized to prescribe Schedule II–V drugs must apply for access to CURES, the state prescription drug monitoring program, upon receiving a DEA registration (Health & Safety Code § 11165.1).
• CURES. Before prescribing a Schedule II, III, or IV substance to a patient for the first time, the prescriber must review the patient's controlled substance history for the past 12 months, no earlier than 24 hours or the previous business day before prescribing, and at least once every six months after that if the prescription is renewed and the substance remains part of treatment. Exemptions include short emergency department and post-procedure supplies of seven days or less, terminally ill patients, and CURES outages (§ 11165.4).
• Opioids. We found no California statute capping the day supply or dose of an adult outpatient opioid prescription. Before the first opioid prescription in a single course of treatment, the prescriber must discuss the risks of addiction and overdose, the added risk for patients with both mental health and substance use disorders, and the danger of combining opioids with benzodiazepines, alcohol, or other central nervous system depressants, with the patient or, for a minor, with the minor, a parent or guardian, or another adult authorized to consent; the duty does not apply to substance use disorder treatment, hospice patients, emergency services or emergency surgery, or when the prescriber judges the discussion would harm the patient (§ 11158.1). The prescriber must also offer a prescription for naloxone or another overdose-reversal drug when the dose reaches 90 morphine milligram equivalents a day or more, when an opioid is prescribed within a year of a dispensed benzodiazepine, or when the patient is at increased overdose risk (Bus. & Prof. Code § 741).
• E-prescribing. Since January 1, 2022, all prescriptions, not only controlled substances, must generally be issued electronically (Bus. & Prof. Code § 688(d)). Exemptions include terminally ill patients, temporary technological or electrical failure, pharmacies outside California, delays that would harm the patient, and prescribers who register annually with the Board of Pharmacy as issuing 100 or fewer prescriptions a year. Medicare Part D separately requires at least 70 percent of Part D Schedule II–V prescriptions to be electronic under 42 CFR 423.160, subject to exceptions and waivers.

Federal law adds a separate layer for controlled substances. Under the temporary rule DEA and HHS published December 31, 2025 (90 FR 61301), which runs through December 31, 2026, a DEA-registered practitioner may prescribe Schedule II–V controlled substances after a real-time audio-video telemedicine encounter without a prior in-person evaluation, when the rule's other conditions are met; audio-only encounters qualify only for Schedule III–V narcotic medications approved by the FDA to treat opioid use disorder. For telepsychiatry groups that federal rule is the practical ceiling; our DEA prescribing report tracks it.

Consent: verbal or written, always documented

Section 2290.5(b) sets the rule. Before delivering care by telehealth, the provider must inform the patient about the use of telehealth and obtain verbal or written consent to it as an acceptable mode of care, and "the consent shall be documented." A general consent agreement that specifically names telehealth satisfies the requirement for Medi-Cal purposes, and the documentation must be available to DHCS on request.

Medi-Cal layers on additional disclosures under Welf. & Inst. Code § 14132.725: the patient's right to in-person services, that telehealth is voluntary and consent can be withdrawn at any time, and that Medi-Cal covers transportation to in-person visits. The provider documents both the disclosure and the patient's verbal or written acknowledgment.

Medi-Cal: broad coverage, audio-only at parity

Live video bills with modifier 95, audio-only with modifier 93, and asynchronous store-and-forward (including e-consult) with modifier GQ; specialty mental health and substance use disorder programs use GT and SC instead. Remote patient monitoring is covered for established patients, with verbal consent acceptable if documented alongside the clinical justification. The originating site is not limited — the patient's home qualifies — and providers do not need to document a barrier to an in-person visit.

Payment parity is statutory: under § 14132.725, fee-for-service Medi-Cal pays synchronous video and audio-only services at amounts not less than the in-person rate. The guardrails sit around new patients. A relationship can be established by video, but by audio-only only for sensitive services, at the patient's request, or when the patient lacks video access, and not by asynchronous means at all. Synchronous providers must also keep protocols to offer in-person care or arrange a referral. FQHCs and RHCs follow separate rules. Confirm plan-specific policies for managed care.

Private insurance: coverage and payment parity

California has both kinds of parity. Health & Safety Code § 1374.14 (health plans regulated by DMHC) and Insurance Code § 10123.855 (insurers regulated by CDI) require coverage of telehealth "on the same basis and to the same extent" as in-person care, and go further: "Services that are the same, as determined by the provider's description of the service on the claim, shall be reimbursed at the same rate whether provided in person or through telehealth." Copayments and coinsurance may not exceed the in-person amount, and telehealth counts toward the same deductible and maximums. The payment parity language took effect January 1, 2022. The rate rule is written into plan–provider contracts, and neither statute requires coverage of telehealth from out-of-network providers unless other law requires it. The insurer version reaches only policies and provider contracts with alternative rates of payment (PPO-type arrangements). Plans may not limit coverage to services from select third-party corporate telehealth providers. Neither statute has a utilization review provision or mentions audio-only care; both borrow the § 2290.5 definition of telehealth, which covers synchronous interactions and asynchronous store and forward. It does not reach Medi-Cal managed care plans, which follow DHCS policy, and it generally does not govern self-funded employer plans regulated under federal law. Our reimbursement guide covers how state parity interacts with Medicare and commercial billing.

What to watch

Three items are live. SB 1002 would have extended the § 2052.5 exemption to patients whose life-threatening condition is in remission and who are continuing care with the same out-of-state physician; it had not passed as of this writing and may return. AB 688, chaptered in October 2025, requires DHCS to publish biennial reports on Medi-Cal telehealth utilization beginning in 2028. And the federal DEA rulemaking governs what California's permissive prescribing baseline is worth for controlled substances. Verify current requirements with the Medical Board of California and DHCS before acting — and compare California's approach with the rest of the country in the national overview.