California telehealth laws require any provider treating a patient located in California to hold a valid California license, obtain and document the patient’s consent to virtual care, meet the same standard of care that applies in person, and follow specific statutes on insurance reimbursement and controlled-substance prescribing. The central statute is Business and Professions Code Section 2290.5, and separate laws govern commercial insurance, Medi-Cal, and remote prescribing.
What Counts as Telehealth in California
Business and Professions Code Section 2290.5 defines telehealth as the delivery of health care and public health services through information and communication technologies. That includes diagnosis, consultation, treatment, education, care management, and patient self-management.1California Legislative Information. California Business and Professions Code 2290.5
The statute recognizes two technology categories:
- Synchronous interaction, meaning a real-time session between patient and provider, such as live video.
- Asynchronous store-and-forward, meaning transmission of medical information like images or test results from the patient’s location to a provider at another site, reviewed later without the patient present.
A plain phone call or email exchange doesn’t automatically qualify as a billable telehealth service. The communication generally has to fit one of those categories or meet other statutory criteria for audio-only reimbursement, which Medi-Cal handles separately.
Licensing: Who Can Legally Provide Care
The patient’s physical location at the time of the visit controls which state’s licensing rules apply. A provider treating someone sitting in California needs a California license, regardless of where the provider is based.2Medical Board of California. Telehealth This applies to physicians, therapists, clinical social workers, and other practitioners covered by the Business and Professions Code.
Two narrow exceptions exist. Business and Professions Code Section 2060 permits an out-of-state physician to consult with a California-licensed practitioner without holding a California license, provided the out-of-state provider does not open a California office, schedule appointments with California patients, or hold ultimate authority over the patient’s primary diagnosis or care.3California Legislative Information. California Business and Professions Code 2060 This works for specialist second opinions where the California-licensed provider retains control of the treatment plan.
Section 719 provides a separate exception for health care practitioners licensed in another state who are employed by a tribal health program. Those providers can deliver services under their out-of-state license when doing work covered by the tribal program’s contract or compact under the Indian Self-Determination and Education Assistance Act.4California Board of Registered Nursing. Tribal Health Programs – Healthcare Practitioners
California has not joined the Interstate Medical Licensure Compact, so the expedited multi-state pathway that physicians in 43 member jurisdictions can use isn’t available for California practice. An out-of-state physician who wants to treat California patients through telehealth has to go through the standard California licensing process.
Consent Requirements Before a Visit
Before delivering any care through telehealth, the provider must tell the patient that telehealth will be used and obtain either verbal or written consent. That consent has to be documented in the patient’s medical record.1California Legislative Information. California Business and Professions Code 2290.5 The provider doesn’t need to be physically present with the patient when obtaining it.
Patients should understand the limits of remote care, including potential technical failures and the inability to perform a hands-on physical exam. A patient can withdraw consent to telehealth at any time without losing access to future care or treatment, and agreeing to a virtual session does not lock the patient out of switching to in-person visits later in the same course of treatment. A provider who fails to follow the consent requirements is committing unprofessional conduct under California law.
Standard of Care Doesn’t Change
The standard of care for a telehealth visit is identical to an in-person visit. Every law governing professional responsibility, unprofessional conduct, and scope of practice applies to a provider delivering services remotely.1California Legislative Information. California Business and Professions Code 2290.5 Delivering care through a screen does not relax any of the clinical obligations a provider would carry face-to-face.
Commercial Insurance and Payment Parity
California imposes payment parity on both health care service plans and health insurers through two parallel statutes. Health and Safety Code Section 1374.14 covers health care service plans (primarily HMOs), and Insurance Code Section 10123.855 covers health insurers. Both require the same core protections:
- Providers must be reimbursed for telehealth services on the same basis and to the same extent as the identical in-person service.5California Legislative Information. California Health and Safety Code 1374.14
- Copayments and coinsurance for a telehealth service can’t exceed what the patient would pay for the same service in person.6California Legislative Information. California Insurance Code 10123.855
- Telehealth services are subject to the same deductibles and annual or lifetime dollar maximums as equivalent in-person services. Insurers can’t impose a separate, lower cap on telehealth.
Insurance Code Section 10123.855 also bars insurers from restricting coverage to services delivered only by select third-party corporate telehealth platforms. If a service is clinically appropriate for telehealth delivery, an insurer cannot deny coverage solely because it was provided remotely.6California Legislative Information. California Insurance Code 10123.855 Insurers and providers can still negotiate reimbursement rates, but once a rate is set, it must apply equally regardless of delivery method.
Medi-Cal Follows a Different Framework
Medi-Cal managed care plans are explicitly excluded from Section 1374.14’s parity requirements.5California Legislative Information. California Health and Safety Code 1374.14 Welfare and Institutions Code Section 14132.725 provides Medi-Cal’s own parity framework instead.
Under that section, the Department of Health Care Services must reimburse providers for telehealth services at amounts no less than what the provider would receive for the same service delivered in person. The rule covers video visits, audio-only synchronous sessions, and asynchronous store-and-forward services, so long as the service meets the applicable standard of care and billing requirements.7California Legislative Information. California Welfare and Institutions Code 14132.725 Medi-Cal managed care plans must similarly reimburse network providers at in-person rates unless the plan and provider mutually agree to different amounts.
Two practical protections matter for patients. The department cannot require a provider to document a barrier to an in-person visit as a condition of Medi-Cal coverage for telehealth. And the department cannot restrict the type of setting where the patient or provider is located during the encounter. A Medi-Cal beneficiary can receive telehealth from home, from a community clinic, or from any other location where connectivity works.
Prescribing Controlled Substances by Telehealth
This is where telehealth compliance gets complicated, because federal and California rules operate at once and neither yields to the other.
The Federal Ryan Haight Act
The Ryan Haight Online Pharmacy Consumer Protection Act generally requires at least one in-person medical evaluation before a practitioner can prescribe a controlled substance via the internet. The statute defines a “valid prescription” as one issued by a practitioner who has conducted at least one in-person evaluation, meaning the patient was physically present with the provider.8Office of the Law Revision Counsel. 21 USC 829 – Prescriptions An exception exists for practitioners engaged in the “practice of telemedicine” as defined by the DEA, but permanent regulations defining that exception have been years in the making.
Temporary DEA Flexibilities Through 2026
As of January 2026, the DEA and HHS are operating under a fourth temporary extension of COVID-era telemedicine flexibilities, effective through December 31, 2026. Under this extension, DEA-registered practitioners can prescribe Schedule II through V controlled medications via audio-video telehealth encounters without ever conducting an in-person evaluation.9U.S. Drug Enforcement Administration. DEA Extends Telemedicine Flexibilities to Ensure Continued Access to Care The audio-only flexibility is narrower, applying only to Schedule III through V medications approved by the FDA for opioid use disorder treatment.
The DEA and HHS have proposed a permanent “Special Registration for Telemedicine” that would allow qualified practitioners to prescribe controlled substances remotely on an ongoing basis, but final regulations have not been adopted. Providers should plan for the possibility that the temporary flexibilities expire at the end of 2026 without permanent replacements.10HHS.gov. HHS and DEA Extend Telemedicine Flexibilities for Prescribing Controlled Medications Through 2026
California Adds Its Own Examination Requirement
Federal flexibility doesn’t override state law. Business and Professions Code Section 2242 makes it illegal to prescribe dangerous drugs or devices without an appropriate prior examination and a medical indication for the prescription. Section 2242.1 specifically targets internet-based prescribing and carries a civil penalty of up to $25,000 per occurrence.11Medical Board of California. Internet Prescribing A telehealth visit with a genuine clinical evaluation can satisfy the examination requirement, but a cursory screening or online questionnaire will not. Providers prescribing controlled substances by telehealth need to satisfy the federal temporary flexibilities and California’s examination standard at the same time.
Privacy: HIPAA and the CMIA Both Apply
Section 2290.5 states that all laws regarding the confidentiality of health care information and a patient’s rights to their medical information apply to telehealth.1California Legislative Information. California Business and Professions Code 2290.5 Providers have to satisfy two regimes at once.
The HIPAA Security Rule requires safeguards for the confidentiality, integrity, and availability of electronic protected health information. For telehealth, that means platforms with appropriate encryption and security controls. Any third-party telehealth vendor that handles patient data is a business associate under HIPAA, and the provider must have a signed business associate agreement before using that vendor’s platform.
California’s Confidentiality of Medical Information Act, codified in Civil Code Sections 56 through 56.37, prohibits a provider, health care service plan, or contractor from disclosing medical information about a patient without authorization, except in limited statutory circumstances.12California Legislative Information. California Civil Code 56.10 The CMIA is in several respects broader than HIPAA. It gives patients a private right of action for improper disclosure, meaning they can sue the provider directly. Telehealth platforms, storage systems, and any recording practices need to comply with both sets of rules.
Billing and Enforcement Risk
Telehealth billing uses standard procedure codes with modifiers that indicate the visit was remote. Improper modifier use is one of the patterns federal enforcement agencies flag when reviewing telehealth claims.
The Office of Inspector General has incorporated multiple telehealth-specific priorities into its current Work Plan, targeting billing for services not actually rendered, upcoding, medically unnecessary services, and kickback arrangements in referral networks. Behavioral health telehealth and remote patient monitoring are receiving particular scrutiny. Providers who see a sudden spike in telehealth volume, or who rely heavily on third-party telehealth marketing platforms, should be especially attentive to documentation. Document the encounter thoroughly, code it accurately, and make sure every billed service reflects a genuine clinical interaction.