Maryland Telemedicine Laws: Licensure, Opioids, Parity

Maryland pays for covered telehealth services 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 calls, and one prescribing sentence does more to shape a Maryland practice than the entire parity statute.

Licensure: Maryland license, compact route, no registration

For physicians, Maryland offers no telehealth-only license and no out-of-state telehealth registration. Other professions differ: until October 1, 2026, the Board of Professional Counselors and Therapists may issue a six-month temporary telehealth license for counseling college students in Maryland, and from that date Chapter 242 of 2026 repeals that license and instead lets an out-of-state counselor or social worker licensed and in good standing in another state continue treating an existing client by telehealth for up to six months after the client moves to Maryland (Health Occupations §§ 17-301(b)(3), 19-301(b)(5)). 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 July 1, 2019, under SB 234, and is a full participant in the Physical Therapy Licensure Compact. Our cross-state licensing tracker records those two, with IMLC status from the Commission and the effective date from Maryland's session law; 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: evaluation, the opiate rule, registration, PDMP, opioid limits and e-prescribing

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' chapter tracks the statute. COMAR 10.32.05.05 requires a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the presenting condition before treatment or a prescription, and a referral to in-person care or another type of telehealth service when clinically appropriate. COMAR 10.32.05.06 holds a telehealth practitioner to in-person standards of practice and documentation and adds two bright lines: a practitioner may not treat a patient or prescribe medication based solely on a static online questionnaire, and must comply with State and federal dispensing law, including the prohibition on mail-order dispensing. Because the Board's definition of telehealth excludes care delivered solely through audio-only calls, email, or fax (COMAR 10.32.05.02B(5)(c)), a telephone-only encounter a payer must reimburse is not one the Board treats as telehealth.

The prescribing restriction is narrow. Section 1-1003(c), repeated in COMAR 10.32.05.06C, 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.

The other state duties apply to a telehealth prescription exactly as they do in person:

• State registration. Criminal Law § 5-301(a) requires registration with the Maryland Department of Health before a person dispenses a controlled dangerous substance in the State, and § 5-101 defines "dispense" to include prescribing. The Department's Office of Controlled Substances Administration issues these CDS registrations. Under § 5-304(a), the Department registers an authorized provider who is authorized under State law to dispense Schedule II–V substances; § 5-301(b) requires a separate registration for each principal place of business or professional practice where the applicant dispenses, and § 5-301(c) requires an attestation of 2 hours of continuing education on prescribing or dispensing controlled dangerous substances. Maryland's CDS registration is separate from, and in addition to, a federal DEA registration. We found no separate OCSA policy for out-of-state telehealth prescribers; confirm with OCSA before prescribing a controlled substance to a Maryland patient.
• PDMP registration. A prescriber of Schedule II–V substances must be registered with the Prescription Drug Monitoring Program before obtaining a new or renewal CDS registration (Criminal Law § 5-304(b); Health-General § 21-2A-04.1(a)), after completing a Department training course (§ 21-2A-04.1(c)). OCSA asks applicants to register through CRISP, the state health information exchange, and to submit the PDMP confirmation.
• PDMP queries. Health-General § 21-2A-04.2 requires a prescriber to request at least the prior 4 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 while that treatment continues past 90 days, to assess the data before deciding to prescribe or continue prescribing, and to document that the data was requested and assessed. No query is required for a supply of 3 days or less; cancer or cancer-related pain; hospital inpatients; hospice patients and other patients diagnosed with a terminal illness; residents of assisted living, long-term care, comprehensive care, or developmental disabilities facilities; or acute pain for up to 14 days after surgery, a fracture, significant trauma, or childbirth. The duty also yields for drugs the Secretary lists as having a low potential for abuse, when a query would delay treatment to the patient's harm, or when the system or connection is down; in those last three cases the prescriber must use reasonable medical judgment and record in the chart why the data was not accessed (§ 21-2A-04.2(b)–(d)).
• Opioid limit. Health Occupations § 1-223 sets no fixed day or MME cap. On treatment for pain, a provider must prescribe the lowest effective dose of an opioid and a quantity no greater than needed for the expected duration of pain severe enough to require an opioid, based on an evidence-based clinical guideline, unless the opioid treats a substance-related disorder, pain associated with a cancer diagnosis, pain during end-of-life, hospice, or palliative care, or chronic pain. The patient must be advised of the benefits and risks of the opioid and of any co-prescribed benzodiazepine. A violation is grounds for discipline.
• E-prescribing. Health-General § 21-220(c) requires a health practitioner to issue a prescription for any controlled dangerous substance electronically. A written or, where State and federal law allow, oral prescription is permitted only under listed exceptions, among them a temporary technological or electrical failure, a prescription to be dispensed by a pharmacy outside Maryland, a prescription issued by a practitioner outside Maryland, patients in nursing or assisted living facilities, hospice or palliative care, or dialysis, a Department waiver, low-volume prescribers as determined by the Maryland Health Care Commission, and a case where an electronic prescription could not be issued in time and the delay would harm the patient. 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. See our guide to federal telehealth laws.

Consent: verify the patient, disclose, and obtain consent

COMAR 10.32.05.04 puts consent and identity in the same list of pre-service duties. Before performing telehealth services, a practitioner must have and follow a procedure to verify the patient's identity (government photo identification; an insurance, Medicaid, or Medicare card; or documented date of birth and home address); disclose name, contact information, license type, and any medical specialty at the initial encounter; obtain oral or written consent from the patient, or from a parent or guardian where State law requires it, including informing the patient of the risks, benefits, and side effects of prescribed treatments (interpretive services excepted); securely collect and transmit patient data and notify patients of a data breach; keep the connection secure, private, and compliant with federal and state privacy laws; and set emergency safety protocols. Except for asynchronous care, the practitioner must also confirm an alternative way to reach the patient if the technology fails, confirm whether the patient is in Maryland and the practice setting, and identify everyone present at each location and confirm they may hear personal health information. These tasks may be delegated.

For minors, Health-General § 20-104 gives a minor 12 or older, whom a licensed provider determines to be mature and capable of giving informed consent, the same capacity as an adult to consent to consultation, diagnosis, and treatment of a mental or emotional disorder. That capacity does not let a minor under 16 consent to prescription medication for a mental or emotional disorder, except as otherwise provided in that subtitle, or let any minor refuse treatment a parent, guardian, or custodian has consented to.

Medicaid adds its own rule. Under COMAR 10.09.49.04, the provider must obtain the participant's consent to services via telehealth unless an emergency prevents it, and the medical record must include the consent or an explanation of why it was not available.

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

Maryland Medicaid covers synchronous telehealth under COMAR 10.09.49, and Health-General § 15-141.2(g) sets a reimbursement rule that 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 Program need not pay for non-covered services or out-of-network providers other than authorized self-referred services. 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 statutory definition in § 15-141.2(a)(7) 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 (UB, under COMAR 10.09.49.08). 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 applies to insurers, nonprofit health service plans, and HMOs whose policies or contracts are issued or delivered in Maryland; self-funded employer plans are generally governed by federal law instead. It defines telehealth as the use of interactive audio, video, or other telecommunications or electronic technology by a licensed provider at a location other than the patient's. An audio-only telephone conversation counts only when it results in the delivery of a billable, covered health care service; other audio-only calls, email, and fax are out. Carriers must cover services appropriately delivered through telehealth regardless of where the patient is, may not exclude a service solely because it was delivered by telehealth, and must reimburse a covered service that can be appropriately provided through telehealth "on the same basis and at the same rate as if the health care service were delivered by the health care provider in person." The rate excludes room and board fees, and excludes clinic facility fees unless the provider is not authorized to bill a professional fee separately.

The statute also sets limits. A carrier need not pay for a service that is not a covered benefit under the policy, or pay a provider who is not a covered provider under the policy (§ 15-139(d)(1)(ii)); the statute uses "covered provider" rather than "in-network," so the policy's provider terms control. Carriers may impose deductibles, copayments, and coinsurance on telehealth benefits as on in-person benefits (§ 15-139(d)(1)(iii)). They may undertake utilization review, including preauthorization, if they determine the appropriateness of a service the same way whether it is delivered in person or through telehealth (§ 15-139(f)). They may not require, as a condition of paying for a covered service, that it be delivered by a third-party vendor the carrier designates (§ 15-139(e)). A coverage denial based on a finding that telehealth is not medically necessary, appropriate, or efficient is an adverse decision under Insurance § 15-10A-01 (§ 15-139(h)).

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 calls from its definition of telehealth, 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.