Maryland Telemedicine Laws: Licensure, Opioids, Parity

Maryland pays for telehealth the way it pays for office visits — by statute, at the same rate, with audio-only inside the definition and no expiration date since 2025. The practice rules are narrower. The Board of Physicians defines telehealth to exclude audio-only and generally requires a synchronous audio-visual evaluation before treatment, and one prescribing sentence does more to shape a Maryland practice than the entire parity statute.

Licensure: Maryland license, compact route, no registration

Maryland offers no telehealth-only license and no out-of-state telehealth registration. COMAR 10.32.05.03 sets the reach of the Board of Physicians' telehealth chapter: it applies when the practitioner is physically located in Maryland or the patient is in Maryland. A Maryland license is required to treat Maryland patients, telehealth included, and needs no separate telehealth authorization.

The exemption most often cited is narrow. Health Occupations § 14-302 lets a physician licensed elsewhere practice in Maryland while "engaged in consultation with a physician licensed in the State about a particular patient" without directing patient care — an e-consult, not a direct-to-consumer practice. COMAR 10.32.05.04 builds enforcement into the visit: a practitioner using synchronous telehealth must confirm whether the patient is in Maryland.

Maryland has been a full Interstate Medical Licensure Compact member since January 19, 2018, under SB 234, and is a full participant in the Physical Therapy Licensure Compact. Our cross-state licensing tracker records those two against the commissions' own data; Maryland is also a Nurse Licensure Compact state and a PSYPACT participating state; it has joined the Counseling Compact but is not yet issuing privileges.

Prescribing: a clinical evaluation, one opioid rule, and a PDMP duty

Health Occupations § 1-1003 sets the baseline. A telehealth practitioner is held to the same standards of practice as in person, must refer to in-person care when clinically appropriate, and must perform "a clinical evaluation that is appropriate for the patient and the condition with which the patient presents" before treatment or a prescription. A synchronous or asynchronous interaction may satisfy it.

The Board of Physicians is stricter. COMAR 10.32.05.05 requires a synchronous, audio-visual evaluation adequate to establish diagnoses and identify contraindications before treatment or prescribing, carving out interpretive services, monitoring of established patients, and asynchronous care for a patient who already had a qualifying evaluation. Because the Board's definition of telehealth excludes audio-only conversations, email, and fax, a telephone encounter a payer must reimburse is not one the Board treats as telehealth.

The prescribing restriction is narrow, not sweeping. Section 1-1003(c) bars prescribing an opiate listed in Schedule II for the treatment of pain through telehealth unless the patient is in a health care facility, the Governor has declared a catastrophic health emergency, or there is an established bona fide practitioner-patient relationship in which the prescriber has ongoing responsibility for the patient and the prescriber — or another practitioner in the same group practice — previously conducted an in-person assessment. That third exception was added in 2025. Read the limits: it reaches opiates, not every Schedule II drug, and pain, not every indication. Everything else falls under the general rule that a telehealth prescriber of a controlled dangerous substance remains subject to federal and state law, which keeps telepsychiatry workable here. Our DEA prescribing report tracks the federal layer, currently extended through the end of 2026; verify current status.

The prescription monitoring mandate applies equally to remote care. Health-General § 21-2A-04.2 requires a prescriber to request at least the prior four months of monitoring data before starting a course of treatment that includes an opioid or a benzodiazepine, to request it again at least every 90 days if treatment continues past 90 days, to assess it before prescribing, and to document both steps. Exceptions cover supplies of no more than three days, cancer pain, inpatients, hospice, and acute pain for a limited period after surgery or trauma. Access runs through CRISP, the state health information exchange.

Consent: verify the patient, then get the acknowledgement

COMAR 10.32.05.04 puts consent and identity in the same list of pre-service duties. A practitioner must verify the patient's identification and obtain oral or written acknowledgement from the patient or a person in interest, except for interpretive services. An initial interaction requires disclosing name, contact information, and specialty; a synchronous encounter requires identifying everyone present at each location, confirming they may hear protected health information, keeping the connection secure, and holding an emergency safety protocol.

Medicaid mirrors the requirement. Under COMAR 10.09.49, the participant must be present at the originating site and must consent to the service, documented in the record unless an emergency prevented obtaining it.

Medicaid: parity written into the program, audio-only made permanent

Maryland Medicaid covers synchronous telehealth under COMAR 10.09.49, and its reimbursement rule matches the commercial one: an appropriately delivered service is paid on the same basis and at the same rate as the in-person version, excluding clinic facility fees except as specified and room and board. The originating site may be any secure location the participant and provider agree on, including the home, with no geographic restriction. Freestanding clinics face the federal "four walls" limit.

Audio-only is the 2025 change. The definition covering an audio-only telephone conversation that results in a billable, covered service had been bracketed to July 1, 2021 through June 30, 2025; Chapter 482 struck that window. Which codes qualify remains program-specific, and audio-only claims carry their own modifier. Store-and-forward is not reimbursed as telehealth under COMAR 10.09.49; the narrow coverage for dermatology, ophthalmology, and radiology sits in the physician services chapter, and remote patient monitoring has its own chapter.

Private insurance: payment parity, and the sunset is gone

Insurance § 15-139 defines telehealth as the use of interactive audio, video, or other telecommunications technology by a licensed provider at a location other than the patient's, and expressly includes an audio-only telephone conversation that results in a billable, covered service. Email and fax are out. Carriers must cover telehealth regardless of where the patient is, may not exclude a service solely because it was delivered by telehealth, and must reimburse "on the same basis and at the same rate as if the health care service were delivered by the health care provider in person," net of clinic facility fees and room and board.

That rate sentence used to carry an expiration. Chapter 482 of 2025, the Preserve Telehealth Access Act, repealed the July 1, 2021 through June 30, 2025 limitation on the Medicaid and commercial parity requirements and on audio-only inclusion, effective June 1, 2025. Maryland now has durable statutory payment parity — a different modeling assumption from a coverage-only state, as our reimbursement guide shows.

What to watch

Three things. First, the Maryland Health Care Commission report that Chapter 482 requires by December 1, 2026 and every four years after, on telehealth modalities and delivery costs — where any argument to revisit parity will start. Second, the gap between payer law and practice law: the Board still excludes audio-only from its definition and requires a synchronous audio-visual evaluation, while carriers and Medicaid must pay for audio-only encounters. Third, the federal layer — DEA prescribing and Medicare flexibilities — which sets what Maryland's controlled-substance rule is worth. Verify current requirements with the Board of Physicians and the Maryland Department of Health before acting, and compare Maryland with its neighbors in the national overview.