New York Telemedicine Laws: Licensure, Prescribing, Consent

New York is a full-licensure state with no compact shortcut, a strict e-prescribing regime, and — after legislation signed in May 2026 — payment parity locked in through the spring of 2028. If you treat a patient located in New York, you need a New York license, and the state treats the care as delivered wherever the patient is sitting.

Here's the quick reference, then the detail.

Licensure: full license, no shortcuts

Any provider treating a patient located in New York needs full NY licensure and current registration, absent a specific statutory exemption. Telehealth is deemed rendered at the patient's location — a physician sitting in Miami treating a patient in Buffalo is practicing medicine in New York.

What makes New York unusual among large states is what it doesn't offer. It is not a member of the Interstate Medical Licensure Compact, has no telehealth-specific registration pathway for out-of-state providers, and doesn't participate in PSYPACT or the Nurse Licensure Compact either. The COVID-era waivers that briefly opened the border are long expired. An IMLC bill (A 6362/S 1505) was introduced in March 2025 and re-referred to committee in January 2026, but it has not been enacted, so plan around full licensure.

The exceptions, under Education Law § 6526, are narrow: an out-of-state physician may consult with a NY-licensed physician (consultation only, not directing care), and a physician licensed in a bordering state who lives near the border may practice in the border vicinity if they keep no New York office. There is no general follow-up-care or temporary-practice exception — a detail that matters for practices near state lines and for telepsychiatry groups with mobile patients.

Prescribing: the relationship can start online, but the rails are strict

New York doesn't require an in-person exam before prescribing non-controlled medications via telehealth; the telehealth encounter can establish the relationship if the standard of care is met.

Controlled substances got a dedicated rule in May 2025, when the state finalized amendments to 10 NYCRR Part 80. The baseline is an in-person medical evaluation, by the prescribing practitioner, for the condition before a controlled substance is prescribed (10 NYCRR 80.63(d)). The exceptions in 80.63(e) are: prescribing through telemedicine or telehealth consistent with state law and DEA rules, explicitly including FDA-approved medications for opioid use disorder; prescribing after reviewing a patient record that contains an in-person evaluation for the same condition by a consulting or referring practitioner within the previous 12 months; a covering practitioner continuing therapy during the initial prescriber's temporary absence, but only if the covering practitioner is in the same practice with direct access to records that warrant continued prescribing, or has consulted directly with the initial prescriber, who confirms the need; and a new condition in an existing patient where an emergency makes immediate administration necessary and no alternative treatment is available, limited to a 5-day supply (10 NYCRR 80.63(e)). In practice, New York's telemedicine window tracks the federal one: if the federal framework tightens, New York's exception tightens with it.

Other New York duties apply on top, telehealth or not:

• Registration. New York has no separate state controlled substance registration for practitioners. A prescriber who e-prescribes controlled substances must register the certified e-prescribing application with the Bureau of Narcotic Enforcement, and prescription monitoring registry access runs through a Health Commerce System account.
• PMP. Every practitioner must consult the prescription monitoring program registry before prescribing or dispensing any Schedule II, III, or IV controlled substance. Exceptions include emergency department prescriptions of no more than a 5-day supply, hospice patients, a registry that cannot be reached in time with no designee available (5-day supply maximum), and registry outages; a designee may run the check, but the prescribing decision stays with the practitioner (Public Health Law § 3343-a(2)).
• Opioid limits. A practitioner may not prescribe more than a seven-day supply of any Schedule II, III, or IV opioid at the initial consultation or treatment for acute pain; pain treated as part of cancer care, hospice or other end-of-life care, or palliative care is excluded. Opioids for pain lasting more than three months require a written treatment plan that follows accepted national guidelines, with exceptions for cancer not in remission, hospice or end-of-life care, and palliative care (§ 3331(5), (8)).
• E-prescribing. Since March 27, 2016, essentially all prescriptions, controlled and non-controlled, must be transmitted electronically (§ 281(3)). Exceptions include temporary technological or electrical failure, a waiver of up to one year, delays that would harm the patient (limited to a 5-day supply for controlled substances), and prescriptions filled by a pharmacy outside New York. 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. Our coverage of the DEA telemedicine prescribing rules tracks where that stands.

Consent

New York handles telehealth consent mostly through the Medicaid program and professional-conduct expectations rather than one general statute. Medicaid requires documented informed consent before or during the first telehealth visit — verbal consent is acceptable, but it must be documented in the chart, and where the member is a minor and the service itself requires parent or guardian consent, the parent or guardian must also consent to telehealth (NYS Medicaid Telehealth Policy Manual, § 8). Mental health programs licensed by the Office of Mental Health carry their own telehealth requirements under 14 NYCRR § 596. For commercial-pay encounters, documented consent and identity verification are standard-of-practice expectations under the Office of the Professions' guidance.

Medicaid: broad coverage, home included

New York Medicaid covers telehealth generously by national standards: live video, audio-only (when audio-visual isn't available or the patient prefers it and the service can be delivered effectively without video), store-and-forward, remote patient monitoring, and eConsults. The patient's home is a permitted originating site.

Reimbursement runs at parity — "on the same basis, at the same rate, and to the same extent" as in-person care under Public Health Law § 2999-dd — currently extended through April 1, 2028. The notable carve-out: facility fees aren't payable when neither party was actually at the facility, a live friction point for Article 28 clinics.

Private insurance: coverage parity permanent, payment parity through 2028

Coverage parity is settled law — insurers can't exclude an otherwise-covered service because it was delivered via telehealth, though they may exclude a service from a provider who is not otherwise covered under the policy (Insurance Law §§ 3217-h, 4306-g). Insurers may apply reasonable utilization management and quality assurance requirements to telehealth only if they are consistent with those for the same service in person, and cost sharing must be at least as favorable as in person. Payment parity, added in 2022, has been extended twice and currently runs through April 1, 2028 under the legislation signed in May 2026, with the same facility-fee carve-out as Medicaid; until then, an insurer with a provider network must also keep that network adequate to meet insureds' telehealth needs when medically appropriate. The version of § 3217-h that takes effect April 1, 2028 keeps coverage parity, cost sharing, and utilization management but drops payment parity and the network adequacy clause. The statute defines telehealth broadly as electronic information and communication technologies and does not address audio-only care by name. For how state parity interacts with Medicare and commercial billing generally, see our telehealth reimbursement guide.

What to watch

Three things are worth tracking if you operate in New York. The IMLC bills — if one passes, the licensure picture changes meaningfully for multi-state groups. The federal DEA rulemaking, because New York's controlled-substance exception incorporates DEA rules by reference. And the April 2028 parity sunset, which will be the next legislative fight. Verify current requirements with the Office of the Professions and the state Medicaid program before building anything that depends on the details — and for how New York compares to its neighbors, start with our national overview.