Montana Telemedicine Laws: Licensure, PDMP, Parity

Montana requires a Montana license, or an Interstate Medical Licensure Compact license, for a physician treating a patient physically located in the state; the separate telemedicine license it once offered was repealed in 2015. Prescribing follows ordinary standards under a Board of Medical Examiners rule, with a mandatory registry check before opioids and benzodiazepines. Medicaid pays telehealth, including telephone, at in-person rates, while commercial plans owe coverage parity but not payment parity.

Licensure: one license, no telemedicine shortcut

MCA 37-3-102(11) defines the practice of medicine to include diagnosis and treatment "by any means," including "electronic and technological means such as telemedicine," and says a person who is neither licensed under the chapter nor exempt from it is practicing medicine in violation of the chapter. Telemedicine is defined in subsection (14) as practice through interactive electronic communications, information technology, audio-only conversations, or other means between a licensee in one location and a patient in another, including secure videoconferencing and store-and-forward technology. Email, instant messaging and fax do not count. One carve-out applies to physicians giving written certification of a debilitating medical condition under MCA 16-12-509: for them, audio-only does not count unless the physician has previously established a physician-patient relationship through an in-person encounter.

ARM 24.156.813(1) fixes the location: treatment of a patient "physically located in Montana" by telemedicine "occurs where the patient is physically located." Montana once issued a telemedicine license under MCA 37-3-341 through 37-3-349; Chapter 154, Laws of 2015, repealed those sections, and the Board states it no longer issues telemedicine licenses.

MCA 37-3-103 lists the exemptions, including one for "the rendering of services in this state by a physician lawfully practicing medicine in another state." It carries conditions: a physician who does not limit services to an occasional case, or who has any established or regularly used hospital connections in Montana, or who maintains or is provided an office or other place for regular use, must hold a Montana license. Neither the statute nor the Board's telemedicine rule says how this applies to telemedicine, so treat it as unconfirmed. For other professions, MCA 37-2-305 lets any person licensed under Title 37 provide services by telehealth when it is appropriate for the services, meets the standard of care, and complies with the licensing board's telehealth rules.

Montana is a full Interstate Medical Licensure Compact member through HB 429 (2015, ch. 203). It is a full Nurse Licensure Compact member, effective January 19, 2018, and a full Physical Therapy Compact member. PSYPACT publishes Montana's final legislation but does not list Montana among its participating states, so Montana has enacted the compact without being listed as participating. Montana has joined the Counseling Compact, which is not yet live for it. See our cross-state licensing tracker and how state telemedicine laws work.

Prescribing: the standard of care, plus the registry

ARM 24.156.813 covers physicians and physician assistants. A licensee must meet in-person standards of care. The provider-patient relationship may be established by an in-person interview and physical examination when the standard of care requires an in-person encounter; by consultation with another licensee or provider who has a documented relationship with the patient and agrees to participate in or supervise care; or through telemedicine if the standard of care does not require an in-person encounter. The licensee must also verify the patient's identity, make the licensee's identity and credentials available, establish the relationship before initiating care, obtain a medical history sufficient for diagnosis and treatment before treating or issuing prescriptions, delegate care only to providers who are known to be qualified and competent, who have an established relationship with the patient, or who have physical or electronic access to the licensee for consultation and follow-up, and keep records available to the patient and other providers.

The rule allows Schedule II prescribing by telemedicine in compliance with DEA requirements and MCA 37-20-404. That statute governs physician assistants: Schedule II prescribing "may be authorized for limited periods not to exceed 34 days."

Two statutory registry duties apply to every prescriber. MCA 37-7-1503(1) requires each Title 37 licensee who prescribes or dispenses to register with the prescription drug registry at initial licensure or renewal. MCA 37-7-1515 requires a prescriber or agent to review the patient's registry records before prescribing an opioid or a benzodiazepine, unless the patient is in hospice care; the prescription is for 7 days or less and cannot be refilled; the drug is lawfully administered in a health care facility; an emergency makes review impossible; the patient is treated for chronic pain and the prescriber reviews the registry every 3 months; or the registry is down or another technological failure occurs and the failure is reported to the board. Montana's former seven-day supply limit on outpatient opioid prescriptions for opioid-naive patients (MCA 37-2-108, enacted in 2019) terminated on June 30, 2025, under its own sunset clause (sec. 8, Ch. 89, L. 2019); the registry review duty in MCA 37-7-1515 did not terminate. We found no Montana mandate for electronic prescribing of controlled substances. 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: borrowed from in-person practice

We found no general Montana telehealth consent statute, and ARM 24.156.813 contains no consent requirement. The Board of Psychologists' telehealth rule, ARM 24.189.424, addresses how the relationship is established, not consent. Consent appears in the Medicaid statute: MCA 53-6-122(2)(b) requires providers to "follow consent and patient information protocols consistent with the protocols followed for in-person visits." No separate form is prescribed.

Medicaid: telephone included, rates matched

MCA 53-6-122, enacted in 2021, allows enrolled providers to deliver medically necessary services by telehealth if the service is clinically appropriate for telehealth as specified by the department, comports with the applicable provider manual, and is not required by that manual to be face-to-face. Services may be delivered by secure portal messaging, secure instant messaging, telephone, or audiovisual communication, and "must be reimbursed at the same rate of payment as services delivered in person." Providers must preserve in-person confidentiality and security and follow the department's recordkeeping rules. An enrollee's residence is not reimbursable as an enrolled originating site provider. That limits originating-site payment, not care to an enrollee at home: the department's 2023 notice says the program is committed to enabling members to remain in their homes.

The March 21, 2023 Montana Healthcare Programs notice, effective May 12, 2023, repeats those conditions, requires claims to carry the appropriate code, place of service and modifier, and cites ARM 37.85.414 for records. An April 29, 2025 notice states that audio-only codes 99441–99443 were discontinued effective January 1, 2025, and that Medicaid pays either 98000–98015 or an E/M code with the appropriate modifier.

Private insurance: coverage parity, no rate rule

MCA 33-22-138 applies to each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that covers health care services. It must cover services delivered by telehealth by a listed health care provider or health care facility if the services are otherwise covered. Plans may not restrict the patient's or the provider's site or distinguish rural from urban patients, and "Coverage under this section must be equivalent to the coverage for services that are provided in person."

Its definition of telehealth includes audio-only communication over a secure connection. Deductibles, coinsurance, copayments and other limitations are allowed but may not be more than those applicable to other medical services covered under the plan. Plans need not cover services that are not medically necessary, subject to policy terms, or cover an otherwise noncovered benefit. The section excludes disability income, hospital indemnity, Medicare supplement, specified disease, and long-term care policies. It has no sunset and says nothing about payment rates. Model commercial revenue from contracts; our reimbursement guide explains the difference.

What to watch

The Montana Legislature meets in regular session in odd-numbered years, so the next telehealth changes are likely in the 2027 session; watch the Board of Medical Examiners for rule changes to ARM 24.156.813. Watch whether PSYPACT lists Montana as participating and when the Counseling Compact goes live for Montana. The Montana Abortion-Inducing Drug Risk Protocol Act (MCA 50-20-701 through 50-20-714), which barred providing abortion-inducing drugs by courier, delivery, or mail and made violations a felony, is permanently enjoined: on June 9, 2025, in Planned Parenthood of Montana v. State, 2025 MT 120, the Montana Supreme Court held the act unconstitutional in its entirety and affirmed the permanent injunction against its enforcement. The sections remain printed in the code, so watch for further litigation or new legislation. Verify current requirements with the Board of Medical Examiners, the Board of Pharmacy, and the Department of Public Health and Human Services.