Pennsylvania Telehealth Compliance for Cash-Pay Clinics: Licensure, the History-and-Physical Rule and Management Agreements
Pennsylvania has no detailed telemedicine statute. The rules that matter are the standard of care, a regulation requiring a history and physical before prescribing controlled substances, and a corporate-practice tradition that has voided management agreements.
Key Highlights
- Pennsylvania requires a Pennsylvania license to treat Pennsylvania patients and has no separate telemedicine license. The compact was fully implemented on July 7, 2025.
- No Pennsylvania statute or Board rule defines the telemedicine relationship. Telehealth is allowed if the standard of care is met and is a violation where a rule requires a physical exam.
- A Board regulation requires a history and physical before prescribing controlled substances, which on its face reaches Schedule III drugs, and we found no Board interpretation for telemedicine.
- Federal courts applying Pennsylvania law have voided management agreements that created de facto partnerships.
Licensure
The Pennsylvania Department of State says a Pennsylvania license is required to treat Pennsylvania patients and that there is no separate telemedicine license. We found no exemption. Pennsylvania fully implemented the Interstate Medical Licensure Compact on July 7, 2025.
The Standard of Care
Pennsylvania has no statute or Board rule that defines the telemedicine patient-practitioner relationship. The Department of State's guidance says telehealth is allowed if the standard of care is met, and that using it is a violation where a rule requires a physical examination. We found no specific store-and-forward or questionnaire rule, so the general standard of care carries the weight, and a documented evaluation is the safe approach.
Consent
The Department of State's telemedicine guidance does not address consent, so we could not confirm a state requirement. Document informed consent anyway: it is the model-policy baseline and the safe practice.
Prescribing Controlled Substances
A Board regulation, 49 Pa. Code section 16.92, requires a history and physical examination before prescribing controlled substances, with an exception for records from the prior 30 days, and its only telehealth carve-out is for opioid treatment program intake. On its face that reaches Schedule III drugs such as testosterone and ketamine, and we found no Board interpretation of how it applies to telemedicine, so counsel should confirm it for your model. The prescription drug monitoring program must be queried on the first controlled-substance prescription, on every opioid or benzodiazepine prescription and on suspicion of misuse, and registration is mandatory.
CRNPs and PAs
Certified registered nurse practitioners need a collaborative agreement naming a physician, plus a separate prescriptive agreement, without a co-location requirement. Physician assistant written agreements are filed with the Board rather than approved.
Corporate Practice
Pennsylvania applies the corporate practice of medicine doctrine from a 1938 Pennsylvania Supreme Court case. As reported by a law firm, federal courts applying Pennsylvania law have voided management services agreements in two cases because they created de facto partnerships. We found no telehealth-specific statement from the Board or Attorney General. The lesson for any Pennsylvania clinic, telehealth or in-person, is that the management agreement has to be a genuine flat-fee services contract and not a share of the practice.
Disclaimer
This article is general educational information, not legal advice. Telehealth rules change often and differ by state, and parts of this summary rest on secondary sources, so confirm specifics with health care regulatory counsel in the state before you rely on them.
MedGrid MSO provides management services to independently owned practices; it does not practise medicine and does not direct clinical decisions. Requirements vary by state and by service, and change over time — nothing on this page is legal or medical advice. Talk to us or your own counsel before making a structural decision for your clinic.