Pennsylvania Telemedicine Laws: License, Prescribing, Parity

Pennsylvania went a decade without a telemedicine statute, then passed one in 2024 that does less than its headlines suggest. Act 42 of 2024 makes commercial insurers and Medicaid managed care plans cover telemedicine — it does not set what they pay, does not touch licensure, and says nothing about consent or prescribing. Around it sits a conventional framework: full Pennsylvania licensure for anyone treating a patient in the state, a completed Interstate Medical Licensure Compact rollout, and a Medicaid program that pays for audio-only care but not remote monitoring.

Licensure: a full license, with the compact as the shortcut

The Department of State's position is plain: a practitioner serving individuals in Pennsylvania needs a Pennsylvania license, whether the encounter happens in an office or over video. Act 42 did not change this; it governs insurance coverage, not who may practice. There is no out-of-state telehealth registration of the kind Florida runs.

The Interstate Medical Licensure Compact is the practical answer for physicians. Pennsylvania began accepting compact applicants in 2024 and has been fully implemented since July 7, 2025 — a physician can now designate Pennsylvania as the state of principal license. Pennsylvania is also a full member of the Physical Therapy Compact. Pennsylvania is also a PSYPACT participating state and, since July 2025, a Nurse Licensure Compact state issuing multistate licenses. It has not joined the Counseling Compact.

Two narrower lanes exist. The Board of Medicine's extraterritorial license lets a medical doctor with an unrestricted license in an adjoining state, who lives or keeps an office near the Pennsylvania border, apply to extend that practice into Pennsylvania, but only if the adjoining state extends the same privilege to Pennsylvania doctors; the license is revoked automatically if the qualifying residence or office moves (49 Pa. Code § 17.4). And Medicaid layers its own rules on top: out-of-state practitioners must meet the Department of State's licensing requirements and enroll in Medical Assistance, and in behavioral health managed care, telehealth providers generally must keep a physical location within 60 minutes or 45 miles of the area served, in Pennsylvania or a bordering state, absent an approved exception.

Prescribing: the Board's exam rule, plus PDMP and e-prescribing duties

Act 42 is silent on prescribing. The Board of Medicine's controlled-substance regulation sets the exam rule, and several statutes add duties that apply to telehealth exactly as in person, listed below. The Board's regulation generally requires an initial medical history and physical examination before a controlled substance is prescribed, unless emergency circumstances justify otherwise, and lets a prescriber rely on another licensed provider's exam from the preceding 30 days.

The one explicit telehealth exception is narrow. Since amendments effective in December 2024, an opioid treatment program may conduct the admission physical examination by telehealth for buprenorphine or methadone treatment, provided an adequate evaluation is possible remotely and a full in-person exam follows within 14 days. Outside that carve-out, the regulation does not say whether a video encounter satisfies the exam requirement, and the Department's FAQ warns that telehealth can run afoul of rules that specifically call for a physical exam. Telepsychiatry groups should get the Board's current reading before relying on video alone. Non-controlled prescribing carries no Pennsylvania-specific telehealth restriction beyond the standard of care, which Act 42 says is the same as in person.

The other state duties:

• Registration. Pennsylvania requires no separate state controlled substance registration of a practitioner licensed by the appropriate state board (Controlled Substance, Drug, Device and Cosmetic Act § 6(a)(3)); a DEA registration is the operative step. The ABC-MAP Act directs the program to require registration of all prescribers with the Prescription Drug Monitoring Program (Act 191 of 2014, § 5(5)(xvi), added by Act 124 of 2016).
• PDMP. A prescriber must query the PDMP the first time the prescriber gives a patient a controlled substance, whenever the prescriber has reason to believe the patient may be abusing or diverting drugs, and each time the prescriber prescribes an opioid or a benzodiazepine. A repeat query is not needed while a patient remains admitted or in observation status at a licensed health care facility after the initial query (Act 191 of 2014, § 8(a)–(a.1), as amended by Act 124 of 2016).
• Opioid limits. A practitioner may not prescribe more than a seven-day supply of an opioid to a patient seeking treatment in an emergency department or urgent care center, or in observation status in a hospital, and may not authorize refills, unless a documented acute condition, cancer pain, or palliative care requires more (Act 122 of 2016). A prescription for a minor may not exceed a seven-day supply of an opioid-containing controlled substance except for a documented acute condition that requires more (with the reason a non-opioid alternative is not appropriate), cancer pain, palliative or hospice care, or chronic pain not associated with cancer. Before the first opioid prescription in a course of treatment, the prescriber must assess the minor, discuss the risks with the minor and a parent, guardian, or authorized adult, and obtain that person's written consent on the state form, unless an exception applies, such as a documented medical emergency, treatment while the minor is admitted or in observation status, or the prescriber's documented judgment that compliance would harm the minor (35 Pa.C.S. §§ 52A03–52A04, added by Act 125 of 2016).
• E-prescribing. Since October 24, 2019, Schedule II through V prescriptions generally must be electronic (Controlled Substance, Drug, Device and Cosmetic Act § 11, as amended by Act 96 of 2018). The statute lists exceptions such as temporary technological or electrical failure, pharmacies outside Pennsylvania, practitioners without internet access or an electronic health record, emergency settings where e-prescribing would cause a harmful delay, hospice and nursing-home patients, and emergencies, and it allows one-year hardship exemptions by petition to the Department of Health. 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. The Board's exam rule still applies on top of that federal rule; our DEA prescribing report tracks the federal side.

Consent: a Medicaid requirement, not a statute

Pennsylvania has no general telehealth consent statute, and Act 42 does not address it. The requirement lives in the Medicaid bulletins. Both the physical-health bulletin (MA Bulletin 99-23-08) and the behavioral-health bulletin (OMHSAS-22-02) require consent from the beneficiary or legal guardian before a service is rendered via telehealth, the right to return to in-person care at any time, and separate consent for any recording. Refusing telehealth cannot be used to limit access to services. Document consent and modality; electronic signatures are acceptable. For commercial patients, documented consent is a standard-of-practice expectation, not a statutory mandate.

Medicaid: same rate, audio-only allowed, no RPM

Medical Assistance fee-for-service pays for telehealth at the same rate as in-person care. Live video is the baseline. Audio-only is permitted when the beneficiary lacks video capability or the situation is urgent, and the record must say why video was not used; behavioral health claims carry the FQ modifier, and a 2022 law removed the regulatory bar on paying for telephone-delivered outpatient psychiatric and drug-and-alcohol clinic services.

The home is an acceptable originating site. Claims use place-of-service code 02 outside the home and 10 in it, and an enrolled originating site may bill the Q3014 facility fee at the amount on the current fee schedule. Store-and-forward, email, fax, and remote patient monitoring devices are not treated as telehealth — they may be part of a covered service but are not paid on their own.

Managed care is where Act 42 bites. MCOs historically could decide whether to allow telehealth at all. Beginning January 1, 2026, Medical Assistance and CHIP managed care plans must pay participating network providers for medically necessary telemedicine services that would be covered in person, when telemedicine delivery is consistent with federal and state law and any required federal approval is in place, at the rate set by the provider contract and the plan's agreement with DHS (40 Pa.C.S. § 4804).

Private insurance: coverage yes, payment parity no

Act 42 requires a health insurance policy offered, issued, or renewed in Pennsylvania to cover medically necessary services delivered through telemedicine by a participating network provider, consistent with the insurer's medical policies, delivered through technology that complies with HIPAA and HITECH, and bars excluding a service solely because it was delivered by telemedicine. The act sets no telemedicine-specific utilization review rule; the insurer's medical policies govern. It has no separate audio-only rule either: telemedicine includes synchronous interactions by audio or video conferencing, so audio falls inside the definition, and the act does not require coverage where telemedicine would be inconsistent with the standard of care. Dental-only and vision-only policies are included; Medicare supplement and similar limited-benefit policies are not.

Payment is separate. Insurers pay per the negotiated provider contract. The act adds two protections — a contract that pays for telemedicine may not refuse payment solely because a service was delivered that way, and payment may not be conditioned on a proprietary technology or vendor — but nothing requires the telehealth rate to match the in-person rate. Out-of-network providers have no claim under the act. The Department of State reads it as applying to policies with forms or rates filed on or after March 31, 2025. Model Pennsylvania revenue from contract terms, not parity assumptions; the broader picture is in our reimbursement guide.

What to watch

Three items. The January 2026 managed-care payment requirement is new, and the Department of Human Services' guidance and plan contracts will determine what it means in practice. Payment parity was the fight Act 42 did not settle; watch whether the legislature returns to it. And the federal DEA special-registration rule will shape what controlled-substance telehealth is worth here. Verify current requirements with the Board of Medicine and the Department of Human Services before building anything that depends on the details — and compare Pennsylvania with its neighbors in the national overview.