In California, therapists must obtain and document informed consent before starting telehealth, verify the client’s current physical location at every session, and hold a California license to treat anyone physically located in the state. Beyond that, you need to disclose your license number, explain telehealth’s risks and limits, keep emergency resources on hand, and follow HIPAA and CMIA for every record you keep.
TL;DR:
- When a client is outside California, check that state’s temporary practice rules before continuing; short term allowances vary, and no nationwide rule applies.
- Record whether consent was verbal or written, when it was obtained, and who obtained it; cover technology risks, data handling, billing, and in person options.
- Before choosing a platform, confirm a signed Business Associate Agreement, encryption in transit and at rest, retention and deletion terms, and access logs.
- If you use an AI tool to record, transcribe, or draft notes, obtain separate documented consent under SB 903 and retain responsibility for its output.
- For California Medicaid claims, use modifier 95 for live video, 93 for live audio, and GQ for store and forward care.
Table of Contents
- The Laws and Board Rules Behind California Telehealth Practice
- What Informed Consent Must Cover and How to Document It
- Client Location and Interstate Practice: Who Actually Needs a California License
- Your Session-by-Session Compliance Checklist
- Privacy, Security, and the New AI Rules Under SB 903
- Medi-Cal Billing Essentials for Telehealth Providers
- Choosing the Right Telehealth Modality for Each Client
- Supervising Trainees and Associates on Telehealth
- Compliance Checklist and Sample Consent Language
- Making These Rules Work in a Small Practice
- Compliant Telehealth Therapy With ReviveHealthTherapy
- FAQ
- Sources
The Laws and Board Rules Behind California Telehealth Practice
Three sources of authority shape what you can and cannot do when you see clients by video or phone instead of in person. Knowing how they fit together keeps you out of regulatory trouble and makes your documentation defensible if a complaint ever lands on your desk.
California Business and Professions Code §2290.5 is the foundation. It defines telehealth broadly as the delivery of health care services using technology to connect patient and provider when they are not in the same room, and it requires the provider initiating telehealth to get verbal or written consent before delivering any service this way. The statute also confirms that confidentiality protections and existing practice laws apply to telehealth exactly as they would to an in-person session, and regulatory materials built on this statute treat a failure to document that consent as unprofessional conduct subject to board enforcement.
The Board of Behavioral Sciences’ Notice of Approval of Regulatory Action adds specifics for marriage and family therapists, clinical social workers, and professional clinical counselors. Title 16 §1815.5 requires you to verify the client’s present location at the start of every session, obtain consent consistent with BPC §2290.5, provide your license or registration number, and document local emergency resources for wherever the client happens to be. The accompanying Board notice on the proposed regulatory changes explains the reasoning: a California license is required to provide psychotherapy to anyone located in California, and telehealth sessions remain fully subject to the Board’s statutes no matter how the session is delivered.
Psychologists answer to a parallel rule. The Board of Psychology’s telehealth standards under 16 CCR §1396.8 mirror the BBS requirements almost item for item: documented consent, an ongoing appropriateness assessment, and attention to the laws of any other jurisdiction involved when a client is physically outside California. The overlap means that whichever license you hold, the practical checklist looks nearly identical:
- Confirm and document the client’s physical location before the session starts.
- Obtain and record consent to telehealth as a mode of service.
- Disclose your license or registration number in writing.
- Note local emergency resources specific to the client’s current location.
- Reassess appropriateness of telehealth at each encounter, not just at intake.
What Informed Consent Must Cover and How to Document It
Consent for telehealth is not a signature on a generic intake form. BPC §2290.5 requires you to obtain and document consent specifically for telehealth as a service mode, which means your existing informed consent paperwork probably needs a dedicated section rather than a single added checkbox.
A defensible consent conversation covers:
- Telehealth as a mode of care, including that it differs from in-person treatment and that the client has a right to request in-person services instead.
- Technology risks, such as connectivity interruptions, limits on confidentiality over video or phone, and what happens if a session drops mid-conversation.
- Data handling, including whether sessions are recorded or transcribed, where notes are stored, and who can access them.
- Billing and insurance implications, since some payers treat telehealth visits differently from in-office visits for coverage purposes.
- Your license or registration number, presented clearly rather than buried in fine print, as the BBS regulation requires.
Document whether consent was given verbally or in writing, the date and time it was obtained, and which clinician obtained it. A chart note that says “telehealth consent reviewed and obtained, client verbalized understanding, 3:14 PM” takes ten seconds to write and holds up far better than an assumption that an intake form covers everything.
Pro Tip: Build a standing telehealth consent template into your electronic health record so the required elements appear automatically at every new intake instead of depending on memory.
Client Location and Interstate Practice: Who Actually Needs a California License
The single most consequential rule in this entire area is simple to state and easy to get wrong in practice: the client’s physical location, not yours, determines which state’s laws govern the session. If a client is sitting in California when the session happens, you generally need a California license, regardless of where you are sitting or where the client normally lives.
This creates a recurring problem for clinicians whose clients travel. A client who vacations in Arizona for two weeks, visits family in another state, or relocates temporarily for work puts you in a position where continuing the session may require a license in that other state, or may not be permitted at all, depending on that state’s own telehealth rules.
Practical steps for handling this:
- Ask where the client is physically located at the start of every single session, not just at intake. This is not optional under Title 16 §1815.5, which requires session-by-session verification.
- Script the question naturally: “Before we start, can you confirm where you’re located right now?” Document the answer in the session note each time.
- When a client discloses they are out of state, check whether that state permits temporary out-of-state practice, often tied to short visit windows such as 30 days, before continuing the session.
- When you cannot confirm the destination state allows it, decline to hold the session as scheduled and offer to reschedule once the client returns to California or until you confirm permissibility elsewhere.
- Keep a simple log of any out-of-state sessions, including the state, dates, and the basis on which you proceeded or declined.
Our guide to interstate teletherapy questions walks through the specific questions worth asking clients before travel affects a scheduled session, which is worth bookmarking if your caseload includes frequent travelers. Because every other state sets its own telehealth and temporary-practice rules, there is no single national answer. When in doubt, the safer move is always to confirm permissibility before the session rather than after.
Your Session-by-Session Compliance Checklist
Every telehealth session has the same handful of non-negotiable steps, regardless of modality or client history. Building them into a fixed routine means you are not relying on memory during a clinical hour that may already be emotionally demanding.
At the start of each session:
- Verify the client’s name and confirm their current physical location out loud.
- Confirm consent to telehealth is on file and still current; re-confirm verbally if it has been a while since the last review.
- Note the modality being used (video, audio-only, or asynchronous) in the session record.
- Reassess whether telehealth remains clinically appropriate given the client’s current presentation.
During and at the close of the session:
- Document any safety concerns and confirm the client knows local emergency resources for their current location.
- Record any technology interruptions, including dropped connections or audio issues, and how they were resolved.
- Note the time the session started and ended, consistent with standard documentation practice.
Pro Tip: Keep a one-page regional emergency resource reference, organized by county, next to your telehealth setup so you can name a local crisis line within seconds if a client discloses they are in an unfamiliar area.
Our teletherapy etiquette playbook offers additional preparation tips worth sharing with clients before their first virtual session, which can reduce the number of avoidable technical hiccups mid-session.
Privacy, Security, and the New AI Rules Under SB 903
Telehealth records carry the same protected status as any other psychotherapy record. HIPAA governs how you store, transmit, and share protected health information, while California’s Confidentiality of Medical Information Act (CMIA) layers additional state-level protection on top of it. Together, they mean your video platform, your note-taking software, and your billing system all need to meet a baseline of encryption and access control, not just your paper files.
Before adopting any telehealth platform, confirm:
- A signed Business Associate Agreement (BAA) is in place with the vendor.
- Data is encrypted both in transit and at rest.
- The vendor’s storage policy specifies retention periods and deletion procedures.
- Access logs exist so you can show who viewed a record and when.
- The platform is marketed specifically for healthcare use, not a general-purpose video tool repurposed for therapy.
Our privacy guide for secure telehealth goes deeper into vendor evaluation if you are setting up a practice from scratch.
SB 903 adds a newer layer specific to artificial intelligence in psychotherapy. The bill places limits and oversight on AI tools used in clinical workflows, including restrictions around automatically recording or transcribing sessions, and it requires that a licensed professional remain responsible for any AI tool used in the course of care. If you use a transcription or note-generating tool during telehealth sessions, SB 903 means you need explicit, documented client consent for that specific use and a clear line of professional accountability for the tool’s output, not just a general telehealth consent covering the session itself.
SB 903 reflects a broader regulatory shift toward scrutinizing AI in mental health care, and its recording and transcription provisions are the clearest signal yet that informal use of AI note-takers needs its own consent conversation. (SB 903, Leginfo)
Medi-Cal Billing Essentials for Telehealth Providers
If you bill Medi-Cal for telehealth, enrollment and documentation requirements sit on top of everything already covered. You need to be enrolled as a Medi-Cal provider and, where applicable, affiliated correctly with any managed care plan or group billing arrangement before claims will process.
The DHCS telehealth FAQ confirms the consent requirement applies equally to Medi-Cal visits and lays out modality-specific billing rules. Common elements to get right:
- Use modifier 95 for synchronous telehealth via interactive audio and video.
- Use modifier 93 for synchronous telehealth delivered by audio only.
- Use modifier GQ where asynchronous, store-and-forward telehealth applies.
- Bill the Q3014 originating site facility fee when the originating site qualifies and bills separately from the distant site provider.
- Maintain documentation parity: a telehealth note needs to meet the same clinical content standards as an in-person note, including the appropriateness assessment Medi-Cal expects for reimbursement.
DHCS Policy Letter 23-03 adds further detail on documentation and billing mechanics for specific program types, including PACE arrangements, and is worth reviewing directly if your practice bills across multiple program lines. DHCS guidance also treats audio-only differently from video for establishing new Medi-Cal patient relationships, which brings us to modality selection generally.
Choosing the Right Telehealth Modality for Each Client
Not every clinical situation calls for the same delivery method, and California’s rules treat each modality a little differently.
- Synchronous video is the default expectation for most psychotherapy telehealth and the modality most consent forms describe by default.
- Synchronous audio-only sessions are permitted but carry restrictions for Medi-Cal, particularly around establishing a new patient relationship; DHCS guidance generally expects video to be offered and chosen or declined by the patient rather than defaulted to audio-only.
- Asynchronous (store-and-forward) communication, where information is sent and reviewed at different times rather than live, has a narrower role in psychotherapy but can support specific documentation or check-in needs.
Document which modality you used for each session and, where a client requests audio-only over video, note that preference explicitly in the chart. That single line of documentation protects you if a payer or board later questions why a session did not use video.
Supervising Trainees and Associates on Telehealth
Associates and trainees can deliver telehealth when their supervision agreement permits it, but the supervisory relationship needs to extend to telehealth-specific competence, not just general clinical skill. A supervisor who has never asked a trainee how they verify client location or handle a dropped connection has a gap in oversight that matters if something goes wrong.
Supervisors should confirm trainees can:
- State the required session-opening verification script from memory.
- Identify local emergency resources quickly when a client is in an unfamiliar location.
- Use the practice’s approved telehealth platform correctly, including what to do if the connection fails mid-session.
Document these competencies as part of the regular supervision record, the same way you would document any other clinical skill under review.
Compliance Checklist and Sample Consent Language
Keep this as a working reference rather than a one-time read.
- Confirm consent to telehealth is documented before the first session and reviewed periodically.
- Verify the client’s physical location at the start of every session, every time.
- Disclose your license or registration number clearly in writing.
- Reassess clinical appropriateness of telehealth at each encounter.
- Log emergency resources relevant to the client’s current location.
- Confirm your platform meets HIPAA and CMIA requirements, including a signed BAA.
- Get explicit consent for any AI recording or transcription tool under SB 903.
Sample consent language to adapt: “I understand that my therapist will be providing services to me through telehealth technology. I understand the potential risks of this technology, including interruptions, unauthorized access, and technical difficulties. I understand I have the right to request in-person services and can withdraw consent to telehealth at any time. My therapist’s license number is [number], and we have reviewed emergency resources available in my current location.”
Store consent records and session verification entries in the same chart location every time, whether that is a dedicated EHR field or a standing note template, so an audit or board inquiry does not require reconstructing scattered records.
Making These Rules Work in a Small Practice
Rules on paper and rules in a busy practice are different things. When telehealth expanded, the most useful change was not a new policy document but a rewritten intake script that walked front-desk staff and clinicians through the same location-and-consent questions in the same order, every time, so nothing depended on which staff member happened to be on shift.
Two habits made the biggest difference: a standing tech check before the first session with any new client, so connectivity problems surface before the clinical hour starts, and a simple shared document listing emergency resources by county, updated as the caseload’s geography changes. Session location went into the same chart field every time, which made it trivial to confirm compliance during a later file review.
None of this replaces checking with your own licensing board or an attorney when a cross-jurisdiction question gets genuinely complicated. The rules above cover the common cases; the unusual ones deserve a direct call.
— Amy
Compliant Telehealth Therapy With ReviveHealthTherapy
We built our telehealth practice around the same compliance steps covered above, which means consent documentation, session-by-session location verification, and emergency resource planning are already part of how we see every client, not an afterthought bolted on later. We offer secure telehealth therapy statewide across California, alongside in-person sessions in multiple locations, so clients can choose the format that fits their schedule and comfort level.
Our clinical approach centers on trauma-informed, evidence-based methods, including EMDR and CBT, and we work to keep care accessible through sliding-scale fees and acceptance of insurance and flexible spending plans. For clinicians seeking adjunctive support for clients working through performance anxiety or phobias, MindShift Hypnosis + Life Coaching offers complementary hypnotherapy services worth knowing about as a referral option alongside traditional care.
If you or someone you know is looking for a California-licensed therapist who takes telehealth compliance seriously, visit our services page to see current offerings or reach out through our telehealth therapy page to book a session.
This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.
FAQ
Does California allow out-of-state telehealth?
California generally requires a California license for anyone treating a client physically located in California, regardless of where the therapist is based. For a client located outside California, permissibility depends on that other state’s own licensing and temporary-practice rules, which vary and should be confirmed before the session.
Can I provide virtual therapy to a client in another state?
It depends entirely on the laws of the state where the client is physically located at the time of the session, since many states require their own license to treat someone within their borders. Some states offer temporary or short-term practice allowances for visitors, often tied to a limited number of days, but these vary and should be verified directly with that state’s licensing board before proceeding.
Do telehealth laws vary by state?
Yes, every state sets its own telehealth licensure, consent, and practice rules, so a practice that is compliant in California may not automatically be compliant elsewhere. California’s framework rests on BPC §2290.5 and board-specific regulations, and clinicians working across state lines need to check the destination state’s rules separately.
What are the main rules for telehealth therapy in California?
California therapists must obtain and document informed consent before starting telehealth, verify the client’s physical location at every session, and hold a California license to treat anyone located in the state. Additional requirements include disclosing your license number, documenting local emergency resources, and following HIPAA and CMIA privacy standards for all records.
Is telehealth therapy legal in California?
Telehealth therapy is legal in California and is governed by Business and Professions Code §2290.5 along with board-specific regulations for each license type. It requires documented consent, session-by-session location verification, and compliance with the same standards of care that apply to in-person treatment.
Sources
- California Business and Professions Code §2290.5
- Board of Behavioral Sciences — Notice of Approval of Regulatory Action (Title 16 §1815.5)
- Telehealth Frequently Asked Questions – DHCS – CA.gov