Telepsychiatry has made mental health care more accessible than ever, allowing people to receive support from virtually anywhere. It has broken down common barriers such as mobility issues, healthcare inaccessibility in rural areas, or limited transportation options, bringing mental health care right to our doorsteps.

Nearly one in four Americans faces a mental health condition, and telepsychiatry is helping to remove obstacles and reach more people in need of support. The global telepsychiatry market reflects this growing demand. Valued at an estimated USD 9.62 billion in 2024, the market is expected to expand to USD 24.03 billion by 2029, with a robust compound annual growth rate (CAGR) of 20.10% over the next five years. 

However, while telepsychiatry creates new opportunities and removes many barriers to care, psychologists must comply with specific licensure requirements for providing care across state lines. Each state has unique regulations governing interstate healthcare, so mental health professionals must ensure compliance before delivering telehealth services to out-of-state patients. Let's dive into a few scenarios and understand the billing regulations surrounding them.

Telepsychiatry Rules for Interstate Billing

As of January 1, 2025, CMS reinstated several limitations on Medicare telehealth services that were in place before the COVID-19 pandemic. These renewed guidelines impose geographic and location-based requirements and restrict the types of practitioners eligible to deliver telehealth services under Medicare.

Besides, medical billing is far from standardized, with practices varying widely across state lines. Each state has its own set of rules, which can impact billing protocols and compliance for telehealth, including telepsychiatry. Here are a few common scenarios that psychologists frequently encounter in interstate telehealth billing. Let’s take a closer look at each one.

1. Your Patient Visits Another State

As per the state licensing and medical regulations, a telepsychiatry session can be performed if the provider is licensed — or legally permitted — to practice in the state where the patient is physically present during the session. So, if your patient is temporarily in another state and needs a teleconsultation, you’ll need a license in that particular state.

Fortunately, some states have temporary practice laws that allow out-of-state providers to offer services for a limited period, such as up to 20 days per year. It’s recommended to check with the psychology board of the state your patient is visiting to apply for a temporary permit and ensure you meet all requirements.

Note: Temporary practice is not allowed in all states. Verify the specific regulations for the state where your patient is currently located.

2. Your Patient Permanently Moves to Another State

As mentioned earlier, to provide telepsychiatry services, you’ll need licensure both in the state where you reside and where your patient is physically located. However, if your patient is permanently relocating to a new state, referring them to a local psychologist who can offer in-person support is advisable. While remote treatment is possible, transitioning care to a provider within the new state could better serve the patient’s long-term needs and ensure continuity of care with available local resources.

3. You Are Temporarily Working Remotely from Another State

Sometimes, you might need to go to a different state for work or leisure and still want to consult with your patient. In this case, you’ll need to be licensed both in the state you’re currently in and your patient's state of residence. Typically, the patient’s location is the main factor for licensure, but some states also factor in the provider’s location. Some states view telehealth services as practicing psychology in both locations, so check with the relevant state boards to ensure you’re meeting their requirements.

4. You Permanently Relocate to Another State

If you permanently move to a new state, you’ll need to obtain that state's licensure to practice medicine there, even if you’re still seeing patients from your previous state. Getting licensed in your new location also legally allows you to see local patients. Given the complexities of telemental health regulations, securing licensure in your new state ensures regulatory compliance.

5. A New Out-of-State Patient Seeks Treatment

Sometimes, a new patient from another state might want to consult you for treatment. Most states don’t mandate that the initial session occur in person or within the same state. If there’s a clinical benefit for the patient — like your unique expertise — you can consider proceeding with the treatment. However, if the patient could benefit from an in-person consultation with a local provider, do consider this alternative. Prioritizing the patient’s access to care is key here.

6. Your Patient Temporarily or Permanently Moves to Another Country

International scenarios can bring unique challenges. For example, if your patient moves abroad, whether temporarily or permanently, you’ll need to consider the specific licensing laws of that country. Note that these can vary widely.

Each country has a national psychology association where you can find helpful information regarding their medical licensing guidelines. However, it’s also crucial to consider practical factors like time zone differences, access to emergency care, and privacy regulations, all of which can impact the quality and continuity of care. Addressing these aspects ensures that treatment remains effective and uninterrupted.

7. Emergency Situations with Out-of-State or International Patients

In an emergency, your top priority and ethical obligation is to protect your patient’s well-being, wherever they’re located. Address your patient's emergency immediately, and then handle any licensing or jurisdictional issues as soon as possible. Your patient’s safety comes first; compliance follows as appropriate.

Physician Licensure Flexibility Models

State licensure for medical professionals was established to regulate healthcare delivery and protect the public from unprofessional and improper medical practices. However, with the changing dynamics of healthcare delivery, states are adapting their licensure processes to facilitate physician licensure across state lines. Here are ways in which physicians can obtain licensure in other member states:

1. Interstate Compact 

Interstate licensure compacts streamline the licensing process for physicians. The Interstate Medical Licensure Compact (IMLC) allows physicians licensed in one member state to quickly get the licensure they need to practice in any other participating state. More than half of the states are part of the IMLC, making it easier for physicians to reach patients across state lines.

In addition, the Psychology Interjurisdictional Compact (PSYPACT), a multi-state licensing agreement, allows psychologists licensed in member states to provide telepsychiatry services or temporary in-person care to patients in other PSYPACT states. This makes it easier for psychologists to support patients wherever they are!

2. Licensure by Endorsement or Reciprocity

Licensure by endorsement is an expedited state licensure process that allows physicians already holding a license in other states who meet specific qualifications to practice medicine in the endorsing state. For example, Hawaii requires applicants to have an active license from a jurisdiction with similar or greater qualifications than itself. Likewise, Virginia mandates that physicians must have held a license in one state for at least five continuous years before applying.

Conversely, licensure by reciprocity offers a faster path for physicians, as some jurisdictions recognize licenses from other states. For example, the District of Columbia, Maryland, and Virginia allow this reciprocity for doctors licensed within those states.

3. Telehealth Registries or Licenses

Many states, such as Florida, New Jersey, Kansas, Louisiana, Minnesota, Nevada, and New Mexico, have established special telehealth registries or licenses. Licensed physicians who comply with resident state regulations can register or obtain a specific license to provide telehealth services to individuals in their state of interest. 

However, each state has specific regulations. For instance, Minnesota and Florida offer special telehealth registration but prohibit physicians from providing in-person services or having a physical address in the state. Furthermore, Florida requires physicians to maintain liability coverage for telehealth services delivered within the state.

4. In-State Licensing Exemptions

If you're a physician in good standing, certain states may exempt you from needing an in-state license under specific circumstances, such as:

• Emergencies — Minnesota and Georgia
• Follow-up care — Arizona and Virginia
• Consultative services — Hawaii and New Hampshire
• Unique travel situations — when a patient is temporarily in the state, e.g., Kentucky

Video-based telepsychiatry offers patients and providers a convenient and often more affordable way to access mental health care, regardless of location. Nevertheless, providers must comply with interstate licensing laws before initiating or continuing treatment across state or national borders. Understanding the various cross-border scenarios helps you uphold ethical and legal practices and confidently navigate telepsychiatry’s legal landscape, avoiding unnecessary issues.