Virginia telehealth MSO-PC: licensing, coverage, and who owns the practice
Virginia requires a Board of Medicine license to practice into the Commonwealth, sets telemedicine coverage in the insurance code, and still limits professional-corporation shareholders. See where the PC fits.
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A Virginia telehealth company needs clinicians licensed by the Virginia Board of Medicine when they treat patients located in Virginia. Va. Code § 54.1-2902 makes unlicensed practice unlawful. Va. Code § 54.1-3303 sets the bona fide practitioner-patient relationship for prescribing, including telemedicine conditions. Va. Code § 38.2-3418.16 requires covered plans to cover telemedicine services on the same basis as face-to-face care. A professional corporation's shareholders must be licensed to render the same professional service under Title 13.1 Chapter 7. A founder-owned MSO is paid a fixed fair-market-value fee. Foundry forms that MSO-PC for $15,000 one-time and matches a Virginia-licensed friendly PC owner for $3,000/mo.
Virginia is Limited on the CPOM 50-state guide. Licensure, professional-corporation rules, and the diligence default are on Virginia CPOM. The telehealth MSO-PC hub covers the multi-state build. After papers, run CPOM compliance. General information only, not legal advice. Foundry is not a law firm.
Licensing: who may treat Virginia patients online
| Path | Who it fits | Limits |
|---|---|---|
| Virginia Board of Medicine license | A physician treating a patient located in Virginia | Va. Code § 54.1-2902. Issued through the Virginia Board of Medicine |
| Interstate Medical Licensure Compact | A physician who qualifies in a compact state | The result is still a Virginia license. Compact membership does not waive § 54.1-2902 |
| Out-of-state physician with no Virginia license | Not the ordinary path for a new patient relationship | Board guidance treats establishing a new practitioner-patient relationship by telemedicine as requiring a Virginia license. Consultation and follow-up exceptions are narrow |
Va. Code § 38.2-3418.16 defines telemedicine services for insurance coverage as electronic technology or media, including interactive audio or video, used to diagnose or treat a patient, provide remote patient monitoring, or consult about a patient's diagnosis or treatment. That definition excludes an audio-only telephone, email, fax, or online questionnaire for the mandated telemedicine benefit, while still allowing other coverage rules for some audio-only care. There is no separate Virginia telemedicine license that replaces a full Board of Medicine license.
Prescribing and coverage
| Rule | What it says | What it means for the PC |
|---|---|---|
| Va. Code § 54.1-3303 | Bona fide practitioner-patient relationship before a prescription. Exam may use electronic images and records. Telemedicine prescribing of Schedule II through V needs a Virginia practice location or a referral path for in-person exam when the standard of care requires it | Prescribing authority stays with the Virginia-licensed clinician on the PC |
| Va. Code § 38.2-3418.16 | Covered plans must cover telemedicine services and reimburse diagnosis, consultation, or treatment on the same basis as face-to-face care. Controlled-substance prescribing via telemedicine must also meet § 54.1-3303 and federal law | Covered services can move online. Negotiate the rate in the PC contract |
| Va. Code § 54.1-2902 | Unlawful to practice medicine without a Board of Medicine license | Every treating physician for Virginia patients needs a Virginia license path |
Federal controlled-substance telemedicine rules are separate. The DEA telemedicine flexibilities under 21 CFR 1307.41 run through December 31, 2026, and each prescriber needs the registration that applies to the patient's location. Confirm the Virginia Prescription Monitoring Program check for the drug you prescribe.
Who owns the Virginia practice
| Role | Where it sits | Virginia note |
|---|---|---|
| Physician owner | Owns the Virginia professional corporation | Virginia-licensed MD or DO. Title 13.1 Chapter 7: shareholders licensed to render the same professional service |
| Treating clinicians | Employed or contracted by the PC | Virginia license. Not the MSO payroll as the practice of medicine |
| Founder and investors | Own the MSO | Brand, software, marketing, billing support. Limited CPOM label is not a structural waiver |
| MSO fee | Written management services agreement | Fixed or cost-plus at fair market value. Run the MSA red-flag audit on CPOM compliance |
Clinical revenue and the claim TIN belong to the PC. The MSO invoices for defined non-clinical work. If any patient is in Utah, Utah requires a domestic professional entity. See Utah CPOM. See how the MSO and the PC fit together before you sign.
Setup steps for a Virginia telehealth company
- List each visit type, the payers you plan to bill, and any controlled substances.
- License each physician in Virginia directly or through the compact, and confirm NP and PA licenses for Virginia patients.
- Match a Virginia-licensed physician to own the PC through friendly PC owner matching ($3,000/mo).
- Form the Virginia professional corporation and the MSO, and sign a fair-market-value MSA. See MSO-PC formation ($15,000). Typical formation is 1 to 3 days after the states, the clinical model, and the physician match are scoped.
- Build the § 54.1-3303 relationship steps into the PC's intake. Keep prescribing authority on the licensed Virginia prescriber.
- Put the claim TIN and group NPI on the PC, and route clinical payments to the PC's bank account.
Pricing
MSO-PC formation
$15,000One-time. The MSO and the Virginia physician-owned PC, scoped to your visit model.
Friendly PC owner
$3,000/moA Virginia-licensed physician who owns your PC.
Virginia telehealth MSO-PC FAQ
Do I need a Virginia license to treat Virginia patients by telehealth?
Yes. Va. Code § 54.1-2902 makes it unlawful to practice medicine in the Commonwealth without a Board of Medicine license. Board of Medicine guidance treats telemedicine into Virginia the same way: a Virginia license is required to establish a new practitioner-patient relationship. Limited consultation and follow-up exceptions exist; do not treat a patient panel on them.
What does Virginia require for telemedicine prescribing?
Va. Code § 54.1-3303 sets the bona fide practitioner-patient relationship for prescriptions, including an appropriate examination that may use electronic images and records. A practitioner who meets that section may prescribe Schedule II through VI controlled substances via telemedicine when federal telemedicine rules are met. For Schedule II through V, the prescriber must maintain a practice at a physical location in Virginia or be able to refer the patient to a Virginia practitioner for an in-person exam when the standard of care requires it. The prescriber must be actively licensed in Virginia.
Does Virginia require coverage for telemedicine?
Va. Code § 38.2-3418.16 requires covered insurers, subscription contracts, and HMOs to cover the cost of health care services provided through telemedicine services. They may not exclude a service solely because it is delivered by telemedicine when the service is appropriately provided that way, and they reimburse diagnosis, consultation, or treatment on the same basis as face-to-face care. Telemedicine services in that section do not include an audio-only telephone, email, fax, or online questionnaire, though the statute still allows coverage for some audio-only care under other terms. Confirm the rate in each PC contract.
Can a lay founder own a Virginia telehealth practice?
Virginia is often labeled Limited or no classic CPOM on vendor tables, but Va. Code § 54.1-2902 still bars unlicensed practice, and Title 13.1 Chapter 7 limits professional-corporation shareholders to people licensed to render the same professional service. Diligence still wants a physician-owned PC plus a fair-market-value MSA so ownership and funds flow have one answer. Treating clinicians belong on the clinical entity, not the MSO payroll as the practice of medicine.
How much does Foundry charge for a Virginia telehealth MSO-PC?
MSO-PC formation is $15,000 one-time. A Virginia-licensed friendly PC owner is $3,000/mo.
Related reading
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