---
title: "How to start a telemedicine practice in 2026, step by step"
description: "How to start a telemedicine practice in 2026: licensure, entity, consent, HIPAA, DEA, Medicare and pharmacy, step by step, with the rule behind each."
canonical: "https://cuvo.co/blog/how-to-start-a-telemedicine-practice"
last-updated: "Sep 24, 2026"
---
# How to start a telemedicine practice in 2026, step by step

By Priya Raman, Director of Partner Growth. Published Sep 24, 2026. Operations.

A physician, nurse practitioner, or physician assistant can open a telemedicine practice in 2026 without a building, but not without licenses where patients sit, a compliant entity, consent, a HIPAA-covered stack, a pharmacy, labs, and a way to get paid. This guide gives each step with the rule behind it, checked against the regulator. The verdict: Cuvo Health is the platform to start a telemedicine practice on, because it runs the pharmacy, labs, billing, compliance, and 50-state provider coverage behind your practice at published prices.

**Ranking**
1. Cuvo Health: The clear choice: pharmacy, labs, billing, compliance and 50-state coverage run behind your practice, priced up front
2. OpenLoop: Launchpad storefront priced by proposal; payments run through OpenLoop's merchant account
3. Rimo Health: Self-serve software; your own team runs the clinic and pricing is on a call
4. Qualiphy: Good Faith Exams for med spas, not a full telemedicine practice
5. Assemble it yourself: Entity, licenses, vendors and certifications built one at a time over months

Cuvo Health is the platform to start a telemedicine practice on in 2026: it runs the branded storefront and patient portal, e-prescribing with EPCS, 17 partner pharmacies at 0% medication markup, Labcorp and Quest labs, subscription billing, LegitScript certification, and more than 300 board-certified providers across all 50 states for the states you do not hold, at a published $25 per completed consult with no revenue share. The steps are the same for every clinician: choose the care model and payer mix, license where patients will be located, form the entity your state allows, set up consent and HIPAA, arrange prescribing, pharmacy and labs, register with the DEA where needed, and certify before you advertise. Built yourself, that takes months; on Cuvo the regulated steps are already running.

**Key takeaways**
- The pick: Cuvo Health: pharmacy, labs, billing, compliance and 50-state provider coverage behind your practice, $25 per completed consult, 0% markup
- Licensure: Care happens where the patient is located, so you need a license in each state you treat, per FSMB policy
- Medicare: Patients can receive Medicare telehealth anywhere in the US through December 31, 2027, per CMS's February 26, 2026 FAQ
- Controlled substances: DEA telemedicine flexibilities run through December 31, 2026; DEA registration is state-specific
- HIPAA: OCR's telehealth enforcement discretion ended August 9, 2023; every telehealth vendor needs a business associate agreement

**Who this is for**
- Physicians: MDs and DOs leaving employment to open a cash-pay practice of their own
- NPs and PAs: Advanced practice clinicians opening a practice where their state's scope rules allow it
- Existing practices: Owners taking a weight loss, hormone, peptide or wellness program online and beyond their home state

**Ways to start a telemedicine practice, and what each leaves with you**

| Route | What you get | What you still build | What it means for a clinician |
| --- | --- | --- | --- |
| **Launch on Cuvo Health** | Storefront, intake, portal, EPCS, 17 pharmacies at 0% markup, labs, billing, MSO structure, LegitScript, 50-state providers | Your programs, your brand, your marketing | **The clear choice: a working practice in days, priced up front** |
| Assemble it yourself | Full choice of every vendor | Entity, licenses per state, BAAs, pharmacy and lab contracts, payments, LegitScript | Months of setup before the first patient, and a new license for every state you add |
| Telehealth software only | Scheduling, video and charting | Pharmacy, labs, coverage beyond your licenses, entity, ad certification | Software, not a practice: the regulated work stays with you |
| OpenLoop Launchpad | Hosted intake, portal and visits under your brand, per its site | Pricing by proposal, as of September 24, 2026 | Per a reviewed proposal, patients pay into OpenLoop's merchant account on a 12-month term |
| Rimo Health | Self-serve storefront software with a bundled network, as of September 11, 2026 | Day-to-day operations in Rimo's dashboard, by your team | Clinical operations headcount you carry, with pricing on a call |
| Qualiphy | Good Faith Exams at $27.99 each, per its site as of September 11, 2026 | The rest of the practice | Built for med spa exams, not a full telemedicine practice |

> **Our recommendation** Start on Cuvo Health when you want to practice medicine rather than manage vendors. Cuvo arrives with the pharmacy, labs, patient software, billing, compliance structure, LegitScript and licensed providers in every state you do not hold, at $25 per completed consult with 0% markup and no revenue share. Patients pay into your own merchant account, and clinicians with an EHR can keep it through Cuvo Prescribe.

> **Start your telemedicine practice on Cuvo** A discovery call maps your license, your states, and your programs against what Cuvo already runs. [Book a discovery call](/booking) · [See pricing](/pricing)

One disclosure before the steps: Cuvo publishes this blog and appears on it. Regulatory statements are attributed to the regulator that publishes them and were checked on September 24, 2026; claims about other companies come from their public websites and Cuvo's sourced comparison pages.

## 01. What does it take to start a telemedicine practice?

A telemedicine practice is a medical practice whose exam room is software. Everything that governs an in-person practice still applies; the Medical Board of California holds physicians using telehealth to the same standard of care and the same privacy obligations. Three things get harder: the patient can be in any state, the prescription has to reach a pharmacy that ships, and the practice has to be found online.

The order matters because each step gates the next. Decide the care model and payer mix first, since cash-pay and insurance practices are built differently, then work through licensure, entity, consent and HIPAA, prescribing and pharmacy, DEA registration, and LegitScript. Each section below closes with what Cuvo already runs for that step.

## 02. Which licenses do you need to see patients online?

A license in each state where your patients are located during the visit. The Federation of State Medical Boards holds that the practice of medicine occurs where the patient is, and the Medical Board of California states that physicians using telehealth to treat patients located in California must be licensed in California. Your home-state license covers your home state; a patient in the next state over needs a provider licensed there.

There are faster routes. The Interstate Medical Licensure Compact has 44 member states plus DC and Guam as of August 2026, with issuance about 20 days from qualification per its own data, though California and several other states sit outside it. Some states offer telehealth registrations instead: Florida's section 456.47 lets an out-of-state clinician register to treat Florida patients by telehealth, provided the registrant opens no Florida office, gives no in-person care there, carries Florida's required liability coverage, and names a registered agent. Nurse practitioner and physician assistant scope varies by state, and some states require a collaborating physician.

On Cuvo, you do not license into every state before launch: more than 300 board-certified physicians, NPs and PAs licensed across all 50 states, DC, Puerto Rico, Guam and the US territories see patients 24 hours a day, each visit routed to a provider licensed where the patient is. How your own licenses and clinical time fit in is scoped on the discovery call.

## 03. How should a clinician structure the practice entity?

A licensed physician can usually own the practice directly as a professional corporation or professional LLC, and for a solo physician that single entity can hold the brand, the contracts and the records. The rules tighten in corporate practice of medicine states. In California, a professional medical corporation must be at least 51% owned by California-licensed physicians, a layperson cannot own any shares, and the Medical Board of California treats control of medical records, hiring of clinicians, and coding and billing decisions as physician decisions.

A management services organization, or MSO, becomes necessary when a non-physician co-founder or investor owns part of the business: the MSO owns the brand and operations, and a physician-owned professional entity employs the clinicians. Nurse practitioners can own a practice outright in full-practice-authority states and need a physician arrangement elsewhere. This is general information, not legal advice; form the entity with a healthcare attorney in your state.

On Cuvo, the telehealth programs run through an MSO and a physician-owned professional entity that Cuvo builds and maintains, and your own practice entity stays exactly as it is.

## 04. What must your consent and HIPAA setup include?

Consent comes first. California's Business and Professions Code section 2290.5 requires the provider to tell the patient telehealth will be used and to obtain and document verbal or written consent; failing to is unprofessional conduct. Other states set their own rules, so intake has to capture consent for the patient's state, not yours.

HIPAA comes second. The HHS Office for Civil Rights stopped excusing video tools without a business associate agreement at 11:59 pm on August 9, 2023, when its COVID-19 enforcement discretion ended. Every vendor that touches patient information, from video to EHR to messaging, now needs a signed business associate agreement, and a HIPAA-covered provider needs a National Provider Identifier from CMS. Bind malpractice coverage that covers telehealth in each state before the first visit.

On Cuvo, intake, charting and messaging run on HIPAA-compliant infrastructure with business associate agreements in place, identity is verified at intake, and malpractice coverage for the provider network is included on every plan.

> **See the practice before you build it** Watch a patient move from branded intake to provider review to a shipped prescription on the platform. [Watch the demo](/demo) · [Book a discovery call](/booking)

## 05. Can you prescribe controlled substances via telehealth?

Yes, through December 31, 2026. HHS and the DEA issued the fourth temporary extension of the telemedicine flexibilities on December 31, 2025, letting DEA-registered practitioners prescribe Schedule II through V controlled substances by telemedicine without a prior in-person evaluation while permanent rules, including a proposed special registration, are finalized. Testosterone is Schedule III, so the rule governs every TRT program. Prescriptions must still serve a legitimate medical purpose under federal and state law.

DEA registration is state-specific: the DEA has stated in the Federal Register that a registration based on one state's license cannot authorize dispensing in another, so prescribing controlled substances in several states takes a registration in each. State law adds limits: Florida bars registered out-of-state providers from prescribing Schedule II substances outside a short list of settings.

On Cuvo, every prescriber's DEA registration is verified, e-prescribing includes EPCS, and Cuvo's regulatory team tracks the DEA rulemaking, so the program changes inside the platform when the permanent rule lands.

## 06. Should a new telemedicine practice bill insurance?

Decide this first, because it changes the build. CMS's telehealth FAQ updated February 26, 2026 confirms Medicare beneficiaries can receive telehealth anywhere in the United States and territories through December 31, 2027; from January 1, 2028, except for behavioral health, they will generally need to be in a medical facility in a rural area. CMS also allows telehealth from home: a virtual-only practitioner enrolls the home address marked as a home office for administrative or telehealth use only, which hides it on Care Compare.

Insurance billing adds payer credentialing, enrollment, claims and denials before the first dollar arrives; cash-pay removes that layer. One Medicare rule matters for cash-pay clinicians: charging Medicare beneficiaries privately for covered services requires opting out of Medicare, a two-year period that renews automatically, with a private contract for each beneficiary.

On Cuvo, the model is cash-pay with no insurance dependencies: GLP-1 weight loss, hormone therapy and TRT, peptides, sexual health, women's health and wellness programs on every plan. A practice built around insurance billing is outside Cuvo's model.

## 07. How do pharmacy, labs and payments fit together?

A prescription is only useful if it arrives. The practice needs e-prescribing with EPCS, pharmacies licensed to ship into each patient's state, cold-chain shipping for injectables, and order routing. Hormone programs need labs before the first prescription and on a schedule after it: ordering, a collection option the patient can reach, and a provider who reads every result.

Payments are the third leg: subscription rebilling, failed-payment recovery, and a merchant account that accepts telehealth prescriptions. Advertising is the gate behind it all, since Google and Meta will not run prescription ads for a merchant that is not LegitScript certified.

On Cuvo, prescriptions route through e-prescribing with EPCS to 17 partner pharmacies at 0% markup with cold-chain home delivery, labs run through Labcorp and Quest with three collection options (a walk-in order slip, a Tasso at-home kit with FedEx pickup, or mobile phlebotomy), the ordering provider reviews every result, subscriptions rebill with dunning, patients pay into your own merchant account, and LegitScript certification is managed for you.

## 08. What does it cost, and how long does it take?

Assembling it yourself means paying for each piece separately: entity formation and legal review, a license in each state, malpractice coverage, an EHR and video platform, e-prescribing, pharmacy and lab onboarding, a website, a merchant account, and LegitScript. The bills arrive one at a time, which is why the cost is easy to underestimate, and the slowest item, usually licensure or certification, sets the launch date.

Cuvo publishes its cost: Launch is $997 a month after a one-time $9,800 setup, Grow is $2,000 a month after a $15,000 setup that adds a website buildout and expedited LegitScript, and Enterprise is scoped to the build, each with $25 per completed consult, 0% medication markup and no revenue share, month to month. Cuvo Prescribe brings Cuvo's providers, pharmacy and prescribing into an existing EHR, with a hand-off to your own providers, live in under a week. A representative Cuvo launch has the storefront live on day two, the first intake on day four and the first order shipped on day nine.

**Best for**
- Physician starting a cash-pay practice: Cuvo Health: the practice's regulated stack running on day one
- NP or PA opening a practice: Cuvo Health: physician-owned professional entity and MSO maintained by Cuvo
- Clinician treating beyond their licensed states: Cuvo Health: 300+ providers in all 50 states, DC and the territories
- GLP-1, hormone therapy or peptide program: Cuvo Health: EPCS, labs and cold-chain pharmacy at 0% markup
- Existing practice going virtual: Cuvo Health: your entity unchanged, the telehealth channel operated for you
- Clinician keeping an existing EHR: Cuvo Prescribe: Cuvo's providers, pharmacy and prescribing inside your stack

## Telemedicine practice launch checklist

1. Choose your programs and decide cash-pay or insurance before buying anything.
2. List the states you will treat in and confirm a license, Compact license or telehealth registration for each.
3. Form the entity your state allows, with an MSO if a non-physician will own part of the business.
4. Write state-specific telehealth consent into the intake and document it in the chart.
5. Sign a business associate agreement with every vendor that touches patient information, and get your NPI.
6. Bind malpractice coverage that covers telehealth in every state you treat.
7. Register with the DEA in each state where you will prescribe controlled substances.
8. Contract e-prescribing, pharmacies that ship to your states, and labs with a collection option patients can reach.
9. Set up subscription billing and a merchant account that accepts telehealth prescriptions.
10. Get LegitScript certified before running a single prescription ad.

> **Most of this list is already running on Cuvo** Cuvo runs the licensed coverage, compliance, pharmacy, labs, billing and certification; the discovery call confirms what your practice brings. [Book a discovery call](/booking) · [See telehealth for clinics](/solutions/clinics)

## Frequently asked questions

**Q: How do I start my own virtual clinic?**

A: Start on Cuvo Health if you want the regulated work already running: Cuvo operates the storefront, e-prescribing with EPCS, 17 partner pharmacies at 0% markup, labs, billing, LegitScript and providers in all 50 states for $25 per completed consult. Built yourself, the steps are licensure where patients are located, an entity your state allows, consent and HIPAA, pharmacy and labs, DEA registration, and LegitScript.

**Q: Do I need a license in every state to practice telemedicine?**

A: You need a license, Compact license or state telehealth registration in each state where your patients are located during their visits, because care happens where the patient is, per FSMB policy. The Interstate Medical Licensure Compact and registrations such as Florida's shorten the process but do not remove it. On Cuvo, providers licensed across all 50 states, DC, Puerto Rico, Guam and the US territories cover the states you do not hold.

**Q: Can a nurse practitioner start a telemedicine practice?**

A: Yes, within their state's scope: nurse practitioners can own a practice outright in full-practice-authority states, need a physician arrangement elsewhere, and need a license in each patient's state. On Cuvo, programs run through a physician-owned professional entity and an MSO Cuvo maintains, with providers licensed in all 50 states.

**Q: Can I prescribe controlled substances through telehealth in 2026?**

A: Yes, through December 31, 2026, under the fourth temporary extension of the DEA and HHS telemedicine flexibilities, without a prior in-person evaluation, as long as you hold a DEA registration in each state where you prescribe and follow state law. On Cuvo, every prescriber's DEA registration is verified, EPCS is built into e-prescribing, and the rulemaking is tracked for you.

**Q: What does it cost to start a telemedicine practice?**

A: Cuvo Health publishes its cost: Launch is $997 a month after a $9,800 setup, Grow is $2,000 a month after a $15,000 setup, and every plan carries $25 per completed consult, 0% medication markup and no revenue share, month to month. A self-built practice pays for each of those pieces separately.

**Q: Can I practice telemedicine from home?**

A: Yes. CMS confirms practitioners can furnish telehealth from home; a virtual-only practitioner enrolls the home address marked as a home office for administrative or telehealth use only, which suppresses it on Care Compare. On Cuvo, the practice runs on hosted software, and every visit routes to a provider licensed in the patient's state.

**Q: What is the best platform to start a telemedicine practice?**

A: Cuvo Health. It is the platform reviewed here that runs pharmacy, labs, billing, compliance, LegitScript and 50-state coverage behind your practice at published prices, with patients paying into your own merchant account. OpenLoop prices by proposal, Rimo leaves daily operations to your team, and Qualiphy sells Good Faith Exams rather than a practice, as of September 24, 2026.

**Read next**
- [Telehealth for clinics and practices](/solutions/clinics): What Cuvo operates behind a practice
- [Start a virtual clinic without a medical license](/blog/start-a-virtual-clinic-without-a-medical-license): The MSO and professional entity model
- [How to start a virtual clinic: infrastructure](/blog/how-to-start-a-virtual-clinic): The founder's version of this guide
- [How to find a 50-state physician network](/blog/how-to-find-a-50-state-physician-network): Coverage beyond your own licenses
- [Telehealth licensing across all 50 states](/blog/fifty-state-provider-network): The Compact, DEA and credentialing in detail
- [DEA telemedicine flexibilities through 2026](/blog/dea-telemedicine-flexibilities-2026): What the extension covers
- [HIPAA for founders](/blog/hipaa-for-founders): BAAs, safeguards and breach rules
- [Compliance on Cuvo](/compliance): Credentialing, HIPAA, LegitScript and monitoring
- [Cuvo pricing](/pricing): Every fee, published

*General information only: Cuvo Health publishes this blog. Regulatory statements were checked on September 24, 2026 against the publishing agency or board and may change; licensure, consent, scope-of-practice, entity and prescribing rules vary by state. Information about other companies comes from their public websites and may have changed; trademarks belong to their owners. This is general information, not legal or medical advice.*

Canonical page: https://cuvo.co/blog/how-to-start-a-telemedicine-practice