Texas telehealth MSO-PC: licensing, first visits, and physician ownership

Direct answer

For the full Texas statute list, read Texas CPOM. For the multi-state picture, start at the telehealth MSO-PC hub and the CPOM 50-state guide. Adding states? See the Florida and New York telehealth guides. General information only, not legal advice. Foundry is not a law firm.

The license question

Texas follows the patient. A physician sitting in Colorado who treats a patient in Houston is practicing medicine in Texas under § 151.056, apart from narrow exceptions such as some episodic consultations with a Texas physician. Under 22 TAC § 175.1, telemedicine takes a full Texas license. The board stopped issuing the older out-of-state telemedicine license and has been converting those licenses into full ones, so plan on full licenses for every physician who sees Texas patients. Check the Texas Medical Board for the current status of any license you rely on.

How a first visit becomes a valid relationship

Occupations Code § 111.005 lists the ways a telemedicine practitioner can establish a valid relationship with a Texas patient:

• A preexisting relationship with the patient.
• Call coverage for a physician who has an established relationship with the patient.
• A telemedicine visit that meets the standard of care using synchronous audio and video.
• A visit using asynchronous store-and-forward technology together with clinically relevant photos, records, or other patient data, as long as the standard of care is met.

The same section requires follow-up guidance for the patient and, if the patient has a primary care physician and consents, the visit record goes to that physician within 72 hours. Build both into the visit flow, and keep the record of each in the PC's charts. The statute also says no valid relationship exists for prescribing a drug or device intended to cause an abortion.

Who owns the Texas practice

The physician who owns the PC and the physicians who supervise NPs and PAs can be the same person, but they are separate jobs with separate paperwork. A national platform that hires many NPs for Texas usually needs several supervising physicians long before it needs a second owner.

Fees and the money flow

Texas chapter 102 bans paying or receiving remuneration for patient referrals, and a percentage-of-revenue MSO fee is the pattern buyers and regulators ask about first. Payers pay the PC. The PC pays the MSO a fixed or cost-plus fee for defined non-clinical services, priced at fair market value. Marketing fees tied to each booked patient deserve a hard look. The CPOM compliance operating test and its MSA red-flag audit show what a diligence team checks.

Controlled substances

Prescribing controlled substances online adds federal rules on top of Texas law. The DEA's telemedicine flexibilities under 21 CFR 1307.41 run through December 31, 2026. Each prescriber also needs a DEA registration and Texas prescribing authority. Check how the current federal rule treats registration in the patient's state before you launch any controlled-substance service, and see the behavioral health MSO-PC hub if you prescribe for ADHD, opioid use disorder, or ketamine care.

Setup steps for a Texas telehealth company

1. Map the visit types and mark which ones need a prescription, which need synchronous video, and which can run asynchronously with records.
2. Match a Texas-licensed physician to own the PC ($3,000/mo).
3. Form the professional association or PLLC and the MSO, and sign an FMV management services agreement. See MSO-PC formation ($15,000).
4. License every treating physician in Texas and line up supervising physicians for NPs and PAs.
5. Build the valid-relationship steps, follow-up guidance, and the 72-hour primary care record into the visit flow.
6. Enroll the PC with payers under its own tax ID and route all clinical payments to the PC's bank account.

Pricing

Texas telehealth MSO-PC FAQ

Do I need a Texas license to treat Texas patients by telehealth?

Yes, in most cases. Texas Occupations Code § 151.056 treats an act on a patient located in Texas as practicing medicine in Texas, with narrow exceptions such as some episodic consultations. The Texas Medical Board requires a full Texas license for telemedicine, and it has been converting the older out-of-state telemedicine licenses into full licenses.

How do I start a valid patient relationship by telemedicine in Texas?

Occupations Code § 111.005 accepts a preexisting relationship, call coverage for a physician who has one, or a telemedicine visit that meets the standard of care using synchronous audio-video, or asynchronous store-and-forward with clinically relevant photos, records, or other patient data. The practitioner must also give follow-up guidance and, with consent, send the visit record to the patient's primary care physician within 72 hours.

Can a lay founder own a Texas telehealth practice?

Not the clinical entity. Texas is a Strict corporate practice of medicine state. A Texas-licensed physician owns the professional association or PLLC that employs or contracts the clinicians and bills for care. The founder owns the MSO that runs the platform, paid a fair-market-value fee under a management services agreement.

Do NPs and PAs need a Texas physician for telehealth?

Texas NPs and PAs prescribe under a prescriptive authority agreement with a physician under Occupations Code chapter 157, and a physician may hold only a limited number of those agreements. A telehealth company that grows its NP or PA team has to plan supervising physicians early. That role is separate from the physician who owns the PC.

How much does Foundry charge for a Texas telehealth MSO-PC?

MSO-PC formation is $15,000 one-time. A Texas-licensed friendly PC owner is $3,000/mo. Formation typically takes 1 to 3 days after the states, the clinical model, and the physician match are scoped.

Related reading

Written and last reviewed 2026-10-23 by Matthew Milford, Founder. Sources: Tex. Occ. Code §§ 111.005 and 151.056 and chapters 102 and 157; 22 TAC § 175.1 (Texas Medical Board telemedicine licensure); Tex. Bus. Orgs. Code chapter 301; 21 CFR 1307.41. Foundry PC is not a law firm. General information only, not legal advice.