Telehealth Licensure Exceptions for Follow-Up Care and Physician Consults

The question comes up in every multi-state practice: "Our patient is in Arizona for the winter. Can I keep seeing her?" or "A colleague in Ohio wants my opinion on a patient. Do I need an Ohio license?" The answer is in each state's licensure exceptions, the short provisions that say when a clinician licensed elsewhere may treat or advise about a patient located in the state without a local license. CCHP's Fall 2025 summary counts them in 38 states plus DC and Puerto Rico. Most are narrow, and none is a substitute for licensure in a state where a practice has real volume.

What are the two kinds of exception?

• Consultation exceptions. The out-of-state clinician advises a clinician licensed in the state, who keeps responsibility for the patient. These are nearly universal.
• Follow-up or continuity exceptions. The out-of-state clinician continues treating their own established patient who is now in the state, usually temporarily. These are less common and usually carry a time limit or an in-person condition.

A third category, emergencies, appears in most statutes but rarely helps a scheduled telehealth practice.

Where is a physician-to-physician consult exempt?

Almost everywhere, with conditions that matter. From the states we have verified:

• Responsibility stays local. Florida exempts consultation with a Florida-licensed provider "who has ultimate authority over the diagnosis and care of the patient" (Fla. Stat. § 456.47(6)); Arizona, Minnesota, Hawaii, New Hampshire, Oregon, South Carolina and West Virginia use similar language.
• Infrequency. Alabama allows an out-of-state physician to practice on fewer than 10 days or with fewer than 10 patients a year, or in consultation with an Alabama physician (Ala. Code § 34-24-702). New Mexico allows consulting on an irregular or infrequent basis up to ten patients a year (N.M. Stat. Ann. § 61-6-17). Kentucky and New Hampshire exempt infrequent consultation, and New Hampshire says regular or frequent consulting counts as practice.
• Specialty or request. Texas exempts an out-of-state specialist giving only episodic consultation on request to a Texas physician in the same specialty (Tex. Occ. Code § 151.056(b)). Delaware, Missouri and New Jersey exempt episodic specialist consults requested by a local licensee.
• No patient contact. Vermont's exemption covers only a consultation with another clinician "based on a review of records without in-person or remote contact" with the patient (26 V.S.A. § 3059). Rhode Island lets an out-of-state physician be consulted on a singular occasion, but not consult directly with a patient they have no relationship with unless a Rhode Island physician is physically present (R.I. Gen. Laws § 5-37-16.2).
• Unpaid. Delaware, Missouri and Ohio exempt informal or uncompensated consultation; Ohio also exempts infrequent consults and those in Ohio training programs (Ohio Rev. Code § 4731.36).

The design point: a consult exception covers a clinician advising a clinician. It does not cover an out-of-state clinician who sees the patient on video, makes the diagnosis and writes the prescription while a local clinician co-signs. Several statutes say the local clinician must keep "ultimate authority" or "control," and boards read that literally.

Where is follow-up care for an established patient exempt?

A smaller set of states, each with its own trigger and limit:

• Ohio. Follow-up care, including by electronic communication, for the same condition within one year of treating the patient in the physician's licensing state (Ohio Rev. Code § 4731.36(A)).
• North Dakota. Continuing telehealth care for a North Dakota resident whose relationship began in the physician's licensed state, for up to one year before an in-person encounter there is required; also patients temporarily in the state and care before a scheduled in-person visit (N.D. Admin. Code § 50-02-15-03).
• Virginia. Out-of-state MDs, DOs, PAs and APRNs may give continuity-of-care telemedicine to a current patient they examined in person within the previous 12 months (Va. Code § 54.1-2901(A)). Notable for including NPs and PAs.
• Wyoming. A physician or PA who established care in person in their licensed state may continue it by telehealth for up to six months at a time before another in-person visit there (Wyo. Bd. of Medicine Rules ch. 1, § 7).
• Illinois. The Medical Practice Act's telemedicine definition excludes follow-up care after treatment in the physician's licensing state, and care for an existing patient while the patient or physician is traveling (225 ILCS 60/49.5(c)).
• Oregon. An established patient temporarily in Oregon, and temporary or intermittent follow-up care for an established patient (Or. Rev. Stat. § 677.137).
• Washington. Follow-up for an established patient temporarily in Washington who was treated in the clinician's state; also a specialty assessment or recommendation, but not treatment (RCW 18.134.040).
• North Carolina. A physician licensed elsewhere may treat a regular patient by any means of communication while that patient is temporarily in North Carolina (N.C. Gen. Stat. § 90-18(c)).
• District of Columbia. An existing relationship may continue while the patient is temporarily in the District, or for a District resident for up to 120 days (D.C. Code § 3-1201.05(e)).
• Idaho. An established patient temporarily in Idaho, short-term follow-up to ensure continuity, and care to prepare for a scheduled in-person visit (Idaho Code § 54-5713).
• Alaska. Follow-up care where there is an established relationship and a prior in-person visit, or ongoing care for a life-threatening condition on referral from an Alaska physician (AS 08.02.130(b)).
• Arizona. After-care related to a procedure done in person in another state; a home-state primary care or behavioral health provider treating their own non-resident patient; and fewer than ten Arizona telehealth encounters a year (A.R.S. § 36-3606(E)).
• South Carolina. Telehealth between in-person visits under an existing out-of-state specialty treatment plan, excluding episodic care and new conditions (S.C. Code § 40-47-37).

Which states offer no follow-up exception?

Florida, Texas, Georgia, California, Alabama and Arkansas, among those we have verified, have no follow-up care exception for physicians. A Florida patient you treated in New York who moves to Tampa needs you to hold a Florida license or Florida's telehealth registration before the next video visit. California has one narrow treatment exception: an eligible out-of-state physician may treat, by telehealth only, a patient with an immediately life-threatening disease or condition (Cal. Bus. & Prof. Code § 2052.5). For several other states we could not confirm an exception either way; those fields are marked unverified on the state pages rather than guessed.

Do the exceptions cover NPs and PAs?

Usually not. Most consultation and follow-up exceptions sit in medical practice acts and name physicians. Alabama's statute "covers physicians only." Virginia and Wyoming are among the few that expressly include PAs (and Virginia, APRNs). Arizona's and Idaho's exceptions are written for health care providers generally. An NP's or PA's options are usually full licensure, a compact privilege where one is active, or a registration in states that offer one. White Glove APRN covers NP options in multistate APRN practice without the compact, and White Glove PA covers telehealth across state lines as a PA.

What limits catch practices out?

• Clocks. Ohio and North Dakota run one year, Virginia 12 months from the last in-person exam, Wyoming six months, DC 120 days. Track the start date.
• "Temporarily." Most continuity exceptions assume the patient is visiting. A patient who has moved permanently usually falls outside them.
• Prior in-person care. Alaska, Virginia and Wyoming require that the relationship began in person.
• Same condition. Ohio limits follow-up to the condition treated in the other state; South Carolina excludes new conditions.
• Prescribing. An exception to licensure is not a DEA registration. Controlled substances still need a DEA registration in the patient's state and compliance with federal telemedicine rules; see the DEA telemedicine rules hub.
• Jurisdiction. Idaho and North Dakota say exempt clinicians still submit to the state's law, courts and board.

How should a practice use the exceptions?

1. Treat them as a continuity tool for individual patients, never as a market-entry strategy.
2. Record the exception relied on, its start date and its expiry in the chart.
3. Set an EHR alert when a patient's visit location is a state where the clinician is unlicensed, and require the exception to be selected before the visit proceeds. See patient location verification.
4. Start licensure or registration the day a patient's stay looks permanent.

Every state's exception, with its citation, is on its page in our telehealth law index. The 50-State Telehealth Matrix ($2,950 for one service line) assembles them into one table for your counsel, and states with a telehealth registration covers the next step up. Nothing here is legal advice.