Nebraska Telemedicine Laws: Licensure, Consent, Parity

Nebraska spreads its telehealth law across several codes. The Nebraska Telehealth Act, Neb. Rev. Stat. §§ 71-8501 to 71-8508, is mostly a Medicaid statute: its definition of "health care practitioner" is limited to Nebraska Medicaid-enrolled providers, and its consent and payment sections run to that program. Licensure and prescribing sit in the Uniform Credentialing Act and board rules; commercial coverage and payment sit in Chapter 44.

Licensure: a Nebraska license, with two narrow physician exceptions

Nebraska's definition of practicing medicine, § 38-2024(7), includes persons "physically located in another state" who, through any medium, including an electronic medium, perform for compensation a healing-arts service that would affect the diagnosis or treatment of an individual located in Nebraska. Nebraska has no telehealth registration.

Section 38-2025 lists twenty-two classes of exceptions, and two matter most for telehealth. Subdivision (6) covers a physician licensed in good standing in another state who is incidentally called into Nebraska or contacted electronically "for consultation with a physician licensed in this state." Consultation means evaluating the patient's data as provided by the treating physician and making a recommendation to that physician. Subdivision (7) covers such a physician who, from that state, orders diagnostic or therapeutic services "on an irregular or occasional basis" for a person in Nebraska, and only if the physician maintains no office or other place in Nebraska for rendering professional services or receiving calls. A physician previously denied, refused renewal, or disciplined in Nebraska cannot use either exception until licensed, renewed, or reinstated. Other professions follow their own acts.

Nebraska's compact positions: full Interstate Medical Licensure Compact membership, effective April 26, 2017, under LB 88 (2017); Nurse Licensure Compact multistate licenses since January 19, 2018; full PSYPACT participation effective July 1, 2020; and full Physical Therapy Compact membership. Nebraska's Counseling Compact status is pending: enacted, not yet issuing privileges. See our cross-state licensing tracker.

Prescribing: permitted, with physician, e-prescribing and opioid duties

Section 38-1,143 lets any credential holder under the Uniform Credentialing Act establish a provider-patient relationship through telehealth, except holders under ten listed practice acts. A credential holder providing a telehealth service may prescribe a drug "if the credential holder is authorized to prescribe under state and federal law." It bans no drug schedule. Other rules apply, including:

• Physician examination standard. Under 172 NAC 88-009(F), it is unprofessional conduct for a physician to provide treatment or consultation recommendations, including a prescription, "via electronic or other means" unless the physician has obtained a history and physical evaluation adequate to establish a diagnosis and identify underlying conditions and contraindications, and arrangements exist for the physician's availability, or physician coverage, for follow-up care. It covers physicians only.
• Electronic prescribing. Section 38-1,146 bars a prescriber from issuing a controlled-substance prescription in Nebraska unless it is sent electronically from prescriber to pharmacy. It lists ten exceptions, including technological failure, compounded drugs, and prescribers issuing fewer than fifty covered prescriptions a year. A violation is not grounds for discipline under the Uniform Credentialing Act.
• Opioid counseling. Section 38-1,144 requires a covered practitioner, before an initial prescription of a Schedule II controlled substance or other opiate for acute or chronic pain, to discuss addiction and overdose risks, why the prescription is necessary, and alternative treatments, unless another care-team member has had that discussion within the previous sixty days. Hospice, cancer, and palliative care are excluded.
• Opiates for minors. Section 38-1,145 limits an opiate prescription for a patient under eighteen, for outpatient use for an acute condition, to a seven-day supply unless, in the practitioner's professional judgment, more is required to treat the condition or is necessary for cancer pain or palliative care; the practitioner must then document the condition and that a nonopiate alternative was not appropriate. Before a first opiate prescription for the patient, the practitioner must also discuss the risks with a parent or guardian. Both opioid sections terminate on January 1, 2029.
• Abortion. Section 28-335(2) requires the physician who prescribes any drug to induce an abortion to be physically present in the same room with the patient.

The prescription drug monitoring statute, § 71-2454, requires dispensers to report prescription drugs dispensed in Nebraska or to a Nebraska address at least daily, not only controlled substances, with narrow exceptions. It contains no duty for a prescriber to query the system before prescribing.

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: a Medicaid statute, expanded by Medicaid rule

Section 71-8505 applies to a "health care practitioner," which § 71-8503 defines as a Nebraska Medicaid-enrolled provider, and it attaches to an "initial telehealth consultation under section 71-8506," the Medicaid payment section. Beforehand, the practitioner must ensure the patient receives four written statements: the patient may refuse telehealth at any time without affecting future care or program benefits; existing confidentiality protections apply; the patient has access to the resulting medical information; and identifiable images or information will not go to researchers or other entities without the patient's written consent. The patient then signs a statement before or during the initial consultation, or consents verbally during it, confirming the information was understood and discussed with the practitioner or a designee. A legally authorized representative acts for a minor or incapacitated patient. The requirement lifts only in an emergency where the patient cannot consent and the representative is unavailable.

Nebraska Medicaid's rule, 471 NAC 47-004.04, adds more. The written information must be acknowledged in writing or by email and adds disclosures, including whether the session is recorded, who is present, and the client's right to exclude anyone. When a client consents verbally, a signed statement must be collected within ten days and added to the record. We found no Nebraska statute imposing a general telehealth consent requirement outside this framework.

Medicaid: payment floor, audiovisual default, narrow audio-only

Section 71-8506 removes any in-person requirement for otherwise reimbursable Medicaid services and sets the telehealth rate, at a minimum, at the in-person rate, regardless of distance. It reaches managed care only to the extent fee-for-service covers the service and plan contracts were amended to add it.

471 NAC 47, adopted January 20, 2025, supplies the operating rules. Payment covers only services the fee schedule marks telehealth-eligible; hands-on services are excluded. Technology must provide a secure, HIPAA-compliant audiovisual connection. Originating sites have no geographic limits; out-of-state providers must be enrolled and appropriately licensed.

Rule 003.06 limits audio-only to individual behavioral health services or crisis management and intervention, for clients with an established relationship with the provider, when clinically appropriate. An established patient is one seen by the provider, or a same-specialty group colleague, within three years. Children receiving telehealth behavioral health services need an in-person staff member immediately available, unless a parent or guardian waives it, and a safety plan where there is a threat of harm. Provider Bulletin 23-08 assigns modifier 93 to audio-only and 95 to audiovisual.

Private insurance: coverage parity, conditional payment parity

Section 44-7,107(2) bars insurers, including self-funded plans to the extent not preempted by federal law, from excluding a service from coverage "solely because the service is delivered through telehealth," including services originating wherever the patient is, in plans offered or renewed on or after August 24, 2017. It excludes specified-disease and limited-benefit coverage and requires no coverage of services that are not medically necessary. A separate subsection bars excluding asynchronous dermatologist services for coverage beginning on or after January 1, 2021, pays them at a negotiated rate, and permits cost-sharing no higher than for in-person care.

Payment turns on § 44-312(4). Except as § 44-793 provides, the telehealth rate must at least equal the rate for a comparable in-person service, but only if the licensed provider also delivers in-person care at a physical location in Nebraska, or is employed by or holds medical staff privileges at a licensed Nebraska facility that provides in-person care in Nebraska. A telehealth-only practice without that Nebraska tie falls outside this mandate.

Section 44-793 adds a mental health rule for group and self-funded plans, excluding employer groups under fifteen employees. If the plan covers mental health conditions other than alcohol or substance abuse, it may not set a rate, term, or condition (a defined term that excludes deductibles, copayments, and coinsurance) placing a greater financial burden on mental health treatment by telehealth, and must reimburse it at least at the rate for comparable in-person treatment. See our reimbursement guide.

What to watch

The 2026 session did not amend the Telehealth Act. LB 732, which would have generally barred prescribing cross-sex hormones and puberty blockers to patients under nineteen and expressly extended the Let Them Grow Act's ban on gender-altering procedures to telehealth, was indefinitely postponed April 17, 2026. LB 912, approved April 14, 2026, adopted the Athletic Trainer Compact and the Respiratory Care Interstate Compact. Also watch the Counseling Compact, the 2029 termination of the opioid sections, and the federal DEA rule. Verify requirements with DHHS and Nebraska Medicaid, and see how state telemedicine laws work.