Texas Telehealth Compliance for Cash-Pay Clinics: Licensure, the Telemedicine Statute, Consent and Prescribing

Licensure

A full Texas license is required for telemedicine to Texas patients. The state's telemedicine statute defines a telemedicine medical service as one delivered by a physician licensed in Texas. The only exception we found is for physicians who held an out-of-state telemedicine license on September 1, 2022, and the old out-of-state telemedicine license rule was repealed effective January 9, 2025. Texas is a member of the Interstate Medical Licensure Compact under Occupations Code chapter 171 and is issuing licenses. Older citations to the board's chapter 174 telemedicine rules are stale, because that chapter now covers joint ownership and the telemedicine rules moved to chapter 175.

The Relationship and the Standard of Care

Occupations Code section 111.005 allows a relationship through synchronous audiovisual interaction or asynchronous store-and-forward technology if the practitioner uses clinically relevant images or video or the patient's relevant records. Follow-up duties apply, including a report to the primary care provider within 72 hours if the patient consents. Section 111.007 says the standard of care is the same as in person, and agencies may not set a higher one. A valid prescription requires a physician-patient relationship. We found no express ban on questionnaire-only prescribing, and the only in-person or video rule we found is for chronic pain treated with scheduled drugs, which requires audio and video unless the patient is established, gets the same prescription and was seen within 90 days.

Consent

Section 111.002 requires consent before telemedicine services begin. Under HB 1700, effective September 1, 2025, agencies must standardize consent-record formats and retention, including for audio-only services. We could not confirm whether the Medical Board has adopted rules implementing that law.

Prescribing

• Testosterone: a Schedule III anabolic steroid that may be prescribed only for a valid medical purpose. Bodybuilding by a healthy person does not qualify.
• Monitoring: the mandatory prescription monitoring check covers opioids, benzodiazepines, barbiturates and carisoprodol. Checks for testosterone and ketamine are optional.
• Electronic prescribing: an electronic prescription is required.
• Pharmacies: out-of-state pharmacies need a Class E license.
• Telemedicine bar: we found no telemedicine-specific bar on Schedule III prescribing.

NPs and PAs

Under the delegation statute, physicians may delegate Schedule III through V prescribing for up to 90 days, Schedule II is limited to hospital or hospice settings, and the physician registers the nurse practitioner or physician assistant.

Corporate Practice

Texas requires a license to practice medicine, and the Medical Practice Act makes aiding unlicensed practice grounds for discipline. A board rule on certain nonprofit health organizations was repealed on January 9, 2025. We found no telehealth-specific or management-company-specific statement from the board or the attorney general. Our earlier Texas guide covers HB 3749, which limits elective IV therapy to licensed providers from September 1, 2025.

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.