Telehealth General Psychiatry Prescribing: What Psychiatrists Can Do in Michigan

If you’re a psychiatrist, PMHNP, or psychiatric prescriber wondering whether you can prescribe medications—including controlled substances like Adderall or Xanax—via telehealth, the short answer is: yes, with some important caveats. As of early 2026, telepsychiatry has become standard practice, and most states plus the federal government allow remote prescribing for mental health conditions. But the rules around controlled substances, state licensing, NP scope of practice, and collaboration requirements can get messy fast.

This guide cuts through the confusion. We’ll cover what psychiatrists and PMHNPs can legally prescribe through telehealth, how federal DEA rules interact with state laws, the differences between MD and NP prescribing authority, and what you need to know about reimbursement and compliance. Whether you’re considering joining a telehealth platform like Klarity Health or expanding your existing practice online, understanding these regulations is critical.

Federal Rules: The DEA Waiver That Changed Everything

Let’s start with the big one: prescribing controlled substances via telehealth. Historically, the Ryan Haight Act required an in-person medical evaluation before any provider could prescribe Schedule II-V controlled substances. That was a dealbreaker for telepsychiatry treating ADHD, anxiety disorders, or opioid use disorder remotely.

Then COVID hit. In March 2020, the DEA waived the in-person requirement under public health emergency powers. That waiver has been extended multiple times and remains in effect through December 31, 2025 (texasnp.org). This means that as of February 2026, psychiatrists nationwide can initiate controlled substance prescriptions—stimulants for ADHD, benzodiazepines for anxiety, buprenorphine for opioid use disorder—via a telehealth video visit, without ever seeing the patient in person.

What happens after 2025? The DEA has proposed new permanent rules. The likely scenario involves either extending current flexibility or implementing a special telemedicine registration with some guardrails (like 30-day supply limits for new patients, or requiring a referral from an in-person provider for ongoing prescriptions). As of now, those rules aren’t finalized. Providers should monitor DEA announcements closely, but the direction is clear: telepsychiatry prescribing is here to stay in some form (natlawreview.com).

Bottom line for psychiatrists: You can start a new ADHD patient on Adderall via video visit today. You can prescribe a benzodiazepine for acute anxiety after a thorough telehealth assessment. You can initiate Suboxone for a patient you’ve never met in person. Just ensure you’re conducting a legitimate clinical evaluation (real-time audio-visual is typically required) and documenting appropriately.

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State-Specific Telehealth Prescribing Rules

While federal law sets the floor, states add their own requirements—and some carve out exceptions that actually make telepsychiatry easier in certain places. Here’s what you need to know about key states:

Florida: A Telepsychiatry-Friendly Exception

Florida explicitly permits controlled substance prescribing via telehealth for the treatment of psychiatric disorders (www.flsenate.gov). This is unusual—Florida otherwise restricts teleprescribing for chronic pain management (requiring in-person exams). But for mental health? You’re good to go.

Practically, this means a Florida-licensed psychiatrist can manage ADHD medications, start someone on an SSRI and a PRN benzodiazepine, or adjust antipsychotics entirely via video. Florida’s law recognizes that mental health treatment is different from pain management and explicitly allows it.

For PMHNPs in Florida: You’re still restricted by scope of practice (more on that below), but Florida does define a ‘psychiatric nurse’ category—a PMHNP with ≥2 years of experience working under a psychiatrist—who can prescribe psychotropic controlled substances in collaboration with a psychiatrist, with no 7-day limit (www.flsenate.gov). If you meet that definition, you have significant prescribing latitude.

Texas: Psychiatric Exception, But NP Restrictions Remain

Texas allows telemedicine prescribing if the standard of care is met and the patient evaluation is sufficient (real-time audio-visual) (www.cchpca.org). For controlled substances, Texas prohibits teleprescribing opioids for chronic pain, but allows it for mental health treatment like ADHD or acute anxiety.

The catch: Texas has some of the strictest NP supervision laws in the country. PMHNPs must have a Prescriptive Authority Agreement with a physician to prescribe anything, including controlled substances (www.bon.texas.gov). Texas also historically limited NPs from prescribing Schedule II substances in outpatient settings, though recent narrow exceptions exist for pediatric ADHD treatment. The practical reality: most Texas PMHNPs work under psychiatrist supervision, and the psychiatrist often handles Schedule II prescriptions.

For Texas psychiatrists, you’re free to prescribe stimulants and other controlled meds via telehealth. You must check the Texas Prescription Monitoring Program (PMP) before prescribing any controlled substance—this is mandatory, telehealth or not.

New York: Aligned with Federal Flexibility

New York recently finalized regulations that align state law with federal DEA allowances for controlled substance prescribing via telehealth (www.nixonpeabody.com). This removed a prior state-level obstacle. New York psychiatrists can now prescribe controlled substances via telehealth as long as it’s consistent with federal law (i.e., under the DEA waiver).

New York also has a PMP check requirement—providers must query the state’s I-STOP database before prescribing any Schedule II-IV drug. E-prescribing is mandatory for controlled substances in NY (no paper scripts).

For PMHNPs in New York: After completing 3,600 hours of supervised practice (roughly 2 years), you can practice independently without a written collaborative agreement (www.jdsupra.com). That means experienced NY PMHNPs have the same prescribing authority as psychiatrists—they can prescribe controlled substances, see patients via telehealth, and bill independently. This has made New York one of the most attractive states for psychiatric NPs.

California: Transitioning to NP Independence

California allows telehealth prescribing after a ‘good faith exam,’ which can be conducted via video (natlawreview.com). California psychiatrists can prescribe controlled substances via telehealth under the federal waiver, and must check CURES (California’s PMP) before prescribing Schedule II-IV drugs.

For PMHNPs: California is implementing a phased transition to independence via AB 890. As of 2023, experienced NPs (≥3 years) can practice in group settings without direct physician supervision (‘103 NP’ certification). Starting January 1, 2026, those NPs can apply for full independent practice authority (‘104 NP’), allowing solo practice and prescribing without a supervising physician (www.rn.ca.gov).

This is a game-changer. By 2026, California—the most populous state with massive mental health provider shortages—will effectively become a full practice authority state for experienced NPs.

Pennsylvania and Illinois: Collaboration Required, But Paths to Independence

Pennsylvania still requires NPs to maintain a collaborative agreement with a physician indefinitely—there’s no pathway to independence yet (www.pacnp.org). PMHNPs can prescribe controlled substances if delegated by their collaborating physician, but Schedule II prescriptions are limited to 30-day supplies and require physician notification within 24 hours.

Illinois offers a transition: NPs must practice under physician collaboration for 4,000 hours plus complete 250 hours of continuing education in pharmacology, after which they can apply for Full Practice Authority (www.nursepractitionerlicense.com). Once granted FPA, Illinois PMHNPs can prescribe independently, including controlled substances.

Both states allow telehealth prescribing under the federal DEA waiver. Illinois has strong telehealth reimbursement parity laws, making it economically attractive for telepsychiatry.

Psychiatrist vs PMHNP Prescribing Authority: The Real Differences

Let’s be direct: psychiatrists have universal independent prescribing authority. In all 50 states, an MD or DO with a DEA registration can prescribe any psychiatric medication, including all controlled substances, without physician oversight or collaborative agreements.

PMHNPs operate under a patchwork of state-specific rules:

• ~34 states now grant Full Practice Authority (FPA) to NPs, meaning experienced PMHNPs can practice independently, diagnose, and prescribe (including controlled substances) without physician supervision (www.nursepractitioneronline.com). States like New York, Illinois (after transition), Colorado, Arizona, Oregon, and Washington fall into this category.

• Reduced practice states require collaboration for prescribing but allow some independence for evaluation and diagnosis. Pennsylvania is the clearest example—PMHNPs must have a collaborative agreement with a physician for their entire career.

• Restricted practice states like Texas and Florida (for psych NPs) require ongoing physician supervision or delegation for all aspects of practice. In Texas, an NP cannot prescribe anything without a physician’s prescriptive authority agreement. In Florida, psychiatric NPs are excluded from the state’s autonomous practice pathway.

What this means for telehealth platforms: If you’re a psychiatrist, you can practice independently in any state where you hold a license. If you’re a PMHNP, you need to verify:

1. Does this state allow independent NP practice, or do I need a collaborating physician?
2. If collaboration is required, does the platform provide one, or do I need to arrange it myself?
3. Can I prescribe controlled substances in this state as an NP?

Platforms like Klarity Health handle credentialing and often provide collaborative physician relationships where required, removing a major administrative burden for NPs in restricted states.

Reimbursement: Will You Get Paid the Same for Telehealth?

The good news: telehealth reimbursement for psychiatry is strong and generally at parity with in-person visits in 2026.

Medicare pays psychiatrists the same rate for telehealth visits as in-person. For 2026, typical rates are:

• $173 for an initial psychiatric evaluation with medication management (CPT 90792) (therathink.com)
• ~$95 for a 15-minute medication follow-up (CPT 99213)
• ~$136 for a 25-minute follow-up (CPT 99214) (therathink.com)

PMHNPs are reimbursed at 85% of physician rates when billing under their own NPI (www.nursepractitioneronline.com). So a PMHNP would receive roughly $81 for a 99213 and $116 for a 99214 from Medicare.

Private insurance varies by region and payer, but many states have telehealth parity laws requiring equal reimbursement. States like California, Illinois, and New York mandate that private insurers cover and pay for telehealth at the same rate as in-person for behavioral health services (natlawreview.com). In practice, most major insurers now pay equally for tele-mental health visits because demand is high and legislative pressure is real.

Medicaid rates are typically lower than Medicare, but many state Medicaid programs have expanded telehealth coverage permanently and increased behavioral health rates. For example, New York Medicaid pays the same for telepsychiatry as in-person. Pennsylvania Medicaid covers telehealth at parity. Texas Medicaid covers telehealth but doesn’t mandate payment parity by law—though in practice, many plans pay equally for mental health services.

Audio-only telehealth is now reimbursable by Medicare for mental health services, addressing the digital divide for patients without reliable video access. Some private payers and state Medicaid programs have followed suit.

What this means for your practice: If you’re doing 15-minute med checks via video, you can bill 99213 and get paid the same as if the patient sat in your office. If you’re doing therapy + medication management in a 30-minute session, you can bill 99214 + 90833 (psychotherapy add-on) and get paid for both. The economics of telepsychiatry are favorable—lower overhead, no office rent, reduced no-shows (telehealth typically sees 10-20% lower no-show rates), and the ability to see patients across multiple states if you hold licenses.

The Economics of Patient Acquisition: Platform vs DIY Marketing

Here’s where many providers get stuck: acquiring qualified psychiatric patients is expensive and time-consuming.

Let’s be honest about DIY marketing costs:

SEO takes 6-12 months of consistent investment (content creation, technical optimization, backlinks) before you see meaningful patient flow. Most solo providers don’t have SEO expertise or the patience for this timeline.

Google Ads for mental health keywords are expensive—$15-40+ per click for terms like ‘psychiatrist near me’ or ‘ADHD treatment.’ Most clicks don’t convert to booked patients. When you factor in ad spend, agency fees if you hire help, staff time to field and qualify leads, and no-show rates from cold leads, your true cost per booked patient through PPC is typically $200-400+.

Directory listings like Psychology Today or Zocdoc charge monthly subscription fees ($30-100/month) plus per-booking fees ($35-100 per patient). You’re also competing with hundreds of other providers on the same directory page. Total monthly cost can easily hit $300-500+ for modest patient volume.

The hidden costs: Testing and optimizing ad campaigns (many fail before you find what works), consultant or agency fees ($1,000-3,000/month for professional marketing), staff time to answer inquiries and schedule (many leads ghost or aren’t qualified), and the opportunity cost of your time managing all this instead of seeing patients.

When you add it all up, providers who successfully DIY their marketing typically spend $3,000-5,000+ per month with uncertain, variable results—especially in the first 6-12 months.

The Klarity Health model offers a different approach: pay-per-appointment. You pay a standard listing fee per new patient lead, with no upfront marketing spend or monthly subscriptions. Key advantages:

• Pre-qualified patients already matched to your specialty and availability (no wasted time on unqualified leads)
• Guaranteed ROI: you only pay when a qualified patient books with you
• No ad spend risk: Klarity handles all patient acquisition marketing—you’re not gambling $4,000/month on Google Ads that might not work
• Built-in telehealth infrastructure: no separate platform subscription costs
• Both insurance and cash-pay patient flow, giving you payer mix flexibility
• You control your schedule: set your availability, and only pay for the patients you actually see

Think of it this way: instead of spending $4,000/month on marketing with zero guarantee of results (and potentially seeing 5-10 new patients, making your true CAC $400-800), you pay only when a patient books. If you see 20 new patients in a month, you pay 20 listing fees. If you see zero, you pay zero. That’s not just lower risk—it’s zero risk.

For providers just starting out, scaling up, or practicing in multiple states, this model removes the biggest barrier to growth: patient acquisition. You can focus on clinical care while the platform handles the expensive, expertise-intensive work of marketing and lead generation.

Practical Compliance Checklist for Telepsychiatry Prescribing

If you’re prescribing via telehealth in 2026, here’s what you need to have in place:

1. Licensing

• You must be licensed in the state where the patient is located at the time of the visit
• Consider joining the Interstate Medical Licensure Compact (IMLC) if you practice in multiple states—it expedites licensing in 40+ member states (includes Texas, Pennsylvania, Illinois; excludes New York, California, Florida)

2. DEA Registration

• Active DEA registration required for prescribing any controlled substances
• Must be registered in each state where you prescribe controlled substances (if practicing multi-state, you need DEA registrations for each state)

3. Prescription Drug Monitoring Program (PDMP) Enrollment

• Enroll in and check the PDMP database in any state where you prescribe controlled substances
• Texas: mandatory PMP check before every controlled substance prescription
• New York: I-STOP database query required before prescribing Schedule II-IV
• California: CURES check required, at least every 4 months for ongoing controlled substance therapy
• Most states have similar requirements

4. E-Prescribing Capability

• Many states (including New York) require electronic prescribing for controlled substances (EPCS)
• Your telehealth platform or EHR must support EPCS with two-factor authentication

5. Documentation Standards

• Document that the visit was conducted via telehealth (include modality: video, audio-only if allowed)
• Verify patient identity and location (document the state they’re in)
• Obtain informed consent for telehealth (required in states like Texas and California)
• Meet the same standard of care as in-person: thorough history, mental status exam, clinical decision-making
• Document rationale for controlled substance prescriptions (especially for DEA audit protection)
• Have an emergency protocol documented (what happens if a patient in crisis disconnects)

6. For PMHNPs: Collaborative Agreements Where Required

• If practicing in a restricted or reduced practice state, ensure your collaborative agreement is current and filed with the state board where required
• Verify your collaborating physician is licensed in the same state and specialty-appropriate (many states require psychiatrist collaboration for psych NPs)
• Document periodic chart reviews and meetings as required by state law

7. Billing Compliance

• Use appropriate telehealth modifiers or place-of-service codes (POS-02 for telehealth)
• Medicare often requires modifier -95 or GT for telehealth services
• Bill the correct E/M code based on time or medical decision-making
• If billing psychotherapy add-on codes (90833, 90836, 90838), document the therapy time separately from med management time

Why Telepsychiatry Is Here to Stay (And Why Now Is the Time to Scale)

The mental health provider shortage is real and worsening. Here’s the landscape:

• Texas and Florida have psychiatrist-to-population ratios around 1:8,500-9,000—among the worst in the nation (www.healingpsychiatryflorida.com)
• California has over 11 million residents in mental health professional shortage areas (www.healingpsychiatryflorida.com)
• New York has ~197 mental health HPSAs needing 230+ additional psychiatrists (www.healingpsychiatryflorida.com)
• Even states with better ratios like Illinois and Pennsylvania report large underserved populations, especially in rural areas

Demand far outstrips supply. Patients wait weeks or months for psychiatric appointments. Telepsychiatry solves this access problem, and payers know it—that’s why reimbursement parity is here to stay.

States are responding by expanding NP scope of practice (34+ states now have or are transitioning to FPA for NPs), joining interstate compacts, and permanently adopting telehealth coverage laws. The legislative momentum is toward more provider autonomy and more telehealth access, not less.

For prescribers, this is an opportunity: high demand, favorable reimbursement, regulatory support, and technology infrastructure that works. The question isn’t whether telepsychiatry will be a major delivery channel—it already is. The question is how you position yourself to capture that opportunity efficiently.

Next Steps: Getting Started in Telepsychiatry Prescribing

If you’re ready to expand into telehealth or you’re already practicing online and want to scale:

1. Verify your state compliance

• Check if you need additional licenses for states where you want to see patients
• Confirm your DEA registrations cover all states you’ll prescribe in
• For PMHNPs: determine if you need a collaborative agreement in each state

2. Choose your patient acquisition strategy

• DIY marketing: budget $3,000-5,000/month and 6-12 months for results
• Join a platform like Klarity Health: pay-per-appointment model with pre-qualified patients, zero upfront marketing risk

3. Set up compliant infrastructure

• HIPAA-compliant video platform
• EPCS-enabled e-prescribing system
• PDMP enrollment in relevant states
• EHR with telehealth documentation capabilities

4. Optimize your billing

• Credential with payers in high-reimbursement states (or consider cash-pay for simplicity and higher per-visit revenue)
• Ensure your billing system uses correct telehealth modifiers
• Track your reimbursement rates—if you’re getting paid less for telehealth than in-person, push back or consider going out-of-network

Telepsychiatry prescribing in 2026 offers psychiatrists and PMHNPs the ability to reach more patients, practice flexibly, and build sustainable, profitable practices. The regulatory environment is more favorable than ever, reimbursement is strong, and the demand is overwhelming.

If you’re looking to grow your practice without gambling thousands on marketing that might not work, explore joining Klarity Health’s provider network. You’ll get access to a steady stream of pre-qualified patients seeking psychiatric medication management, with no upfront costs and full control over your schedule. Instead of spending your time figuring out Google Ads and SEO, you can spend it doing what you do best: helping patients.

[Learn more about joining Klarity Health’s telepsychiatry network →]

Frequently Asked Questions

Can psychiatrists prescribe controlled substances like Adderall or Xanax via telehealth?
Yes. As of February 2026, the federal DEA waiver allows psychiatrists to prescribe Schedule II-V controlled substances via telehealth without an initial in-person visit, through at least December 31, 2025. This waiver is expected to be extended or replaced with permanent rules supporting telepsychiatry prescribing.

Do I need to be licensed in the state where my patient is located?
Yes. You must hold an active medical license in the state where the patient is physically located at the time of the telehealth visit. Multi-state licensure compacts (like the Interstate Medical Licensure Compact for MDs) can expedite getting licenses in multiple states.

Can PMHNPs prescribe the same medications as psychiatrists?
It depends on the state. In ~34 states with Full Practice Authority, experienced PMHNPs can prescribe independently, including controlled substances, just like psychiatrists. In states like Texas and Florida, PMHNPs must practice under physician supervision and may have restrictions on controlled substance prescribing.

Will insurance pay the same for telehealth visits as in-person?
In most cases, yes. Medicare pays telehealth at parity with in-person for psychiatry, and many states have private payer parity laws. Check your specific state’s telehealth reimbursement laws—states like California, New York, and Illinois mandate equal payment for tele-mental health services.

Do I need to check the prescription drug monitoring program (PDMP) before prescribing?
Yes, in nearly all states. Most states require PDMP checks before prescribing any controlled substance (or at regular intervals for ongoing therapy). Texas, New York, California, Florida, Pennsylvania, and Illinois all have PDMP check requirements.

Can I prescribe to a new patient I’ve never seen in person?
Yes, under current federal rules (DEA waiver through at least December 2025). You must conduct a thorough telehealth evaluation (typically audio-visual) that meets the standard of care. Some states may have additional requirements, but most allow initiating controlled substance prescriptions via telehealth for mental health treatment.

What happens if the DEA rules change in 2026?
The DEA has proposed permanent telemedicine rules that will likely include some form of continued flexibility for mental health prescribing, potentially with conditions like 30-day supply limits or requiring referral from an in-person provider. Providers should stay updated, but the trend is toward maintaining telehealth access for psychiatry.

How much can I earn per telehealth visit?
Medicare pays roughly $95-136 per follow-up medication management visit (CPT 99213-99214) and $173 for initial evaluations. Private insurance often pays higher. Cash-pay rates for psychiatric telehealth visits typically range from $100-250 per visit depending on region and provider credentials. PMHNPs receive 85% of Medicare physician rates when billing under their own NPI.

What if I practice in a state that requires NP supervision but I can’t find a collaborating physician?
This is a common pain point for PMHNPs in restricted states. Some telehealth platforms (like Klarity Health) provide collaborative physician relationships as part of their provider network, solving this problem. Otherwise, you may need to contract with a supervising psychiatrist independently (which often comes with a monthly fee).

Is it worth joining a telehealth platform vs building my own practice?
If you’re starting out or scaling up, platforms offer pre-qualified patient flow with zero marketing risk—you only pay when patients book. Building your own practice through DIY marketing typically costs $3,000-5,000/month with 6-12 months before meaningful results. Platforms remove that risk and administrative burden, though you pay per patient. For established providers with strong local referral networks, independent practice may make sense. For most, especially in telehealth-only models, platform economics are hard to beat.

Sources and References

1. Texas Nurse Practitioners Association – ‘DEA Telemedicine Flexibility Extension’ (texasnp.org) – October 6, 2023 – Cites federal DEA extension of teleprescribing waiver through December 2025 (texasnp.org)

2. National Law Review – ‘Telehealth and In-Person Visits: Tracking Federal and State Updates’ (natlawreview.com) – August 15, 2025 – Comprehensive analysis of federal DEA proposals and state-level telehealth laws including controlled substance prescribing rules (natlawreview.com)

3. Florida Senate Statutes Chapter 464.012 – ‘Advanced Practice Registered Nurse Prescribing Authority’ (flsenate.gov) – 2024 statute compilation – Primary legal source for Florida’s rules allowing controlled substance prescribing via telehealth for psychiatric treatment (www.flsenate.gov)

4. California Board of Registered Nursing – ‘AB 890 Implementation FAQs’ (rn.ca.gov) – Updated November 2023 – Official state guidance on California’s phased transition to nurse practitioner independence (103 NP and 104 NP certifications) (www.rn.ca.gov)

5. TheraThink – ‘Insurance Reimbursement Rates for Psychiatrists [2026]’ (therathink.com) – 2026 rate data – Medicare reimbursement rates for psychiatric CPT codes including telehealth parity information (therathink.com)

Source:

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