Running a telehealth private practice in Texas

1. Texas law in brief

• Telehealth is defined in statute. Texas Occupations Code chapter 111 defines a telehealth service as a health service delivered by a professional licensed in Texas, acting within the scope of that license, to a patient at a different physical location, using telecommunications or information technology. (A physician's equivalent is a "telemedicine medical service.")
• Coverage parity for insured clients. Under Texas Insurance Code chapter 1455, a state-regulated health plan can't exclude a covered service from a contracted provider just because it was delivered by telehealth rather than in person. The Center for Connected Health Policy's Texas summary notes the law doesn't require plans to cover audio-only calls, text or fax. Self-funded employer plans follow federal rules instead, so check each client's plan.
• Your board's rules apply as they do in the office. BHEC treats technology-assisted services as practice under your license: the same standards, records and confidentiality, plus a few telehealth-specific duties covered below.

2. Where the client is decides whose rules apply

BHEC's guidance for marriage and family therapists says that a licensee in another state is practicing in Texas, and subject to Texas law, when the client is physically in Texas at the time of the service, and tells licensees to check with the licensing authority of any other state where a client is located (BHEC MFT guidelines, 2025). The psychology guidelines say the same, and add that the law of the client's state may also apply (BHEC telepsychology guidelines). Plan your practice on that rule for every license: the client's location at the time of the session decides which state's license you need. Your home address, the client's billing address and the plan's state don't.

3. Out-of-state clients and compacts, by license

License	Compact Texas belongs to?	Seeing a client located outside Texas
Psychologist	Yes: PSYPACT, adopted through H.B. 1501 in 2019 (BHEC)	With the Authority to Practice Interjurisdictional Telepsychology, telepsychology to clients in other PSYPACT states; elsewhere, that state's license. See the psychologist guide.
LPC	No. A 2025 bill to join the Counseling Compact didn't pass (SB 498)	That state's license or temporary-practice rule. The compact is live in Arizona, Georgia, Louisiana, Minnesota and Ohio (counselingcompact.gov), but a Texas license can't use it. See the LPC guide.
LCSW	No. 2025 bills to join the Social Work Licensure Compact died in committee (BHEC)	That state's license or permission. See the LCSW guide.
LMFT	No	That state's license or permission; with couples, check each person's location. See the LMFT guide.
LCDC (HHSC)	No	That state's credential. Counselor interns: in a 2024 rule adoption HHSC declined to let interns provide telehealth before passing the licensing exam; see supervising associates and interns.

Each state decides whether it allows short-term or follow-up care by an out-of-state clinician, and the rules differ by profession. Check the board in the client's state, in writing, before the session, not after.

4. Common situations

Situation	What to do
A Texas client is on vacation in another state	Check that state's rules before the session. If it doesn't allow it, reschedule, hold a brief check-in only if that state permits it, or meet when they're back. Have a written policy so the answer isn't made up on the spot.
A college student goes to school out of state	Plan the hand-off before the semester: a license there, a referral to a clinician licensed there, or sessions only when they're home in Texas.
A client moves away	Transition care to a clinician licensed in the new state, with a release, a summary and a final session while they're still in Texas if you can.
You live or travel outside Texas and see Texas clients	Your Texas license covers the Texas clients. The state you're in may have its own rules for clinicians practicing from there; check before you move. Plans also care where you practice from; update NPPES and each plan.
Someone from another state finds your website	Say on your site and intake form which states you're licensed in, and screen for location on the first call.

5. The address problem for video-only practices

• Plans and NPPES want a physical service address. Most plans won't accept a PO box, and many won't list a virtual office. Ask each plan how it lists a home-based or telehealth-only practice before you apply.
• Your home address may become public. NPPES data is public, and plan directories show your service location. Options include a part-time office or shared space you actually use, and what each plan accepts. Decide before the first application, because changing addresses later means updating NPPES, CAQH and every plan.
• Medicare enrolls you at a real practice location; see Medicare for counselors and MFTs.

6. Platforms and BAAs

• The pandemic flexibility is over. HHS's Office for Civil Rights stopped penalizing providers for telehealth on non-HIPAA-compliant platforms during COVID-19; that notification expired with the public health emergency on May 11, 2023, with a transition period through August 9, 2023 (HHS). Today you need a video platform that will sign a business associate agreement (BAA).
• The BAA list is longer than video: the EHR, email, texting and reminders, phone and fax, online scheduling, the AI note tool, cloud storage and your billing service. Keep the signed BAAs in one folder; the HIPAA checklist has the full list and the yearly risk analysis.
• Never use public-facing apps (live-streaming or social video) for sessions.
• In Cima EHR, video isn't built in: you add your own video link from a platform that signs a BAA, it goes in the client's reminder, and Cima signs a BAA for the chart, scheduling and billing (security and BAA).

7. Consent and safety

• A written telehealth consent covering how sessions work, privacy at the client's end, what happens if the connection drops, the risks of technology, recording (and that neither side records without agreement), and your emergency procedure.
• At every session: confirm identity, the client's physical address right now, that they're somewhere private, and a phone number to reach them if the video drops. Put the location in the note; it's what proves which state's rules applied.
• Emergencies: keep an emergency contact on file and the local crisis resources for the client's area, give them to the client before a crisis (BHEC's MFT guidance recommends this), and know how you'd reach 988, a mobile crisis team or 911 near the client, not near you.
• Give your license number and how to reach your board to clients you serve by technology, as BHEC's MFT rule requires (22 TAC 801.44(o)); it's good practice for every license.
• Minors: get the consent your rules require from a parent or guardian before technology-assisted services (for LMFTs, 22 TAC 801.58).

8. Billing: places of service and modifiers

Visit	Place of service	Modifier
Video, client at home	10	95
Video, client somewhere other than home	02	95
Audio only, where the plan covers it	10 or 02	93 (some plans ask for FQ, or both)
In the office	11	None

• Medicare: CMS pays telehealth claims billed with place of service 10 at the non-facility rate for dates of service from January 1, 2024, and pairs POS 02 or 10 with modifier 95 (video) or 93 (audio only) (CMS change request). Behavioral telehealth to a client at home is covered; the in-person visit Medicare would require before starting mental health telehealth is delayed through December 31, 2027, and audio-only flexibility runs through the same date (CMS telehealth FAQ, October 9, 2026; HHS telehealth policy updates).
• Texas Medicaid: follow TMHP's telecommunication services rules in the Texas Medicaid Provider Procedures Manual and each managed care plan's billing guide (TMHP).
• Commercial plans: most follow the table above; some older policies still want modifier GT. Use each plan's written telehealth policy, not habit.
• Out-of-network and self-pay clients: put the same place of service and modifier on the superbill, so the client's plan can process it; see the cash-pay guide.

In Cima EHR, the visit type sets the place of service and modifier from how the session happened, and a telehealth claim without 95 or 93 is flagged before it's sent.

9. The telehealth checklist

• Licensed in every state where your clients will be located; a written policy for travel and moves.
• Website and intake say which states you serve; location screened on the first call.
• A service address each plan accepts, consistent in NPPES, CAQH and every application.
• Video platform, EHR, email, texting and phone vendors with signed BAAs, in one folder.
• Telehealth consent signed before the first session; your license number and board contact given.
• Location, private setting and callback number confirmed and noted each session.
• Emergency contact and local crisis resources on file for each client's area.
• Places of service and modifiers set per plan; audio-only coverage checked per plan.
• Malpractice policy confirmed to cover telehealth and the states you serve.
• Telehealth added to your HIPAA risk analysis and reviewed yearly.

The business steps for any practice are in how to start a private practice in Texas.

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Questions

Can a Texas therapist see clients in another state by telehealth?

Only with that state's license or permission, because the client's location at the time of the session decides which state's rules apply. Texas psychologists can use PSYPACT for telepsychology in other PSYPACT states; Texas LPCs, LCSWs and LMFTs have no compact Texas belongs to as of October 2026.

Can I live in another state and see Texas clients?

Your Texas license covers clients located in Texas, and BHEC treats you as practicing in Texas when the client is in Texas. Also check the rules of the state you live in, and update your address with NPPES and each plan.

What place of service and modifier do I use for telehealth therapy?

Most plans want place of service 10 when the client is at home or 02 when they're elsewhere, with modifier 95 for video or 93 for audio only. Medicare pays POS 10 at the non-facility rate. Follow each plan's written policy.

Do I need a BAA with my video platform?

Yes. The HHS enforcement discretion that allowed non-compliant platforms during COVID-19 ended with the public health emergency in May 2023, with a transition period through August 9, 2023. Use a platform that signs a business associate agreement.

Does Texas require insurance to cover telehealth therapy?

For state-regulated plans, Texas Insurance Code chapter 1455 bars excluding a covered service only because it was delivered by telehealth. It doesn't require coverage of audio-only calls, and self-funded employer plans follow federal rules, so check each client's plan.

Sources

• Texas Legislature, Occupations Code chapter 111 and Insurance Code chapter 1455; Center for Connected Health Policy, Texas telehealth policy
• BHEC, MFT guidelines for technology-assisted services; telepsychology guidelines; PSYPACT; social work compact FAQ
• LegiScan, Texas SB 498 (2025); Counseling Compact Commission
• HHS, notification of enforcement discretion for telehealth
• CMS, change request on telehealth place of service and modifiers; telehealth FAQ (updated October 9, 2026); HHS, telehealth policy updates
• TMHP (Texas Medicaid Provider Procedures Manual)