North Dakota Telemedicine Laws: Licensure, Opioids, Parity

North Dakota's physician statute settles jurisdiction in one sentence: "The practice of medicine is deemed to occur in the state the patient is located." A physician treating a patient located in North Dakota needs a North Dakota license unless a statutory or Board of Medicine exception applies. Around it sit a standard of care that rejects questionnaire-only and audio-only initial exams, a statutory opioid limit, coverage-only insurance parity, and Medicaid audio-only in the home. See also how state telemedicine laws work.

Licensure: patient location, with board exceptions

N.D.C.C. § 43-17-02.3 says a practitioner providing medical care to a patient located in North Dakota "is subject to the licensing and disciplinary laws of this state and shall possess an active North Dakota license for the practitioner's profession." It lets a physician holding a "permanent, unrestricted license" in another state, territory, the District of Columbia or a Canadian province practice without a North Dakota license in five circumstances: on an organ harvest team; on an air ambulance treatment team; for one-time consultation on a diagnosis to a North Dakota-licensed physician, or teaching assistance for not more than seven days; for board-approved charitable consultation or teaching; or "under rules adopted by the board." Section 43-17-02(5) separately exempts licensed physicians from other states "if called in consultation with a person licensed to practice medicine in this state."

Board rule 50-02-15-03, effective January 1, 2025, adds telehealth exceptions. A physician with an active, unrestricted license in good standing elsewhere may practice via telehealth without a North Dakota license if one of five conditions applies:

1. Continued care for a patient who is a resident of North Dakota, where the relationship was established in a state where the physician is licensed. Care must be the "logical and expected continuation" of prior care; a patient with new conditions, or conditions for which the standard of care dictates an in-person encounter, must return to that state or be referred to a North Dakota-licensed provider. Telehealth may continue for up to one year after the relationship was established in the other state, after which an encounter must take place in a jurisdiction where the physician is licensed before telehealth resumes for another year.
2. Temporary care for an established patient in North Dakota temporarily for business, work, education, vacation or other reasons.
3. Services in preparation for a scheduled in-person care visit.
4. Consultation with a North Dakota-licensed physician who remains responsible for the patient's diagnosis and treatment and requests the consultation.
5. Gratuitous service in an emergency.

A physician using these exceptions consents to North Dakota law, including §§ 43-17-44 and 43-17-45, community standards of care, and board discipline. The rule names physicians only. Physician assistants serving patients located in North Dakota need a North Dakota license or a privilege under the Physician Assistant Licensure Compact, chapter 43-17.5 (§ 43-17-02.1(1)). The compact commission is not yet issuing privileges and projects they will be available in early 2027, so for now a physician assistant needs a North Dakota license.

Compacts: full Interstate Medical Licensure Compact member, statutory effective date August 1, 2019, under SB 2173; Nurse Licensure Compact full member, with multistate licenses since January 19, 2018; PSYPACT full member, effective August 1, 2023, under SB 2205; and full Physical Therapy Compact member. North Dakota has enacted the Counseling Compact, which is not yet live. See our cross-state licensing tracker.

Prescribing: an opioid limit, a PDMP rule, and a felony statute

Section 43-17-44 holds Board of Medicine licensees (physicians, resident physicians and physician assistants) to in-person standards of care and ethics in telemedicine. A licensee must establish a bona fide relationship before diagnosis or treatment, verify the patient's identity, and disclose, and let the patient verify, the identity and licensure status of any licensee providing services. Telemedicine records are subject to all North Dakota laws on the adequacy of medical records and their provision to the patient and other treating providers. An examination must precede initial diagnosis or treatment of a specific illness or condition, and may be done entirely by telemedicine if equivalent to an in-person exam, such as secure videoconferencing or store-and-forward with the testing and peripherals a like in-person exam would need, or an appropriately licensed intervening provider supplying physical findings. "An examination or evaluation consisting only of a static online questionnaire or an audio conversation does not meet the standard of care." Licensees must be able to refer patients not amenable to diagnosis or complete treatment by telemedicine, including those needing emergent or complementary in-person care.

Under § 43-17-45, a licensee who has performed a qualifying exam may prescribe according to professional judgment, but opioids may be prescribed through telemedicine only as FDA-approved medication assisted treatment for opioid use disorder or to a patient in a hospital or long-term care facility, and "may not be prescribed through a telemedicine encounter for any other purpose." Board rule 50-02-15-02 (2018) still states only the treatment exception. A licensee who prescribes a controlled substance must comply with state and federal law and participate in the prescription drug monitoring program.

The Board of Medicine's PDMP rule, 50-05-02-01, requires every practitioner who prescribes a controlled substance in North Dakota to register; § 19-03.5-09(2) requires each prescribing profession's licensing board to adopt its own PDMP rule. When reported drugs will be prescribed for more than twelve weeks, the practitioner must request a PDMP report, and at least semiannually thereafter, except for reported drugs prescribed to patients in a controlled setting where drugs are locked and administered, such as admitted hospital or hospice patients, long-term care patients or group home residents. A report is also required when the record documents signs of diversion or abuse; the rule lists twelve examples. Receipt and assessment must be documented.

Section 19-02.1-15.1 is criminal. A controlled substance or "specified drug" (listed muscle relaxants, centrally acting analgesics with opioid activity such as tramadol, butalbital products, and PDE5 inhibitors for erectile dysfunction) may not be delivered, distributed or dispensed by internet or other electronic means to a person or address in North Dakota without a valid prescription based on an in-person medical evaluation, as the section defines it. A violation is a class C felony. Among its exceptions, it does not apply to a practitioner "engaged in the practice of telemedicine in accordance with applicable federal and state laws," using the Ryan Haight Act's definition of that practice (21 U.S.C. § 802(54)). That federal definition is narrow: it lists specific circumstances, such as a patient being treated in a DEA-registered hospital or clinic, a practitioner holding a DEA special registration, and circumstances set by federal regulation. The exception is a condition, not a blanket pass. A telehealth prescription outside it, or one that breaks another state or federal rule such as the § 43-17-45 opioid limit, must be a valid prescription based on an in-person medical evaluation as the section defines it, or delivering or dispensing it is a class C felony. Nor does it limit electronic prescriptions. We found no state e-prescribing mandate for 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: profession by profession

We found no general telehealth consent statute; profession-specific provisions include two. For optometrists, N.D.C.C. § 43-13-13.2 requires informed consent for services by telemedicine to include, at a minimum, information on the provider's technology and how to mitigate or resolve a disconnection. For physical therapists, N.D. Admin. Code 61.5-01-02-01 requires written or verbal consent, documented, before a "consultation by telehealth" with another provider.

Medicaid: audio-only in the home

North Dakota Medicaid's telehealth manual, updated October 2025, requires the in-person standard of care, documented medical necessity and a HIPAA-compliant platform. Audio-only may be used for a telehealth service furnished to a member in their home when the distant-site practitioner can use an interactive system but the patient is not capable of, or does not consent to, video; the reason must be documented. Eligible codes are listed in the Procedure Code Look-up Tool; audio-only E/M bills under CPT 98008–98015 with modifier 93.

The originating-site facility fee (Q3014) is paid only in an office, hospital, or skilled nursing or nursing facility, not the home. Store-and-forward (G2010), the virtual check-in (98016) and codes 98970–98972 are not covered.

Private insurance: coverage parity, negotiated payment

Section 26.1-36-09.15(2) bars an insurer from delivering, issuing, executing or renewing a policy unless it covers telehealth "the same as the coverage for health services delivered by in-person means." Subsection 3 stops short of payment parity: payment "may be established through negotiations" in the same manner as for in-person services. Coverage may be subject to deductible, coinsurance and copayment. The section does not require coverage of services that are not medically necessary, subject to policy terms; telehealth coverage of a service not covered in person; reimbursement to a provider the policy would not reimburse in person; or a provider at the originating site unless the treating provider decides one is needed.

The definition narrows the mandate: telehealth must run over a "secure connection" and excludes email, fax and "audio-only telephone unless for the purpose of e-visits or a virtual check-in." No sunset is stated.

What to watch

HB 1622, passed in the January 2026 special session, enacted the Physician Assistant Licensure Compact, effective on filing with the secretary of state; confirm when privileges begin issuing. Watch for the board to update rule 50-02-15-02 to match the statute's hospital and long-term care opioid exception, and for the Counseling Compact's launch. The Legislative Assembly next meets in regular session in 2027.