Texas telehealth laws let licensed providers diagnose, treat, and prescribe for patients remotely without a prior in-person visit, hold those visits to the same standard of care as office care, and require most health plans to cover them on the same terms. The framework sits in Occupations Code Chapter 111, Insurance Code Chapter 1455, and Texas Medical Board rules in Title 22 of the Administrative Code. The details matter most around controlled substances, licensing, and what your insurance is actually obligated to pay for.
How a Provider Can Start Treating You Remotely
Texas does not require an in-person visit before a provider can treat you through telemedicine. Under Occupations Code Section 111.005, a valid practitioner-patient relationship forms as long as the provider meets the standard of care and uses one of three pathways: a preexisting clinical relationship with you, a call coverage arrangement with a physician who already treats you, or a direct remote evaluation using synchronous audiovisual technology, store-and-forward technology (such as diagnostic images paired with audio), or another qualifying audiovisual method.1Justia. Texas Occupations Code Title 3 Subtitle A Chapter 111 – Telemedicine and Telehealth
The third pathway is what most telemedicine-first companies rely on. A provider who has never met you in person can establish care entirely through qualifying technology, as long as they access clinically relevant information like your medical history, lab results, and diagnostic images.
When care is delivered through that direct remote evaluation route, the provider must give you guidance on appropriate follow-up. If you consent and have a primary care physician, the telemedicine provider must send that doctor a report within 72 hours describing the diagnosis and treatment.1Justia. Texas Occupations Code Title 3 Subtitle A Chapter 111 – Telemedicine and Telehealth
Same Standard of Care as an Office Visit
Occupations Code Section 111.007 holds any professional providing telemedicine, teledentistry, or telehealth to the same clinical standard that would apply if you were in the exam room. Regulatory boards cannot impose stricter rules on remote services than on in-person ones.2State of Texas. Texas Occupations Code OCC 111.007
That cuts both ways. Providers cannot be saddled with telehealth-only requirements, but they also cannot cut corners because the visit is virtual. If your condition genuinely needs a hands-on exam or equipment you don’t have at home, the provider must refer you in person. Failing to do so exposes them to the same malpractice liability as any other substandard care.
Licensing: Who Is Allowed to See You
A provider treating a patient located in Texas needs a Texas license, even when the provider is physically sitting in another state. Texas Medical Board Rule 174.8 states that physicians who treat and prescribe through communications technology are practicing medicine and need a full Texas medical license when the patient is a Texas resident.3Texas Administrative Code. 22 Texas Administrative Code 174.8 – State Licensure
There is a narrow exception under Occupations Code Section 151.056 for an out-of-state physician offering an episodic consultation, so long as it doesn’t amount to ongoing treatment.
Two interstate compacts make cross-state practice easier without changing the licensing requirement. The Interstate Medical Licensure Compact gives eligible physicians an expedited path to a full Texas medical license; it does not replace the license. Physicians licensed through the compact renew biennially with both the compact commission and the Texas Medical Board.4Interstate Medical Licensure Compact. Physician License For nurses, the Nursing Licensure Compact lets a nurse holding a multistate license in a compact state practice in Texas without a separate Texas license. As of 2026, 43 jurisdictions participate.5Nursecompact.com. Nursing Licensure Compact
Practicing without proper licensure is treated as unauthorized practice of medicine. The Texas Medical Board can revoke or suspend a license and impose administrative penalties of up to $5,000 per violation, with each day of a continuing violation counting separately.6Texas Administrative Code. Texas Administrative Code Title 22 Part 9 Chapter 174 – Telemedicine
Informed Consent and Records
Before providing telehealth services, providers must obtain informed consent. Occupations Code Section 111.002 applies to physicians, dentists, and other health professionals who deliver or facilitate telemedicine. Consent may be written or verbal; when it is verbal, the date and details must be documented in the medical record. If a parent or legal representative consents on your behalf, the record must include that person’s name and relationship to you.7Texas Secretary of State. Adopted Rules Title 22 – Examining Boards
Consent records must be kept for at least seven years from the date of last treatment. For patients under 18 at the time of treatment, records are retained until the patient turns 21 or for seven years from last treatment, whichever is longer.7Texas Secretary of State. Adopted Rules Title 22 – Examining Boards
Prescriptions Through a Virtual Visit
Once a valid practitioner-patient relationship exists, a Texas provider can prescribe during a virtual visit. Every prescription must be for a legitimate medical purpose and must comply with the Texas Controlled Substances Act, the Texas Dangerous Drug Act, and all applicable federal law.8Cornell Law Institute. 22 Texas Administrative Code 217.24 – Telemedicine Medical Service Prescriptions
Since March 2020, prescribers must check the state’s Prescription Monitoring Program before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. The requirement applies whether the visit is in person or remote.9Texas State Board of Pharmacy. Texas Prescription Monitoring Program
Issuing a prescription without a valid medical purpose is a criminal offense. A Schedule II prescription without medical purpose is a second-degree felony carrying 2 to 20 years. A prescription in Schedule III, IV, or V without medical purpose is a third-degree felony carrying 2 to 10 years. The Texas Medical Board also monitors prescribing patterns and can revoke a license administratively.10State of Texas. Texas Health and Safety Code 481.129
Controlled Substances and the Federal Layer
The federal Ryan Haight Act normally requires at least one in-person visit before a provider can prescribe controlled substances. Temporary flexibilities first introduced during the COVID-19 pandemic remain in effect through December 31, 2026. Under those flexibilities, DEA-registered practitioners can prescribe Schedule II through V controlled medications after an audio-video telemedicine encounter without any prior in-person evaluation, and audio-only encounters are permitted for medications used in opioid use disorder treatment (Schedule III-V).11Drug Enforcement Administration. DEA Extends Telemedicine Flexibilities to Ensure Continued Access to Care
These are more relaxed than the permanent federal rules. Anyone relying on them, patient or provider, should track the December 2026 deadline; after that, absent further extension, the permanent Ryan Haight framework governs again.
What Your Insurance Must Cover
Texas Insurance Code Chapter 1455 prohibits health benefit plans from excluding a covered service solely because it was delivered through telehealth. If your plan covers a procedure in the office, it must cover the same procedure delivered remotely.12State of Texas. Texas Insurance Code Chapter 1455 – Telemedicine, Telehealth, and Home Telemonitoring Services
Your out-of-pocket exposure is capped. Any deductible, copay, or coinsurance charged for a telehealth visit cannot exceed the in-person amount for the same service. Plans can limit the number of telehealth visits, but only if the same limit applies to in-person visits for that service. Insurers cannot dictate which technology platform your provider uses.
Two limits are worth knowing. Plans are not required to steer you into telehealth if you want to be seen in person. And plans are not required to cover services delivered solely through audio-only interaction like a basic phone call, text, email, or fax. If a telehealth claim is denied and you believe the denial was improper, you can appeal. The Texas Department of Insurance oversees a complaint and review process, and for certain plan types an independent review organization can evaluate the disputed claim.
Medicaid and Medicare Work Differently
Texas Medicaid covers telemedicine and telehealth across medical, behavioral health, and therapy categories for patients of all ages. Reimbursement cannot be denied solely because the provider and patient were in different locations. Unlike the private-plan rule above, Medicaid does reimburse for certain audio-only encounters, and managed care organizations have some discretion in covering them. The Texas Health and Human Services Commission designates which services are eligible for telehealth reimbursement, and providers must obtain informed consent, with verbal consent permitted when written consent is impractical. When services are delivered to a patient at home, no separate patient-site facility fee may be billed.
For Texans on Medicare, coverage runs on a separate track. The Centers for Medicare and Medicaid Services publishes an annual list of services eligible for telehealth reimbursement under the Medicare Physician Fee Schedule, and the 2026 list is available from CMS.13Centers for Medicare and Medicaid Services. List of Telehealth Services Medicare coverage requirements, eligible originating sites, and rates are set federally, not by Texas law, so the state Insurance Code parity rules do not govern Medicare claims.
Privacy Rules for the Visit Itself
Every telehealth encounter must comply with both federal and state privacy law. HIPAA’s Security Rule requires providers to protect the confidentiality and integrity of electronic protected health information. In practice that means encrypted platforms, patient-identity verification, and signed business associate agreements with every software vendor or technology partner handling patient data.
If a breach occurs, federal law sets strict deadlines. Affected individuals must be notified no later than 60 days after discovery. Breaches affecting 500 or more people also require notice to the media and to the HHS Secretary within the same 60-day window. Smaller breaches are reported to HHS annually, no later than 60 days after the end of the calendar year in which they were discovered.14U.S. Department of Health and Human Services. Breach Notification Rule
Texas adds a state layer through Health and Safety Code Chapter 181, which governs medical records privacy and applies additional protections to electronic health information. Providers running telehealth services in Texas must satisfy both HIPAA and Chapter 181, and every remote encounter should be documented and retained under the record-retention timelines described above.