Tessic Health

NC · STATE RULES

Telehealth rules in North Carolina

North Carolina sets its physician telemedicine standard in a Medical Board position statement, not a statute, and that statement rejects prescribing from a static online questionnaire. Opioid duties come from the STOP Act: a five-day cap on a first acute-pain prescription, mandatory e-prescribing and a lookup in the Controlled Substances Reporting System (CSRS). The state began issuing Interstate Medical Licensure Compact licenses in January 2026, and its consumer statute trebles damages without any showing of intent.

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Rules checked September 2026 · 31 sources cited

ONLY IN NORTH CAROLINA

What is different about North Carolina

Each rule here is true of North Carolina and of none of the states that border it. Beside each one: what the neighbours do instead.

  1. 01 · Prescribing

    Five days on a first opioid prescription

    Under G.S. 90-106(a3), a first prescription for acute pain may carry no more than a five-day supply of a targeted controlled substance, the Schedule II opioids and Schedule III narcotics. The cap rises to seven days for pain right after surgery, and later consultations may renew or extend the supply.

    Source: G.S. 90-106(a3)

    Across the border

    • Virginia

      Virginia's Board of Medicine caps opioids for acute or subacute pain, and for a surgical procedure, at a 14-day supply unless extenuating circumstances are documented in the record (18VAC85-21-40).

      Source: 18VAC85-21-40

    • Tennessee

      Tennessee starts lower, at a three-day opioid supply, with exceptions reaching 10 days (500 MME) or 30 days (1,200 MME) when the prescriber documents the reasons and obtains informed consent (T.C.A. 63-1-164).

      Source: T.C.A. 63-1-164

    • Georgia

      Georgia puts no days'-supply cap on a first acute-pain opioid prescription in its prescription statute, O.C.G.A. 16-13-41, or in Composite Medical Board Chapter 360-3; the statute instead forbids refilling any Schedule II prescription.

      Source: O.C.G.A. 16-13-41

    • South Carolina

      South Carolina allows up to a seven-day supply on an initial opioid prescription for acute or post-operative pain, with exceptions for cancer, hospice, sickle cell disease and addiction treatment (S.C. Code 44-53-360(j)).

      Source: S.C. Code 44-53-360(j)

  2. 02 · Advertising

    Triple damages with no proof of intent

    A person injured by an unfair or deceptive trade practice under G.S. 75-1.1 recovers treble damages as of right: G.S. 75-16 says judgment shall be rendered for three times the verdict, with no finding of willfulness required. G.S. 75-1.1(b) exempts professional services of a learned profession, and whether that reaches a brand's own marketing is a question for counsel.

    Source: G.S. 75-16

    Across the border

    • Virginia

      Virginia's Consumer Protection Act awards actual damages or $500, and lets the fact-finder raise that to three times actual damages, or $1,000, only for a willful violation (Va. Code 59.1-204).

      Source: Va. Code 59.1-204

    • Tennessee

      Tennessee's Consumer Protection Act permits up to three times actual damages only when the court finds a willful or knowing violation, and then bars punitive damages for the same practice (T.C.A. 47-18-109(a)(3)).

      Source: T.C.A. 47-18-109

    • Georgia

      Georgia's Fair Business Practices Act requires treble damages only for an intentional violation, and limits exemplary damages to intentional conduct as well (O.C.G.A. 10-1-399).

      Source: O.C.G.A. 10-1-399

    • South Carolina

      South Carolina's Unfair Trade Practices Act trebles actual damages only after the court finds a willful or knowing violation of Section 39-5-20 (S.C. Code 39-5-140(a)).

      Source: S.C. Code 39-5-140

  3. 03 · Licenses

    Three hours of drug-safety classes every cycle

    Every North Carolina physician who prescribes controlled substances must fit three hours of controlled-substance prescribing CME, covering chronic-pain prescribing and signs of misuse, into the 60 Category 1 hours due each three-year cycle (21 NCAC 32R .0101). Completing the federal MATE training satisfies it for that cycle.

    Source: 21 NCAC 32R .0101

    Across the border

    • Virginia

      Virginia's physician renewal rule, 18VAC85-20-235, counts general continuing-learning hours each biennium and names no required controlled-substance or opioid-prescribing topic.

      Source: 18VAC85-20-235

    • Tennessee

      Tennessee requires two hours every two years, and the course must teach the Department of Health's own guidelines on opioids, benzodiazepines, barbiturates and carisoprodol (T.C.A. 63-1-402).

      Source: T.C.A. 63-1-402

    • Georgia

      Georgia's three-hour controlled-substance course is a one-time requirement for DEA-registered physicians, finished by the first renewal after licensure and not repeated (Composite Medical Board Rule 360-15-.01(4)).

      Source: Ga. Comp. R. & Regs. 360-15-.01

    • South Carolina

      South Carolina asks for 40 Category I hours every two years and says two of them may cover prescribing and monitoring Schedule II–IV drugs, which leaves the topic optional (S.C. Code 40-47-40).

      Source: S.C. Code 40-47-40

  4. 04 · Practice

    Telehealth rules come from a board policy

    The Medical Practice Act, Chapter 90, Article 1 of the General Statutes, contains no telemedicine section. North Carolina's operative standard is the Medical Board's Position Statement 5.1.4, a policy document rather than a statute or rule, which holds telemedicine licensees to the in-person standard of care.

    Source: NCMB Position Statement 5.1.4, Telemedicine

    Across the border

    • Virginia

      Virginia writes telemedicine prescribing into statute: Va. Code 54.1-3303(B) lists nine conditions for forming a practitioner-patient relationship by video or store-and-forward, plus an in-state referral path for Schedule II–V drugs.

      Source: Va. Code 54.1-3303

    • Tennessee

      Tennessee's telehealth statute, T.C.A. 63-1-155, holds providers to the in-person standard, forms the relationship by mutual consent and mutual communication, and covers store-and-forward care.

      Source: T.C.A. 63-1-155

    • Georgia

      Georgia pairs a statute with a board rule: O.C.G.A. 43-34-31 requires a Georgia medical or telemedicine license, and Composite Medical Board Rule 360-3-.07 sets the exam standard and an annual in-person visit effort.

      Source: O.C.G.A. 43-34-31

    • South Carolina

      South Carolina's Telemedicine Act is statute: S.C. Code 40-47-37 lists duties for physicians practicing solely by telemedicine and bars Schedule II and III narcotics by telemedicine outside listed settings.

      Source: S.C. Code 40-47-37

PRACTICE RULES

How telehealth works in North Carolina

North Carolina regulates physician telemedicine through Medical Board position statements and a licensee-only ownership rule for medical practices. Both shape how a brand's MSO and friendly PC are organized in the state.

  1. 01

    The patient's location sets the license

    The North Carolina Medical Board deems medicine to be practiced where the patient is, so a clinician treating a patient located in North Carolina by telemedicine needs a North Carolina license unless an exception applies. Position Statement 5.1.4 judges that care against the same standard as an in-person visit.

    Source: NCMB Position Statement 5.1.4, Telemedicine

  2. 02

    Check who and where the patient is

    Position Statement 5.1.4 tells licensees to verify the identity and location of the patient before a telemedicine encounter and to give the patient the licensee's name, location and professional credentials. The chart should hold informed-consent documents covering the risks, limits, alternatives and benefits of the encounter.

    Source: NCMB Position Statement 5.1.4, Telemedicine

  3. 03

    Keep every message in the chart

    The Board expects the telemedicine record to document email, text, photos and phone contact, not only the visit note. Telemedicine licensees are held to the same standards on transferring records and communicating with the patient's primary care provider and medical home as licensees who see patients in person.

    Source: NCMB Position Statement 5.1.4, Telemedicine

  4. 04

    Only licensees may own the practice

    The Board's Corporate Practice of Medicine statement, Position Statement 10.1.2, requires medical practices to be owned entirely by holders of active North Carolina licenses or a combination allowed by G.S. 55B-14, with carve-outs for non-profit hospitals, HMOs and public health clinics. Licensees who work for a non-compliant entity face discipline.

    Source: NCMB Position Statement 10.1.2, Corporate Practice of Medicine

  5. 05

    The practice company registers with the Board

    Under G.S. 55B-4, every share of a North Carolina professional corporation must be held by licensees, and the articles need the licensing board's certification of that ownership. G.S. 55B-10 bars the corporation from opening or operating an establishment until it holds a certificate of registration from the board.

    Source: G.S. 55B-10

FIRST VISIT

Can a first visit happen without a live call in North Carolina?

Yes, with conditions

Yes, with conditions. The Medical Board accepts a telemedicine prescription once the licensee holds the threshold information for a reasonably presumptive treatment plan, but it rejects diagnosis or prescribing based solely on a static online questionnaire.

North Carolina's answer comes from two Medical Board position statements, 4.1.1 and 5.1.4, not from a statute. Read together, they turn on whether the clinician can question the patient beyond a fixed form.

  1. 01

    A fixed questionnaire alone is not enough

    Position Statement 5.1.4 states that diagnosis, prescribing or other treatment based solely on static online questionnaires is not acceptable. A licensee who uses a questionnaire must be able to ask follow-up questions or obtain further history, especially when the patient's presentation requires it.

    Source: NCMB Position Statement 5.1.4, Telemedicine

  2. 02

    Telemedicine is a listed exception

    Position Statement 4.1.1 calls prescribing to someone not examined enough for an accurate diagnosis inappropriate, then lists exceptions. One is an appropriate prescription in a telemedicine encounter where the threshold information for a reasonably presumptive treatment plan has been obtained, and the process must be documented.

    Source: NCMB Position Statement 4.1.1, Contact With Patients Before Prescribing

  3. 03

    Internet and phone questionnaires

    The same statement calls prescribing based solely on answers to a questionnaire delivered through an internet or telephone service inappropriate and unprofessional. Paired with 5.1.4, the line in North Carolina is interactivity: a form the clinician can question and extend is permitted, a form on its own is not.

    Source: NCMB Position Statement 4.1.1, Contact With Patients Before Prescribing

  4. 04

    Pain care may need an in-person visit

    Position Statement 5.1.4 warns that encounters conducted exclusively through telemedicine may not suit some circumstances, naming the treatment of pain. It also expects every licensee who prescribes by telemedicine to take part in the Controlled Substances Reporting System.

    Source: NCMB Position Statement 5.1.4, Telemedicine

PRESCRIBING

Prescriptions and controlled drugs in North Carolina

North Carolina's STOP Act duties attach to targeted controlled substances, which G.S. 90-87 defines as the Schedule II opium derivatives and opioids plus Schedule III narcotics. Stimulants, testosterone and Schedule IV drugs such as phentermine fall outside that term, though federal DEA rules still govern them.

  1. 01

    Look up the patient's history first

    G.S. 90-113.74C requires a practitioner to review the patient's prior 12 months in the CSRS, the state's prescription-monitoring database, before first prescribing a targeted controlled substance, and again every three months while it stays part of treatment. Drugs administered in a health care setting, cancer treatment and hospice or palliative care are excepted.

    Source: G.S. Chapter 90, Article 5E (CSRS Act)

  2. 02

    Sign up for the CSRS within 30 days

    Within 30 days of an initial or renewed license that carries controlled-substance authority, a North Carolina prescriber must show the licensing board that the prescriber is registered for CSRS access (G.S. 90-113.74A). Failing to register can lead to suspension or revocation of the license.

    Source: G.S. Chapter 90, Article 5E (CSRS Act)

  3. 03

    E-prescribe opioids and codeine syrups

    G.S. 90-106(a1) requires electronic prescribing of every targeted controlled substance and of Schedule V codeine preparations holding no more than 200 mg per 100 mL. Exceptions cover direct dispensing, facility orders, documented technical failures and federal pharmacies, and a pharmacist who fills a non-compliant prescription is immune from Board of Pharmacy discipline.

    Source: G.S. 90-106

  4. 04

    No state ban on controlled drugs by video

    Neither the STOP Act provisions in G.S. 90-106 and Article 5E nor the Medical Practice Act mentions telemedicine, so no North Carolina statute bars Schedule II–V prescribing after a video visit. Limits come from the Board's pain caution and federal law; DEA telemedicine flexibilities run through December 31, 2026.

    Source: G.S. 90-106

  5. 05

    What nurse practitioners may prescribe

    Under 21 NCAC 32M .0109, a nurse practitioner may prescribe Schedule II, IIN, III, IIIN, IV and V drugs as the collaborative practice agreement allows, entering the NP's own DEA number on each prescription. The primary supervising physician must hold DEA schedules at least as broad as the nurse practitioner's.

    Source: 21 NCAC 32M .0109

Federal rules apply on top of every state's. Prescribing controlled substances by telehealth without an in-person visit runs on DEA flexibilities currently extended through December 31, 2026, with a permanent rule still pending.

LICENSES

Who can treat patients in North Carolina

North Carolina opened a compact pathway for physicians on January 1, 2026, while keeping nurse practitioners under dual-board approval and scheduled physician oversight. The same workforce act loosens supervision for experienced physician assistants.

  1. 01

    The compact now issues state licenses

    Part I of the Healthcare Workforce Reforms act, House Bill 67, made North Carolina an Interstate Medical Licensure Compact (IMLC) member on January 1, 2026. A physician with a Letter of Qualification from another member state applies through the compact and pays the Medical Board a $400 fee; the Board can also serve as a state of principal license.

    Source: NCMB: Interstate Medical Licensure Compact

  2. 02

    Nurse practitioners need both boards

    A North Carolina nurse practitioner may not perform medical acts until both the Board of Nursing and the Medical Board approve the application and a collaborative practice agreement with a primary supervising physician is in place (21 NCAC 32M .0104). The Medical Board confirms the supervising physician's license as part of that approval.

    Source: 21 NCAC 32M .0104

  3. 03

    Set meetings with the supervising doctor

    21 NCAC 32M .0110 requires monthly quality-improvement meetings between the nurse practitioner and the primary supervising physician for the first six months of an agreement, then at least every six months. Signed notes naming the issues and actions are kept for five calendar years for either board to review.

    Source: 21 NCAC 32M .0110

  4. 04

    Experienced PAs gain team-based practice

    House Bill 67 also lets physician assistants with more than 4,000 practice hours, 1,000 of them in their specialty, work in team-based settings without filing an intent to practice with the Medical Board, starting when the Board adopts rules or June 30, 2026, whichever is first. Its PA Licensure Compact part stays deferred until that compact operates.

    Source: NCMB: Healthcare Workforce Reforms

ADVERTISING

Marketing to patients in North Carolina

North Carolina polices health marketing through the Medical Board's advertising statement, a referral-fee statute and state telemarketing limits. Consumer suits under G.S. 75-1.1 add automatic treble damages on top.

  1. 01

    No false reviews or borrowed photos

    Position Statement 8.3.1, amended July 2026, treats deceptive, false or misleading advertising as unprofessional conduct, expects every claim to be substantiated and bars false patient testimonials. Before-and-after photos must show the licensee's own patients and realistic outcomes, and business cards and letterhead count as advertising.

    Source: NCMB Position Statement 8.3.1, Advertising and Publicity

  2. 02

    Board certified means a named board

    Under the same statement, a licensee may advertise as board certified only through ABMS, AOA-BOS, the Royal College of Physicians and Surgeons of Canada or an alternative board meeting seven listed criteria, and the ad must name the specialty board that granted it.

    Source: NCMB Position Statement 8.3.1, Advertising and Publicity

  3. 03

    No paying for patient referrals

    G.S. 90-401 bars a health care provider from compensating any person, firm or corporation for recommending or securing the provider's employment by a patient, and bars taking payment from another provider for a referral. A brand that pays marketers per booked patient should have counsel review that model against it.

    Source: G.S. 90-401

  4. 04

    Do-not-call hours and robocalls

    G.S. 75-102 forbids telephone solicitations to numbers on the Do Not Call Registry and any solicitation before 8:00 a.m. or after 9:00 p.m. G.S. 75-104 bans unsolicited calls made with an automatic dialing and recorded message player unless a live operator first describes the message and gets approval.

    Source: G.S. 75-104

TESSIC HEALTH IN NORTH CAROLINA

How Tessic Health's providers cover North Carolina

Tessic Health's providers treat North Carolina patients under the brand's name, inside its MSO and friendly-PC structure. The practices below follow from the statutes and board statements cited above.

  1. 01

    Licensed where the patient is

    Every clinician who treats a patient located in North Carolina holds a North Carolina license, issued directly or through the IMLC. The friendly PC that employs them is owned entirely by North Carolina licensees and holds a Medical Board certificate of registration under G.S. 55B-10.

  2. 02

    A two-way history before a first prescription

    An intake questionnaire opens the chart, then a Tessic Health clinician reviews it, asks follow-up questions through the portal or by video, and records the patient's identity, location and telemedicine consent before any first North Carolina prescription.

  3. 03

    CSRS reviewed before opioid prescriptions

    Before a first targeted controlled substance, and every three months while it continues, the prescriber reviews the patient's 12-month CSRS history. Those prescriptions, like testosterone and every other controlled drug, go to the pharmacy through EPCS.

  4. 04

    Pharmacies registered to ship in

    Pharmacy fulfillment at 0% markup runs through pharmacies holding the annual out-of-state registration that G.S. 90-85.21A requires before dispensed drugs ship into North Carolina, with cold-chain shipping for refrigerated drugs such as GLP-1 injections.

  5. 05

    The brand owns the chart

    The brand owns its North Carolina patients, records and data. Tessic Health's providers keep the full record the Medical Board expects, including portal messages, photos and phone contact, and send records to a patient's primary care provider when the patient asks.

COMMON QUESTIONS

Questions about telehealth in North Carolina

  • Only when a clinician can follow up. North Carolina's Medical Board rejects prescribing based solely on a static online questionnaire, but allows a telemedicine prescription once the clinician has enough information for a reasonably presumptive treatment plan (Position Statements 5.1.4 and 4.1.1).

  • Yes, since January 1, 2026. A physician with a Letter of Qualification from another member state can obtain a full North Carolina license through the IMLC for a $400 Medical Board fee, and the traditional application remains open.

  • No. G.S. 90-106(a3) caps only targeted controlled substances, the Schedule II opioids and Schedule III narcotics, on a first acute-pain prescription. Testosterone is a Schedule III anabolic steroid under G.S. 90-91(k), outside that definition, and GLP-1 drugs are not controlled substances.

  • Yes. Both the Board of Nursing and the Medical Board must approve a North Carolina nurse practitioner's collaborative practice agreement with a primary supervising physician, and 21 NCAC 32M .0110 adds monthly quality-improvement meetings for six months, then meetings every six months.

  • Only holders of active North Carolina licenses, in the Medical Board's view, apart from combinations G.S. 55B-14 permits and exempt bodies such as non-profit hospitals. A brand's clinical entity is therefore a licensee-owned professional corporation registered with the Board, with the MSO running non-clinical work.

  • Two separate consequences can follow in North Carolina. The Medical Board can treat the ad as unprofessional conduct under Position Statement 8.3.1, and a consumer who proves an unfair or deceptive practice under G.S. 75-1.1 receives treble damages automatically under G.S. 75-16, subject to the learned-profession exemption.

SOURCES

Rules checked September 2026 · 31 sources cited. A planning summary, not legal advice. Statutes, board rules and enforcement priorities change; a brand's own counsel should review its model and marketing before launch.

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Rules in other states

Each state page is researched from that state's own statutes and board rules.

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