Telehealth · Washington

Washington telehealth MSO-PC: licensing, parity, and who owns the practice

Washington requires a Washington or compact license for most telehealth, pays telemedicine at in-person rates with a carve-out for larger groups, and limits audio-only billing to established patients. See where the PC fits.

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Direct answer

A Washington telehealth company needs clinicians licensed in Washington, directly or through the Interstate Medical Licensure Compact, because RCW 18.134.050 limits out-of-state clinicians to consultations, specialty assessments, and short continuity follow-ups. Washington is a Moderate corporate practice of medicine state, so the clinical side usually sits in a professional service corporation owned by Washington-licensed physicians under chapter 18.100 RCW, and the founder owns an MSO paid a fixed fair-market-value fee. RCW 48.43.735 requires telemedicine to be paid at the in-person rate, but telemedicine companies and groups of 11 or more providers may negotiate a different rate. Foundry forms that MSO-PC for $15,000 one-time and matches a Washington-licensed friendly PC owner for $3,000/mo.

The statute list for the entity rules sits on Washington CPOM, and the CPOM 50-state guide compares Washington with other states. For the multi-state view, start at the telehealth MSO-PC hub. General information only, not legal advice. Foundry is not a law firm.

Licensing: who may treat Washington patients online

Path	Who it fits	Limits
Washington license	Any clinician treating Washington patients	Physicians licensed by the Washington Medical Commission
Interstate Medical Licensure Compact	Physicians with a clean license in another compact state	Washington joined in 2017; still a full Washington license
Out-of-state license only	RCW 18.134.050 exceptions	Consultation with the treating Washington clinician, a specialty assessment with no treatment, or follow-up with an established patient temporarily in Washington

The Medical Commission's telemedicine policy holds practitioners to the same standard of care as in person and allows the relationship to start by telemedicine when the standard of care does not call for an in-person visit. Under RCW 43.70.495, licensed clinicians other than MDs and DOs, such as NPs, PAs, and therapists, complete a telemedicine training and keep a signed attestation.

Payment parity and audio-only rules

Rule	What it says	What it means for the PC
RCW 48.43.735	Telemedicine paid at the same rate as the in-person service	Bill under the PC's contracts
RCW 48.43.735	Hospitals, telemedicine companies, and provider groups of 11 or more may negotiate a different rate	A larger PC may see a lower telehealth rate in its contracts
RCW 48.43.735	Audio-only requires an established relationship: an in-person or audio-video visit in the past three years, or a referral	Book the first visit by video
RCW 48.43.735	Patient consent before billing an audio-only visit	Capture consent in intake

The patient's home counts as an originating site, and carriers may apply the same utilization review and cost sharing as in person. Claims belong to the physician-owned PC under its own tax ID and group NPI.

Controlled substances and the PMP

Under WAC 246-919-985, physicians who prescribe Schedule II to V drugs in Washington register for access to the Prescription Monitoring Program, query it at set points in opioid prescribing, and query it for every opioid prescription when their EHR integrates the PMP. The DEA telemedicine flexibilities under 21 CFR 1307.41 run through December 31, 2026, and each prescriber needs a DEA registration for the state where the patient sits.

Who owns the Washington practice

Role	Where it sits	Washington note
Physician owner	Owns the Washington professional service corporation or PLLC	Washington-licensed MD or DO
Treating clinicians	Employed or contracted by the PC	Washington or compact license
Founder and investors	Own the MSO	Brand, software, marketing, billing support
MSO fee	Written management services agreement	Fixed or cost-plus at fair market value; review against chapter 19.68 RCW on rebates

Run the MSA red-flag audit on CPOM compliance before you sign. Opening a physical studio instead? Read the Washington med spa MSO-PC guide.

Setup steps for a Washington telehealth company

List each visit type, the payers you plan to bill, and any controlled substances.
License each clinician in Washington directly or through the compact, and collect telemedicine training attestations.
Match a Washington-licensed physician to own the PC through friendly PC owner matching ($3,000/mo).
Form the Washington PC and the MSO, and sign a fair-market-value MSA. See MSO-PC formation ($15,000).
Set first visits to video so later audio-only visits can be billed, and record consent.
Credential the PC with payers and route all clinical payments to the PC's bank account.

Pricing

MSO-PC formation

$15,000

One-time. The MSO and the Washington physician-owned PC, scoped to your visit model.

Friendly PC owner

$3,000/mo

A Washington-licensed physician who owns your PC.

Washington telehealth MSO-PC FAQ

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

In most cases, yes. RCW 18.134.050 allows a Washington license or a compact license, with narrow exceptions for consultations, specialty assessments without treatment, and continuity follow-up for established patients temporarily in Washington.

Does Washington require telehealth payment parity?

Yes. RCW 48.43.735 requires carriers to pay telemedicine at the in-person rate, but hospitals, telemedicine companies, and provider groups of 11 or more may negotiate a different rate.

Can Washington telehealth visits be audio-only?

Yes, for established patients. Audio-only billing requires an in-person or audio-video visit within the past three years or a referral, plus patient consent before billing.

Can a lay founder own a Washington telehealth practice?

Not the clinical entity. Washington is a Moderate CPOM state, and the common structure is a Washington physician-owned professional service corporation or PLLC plus a founder-owned MSO under a fair-market-value MSA.

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

MSO-PC formation is $15,000 one-time. A Washington-licensed friendly PC owner is $3,000/mo.

Ready to treat Washington patients online?

Book a free 20-minute call with your visit model and states. We will scope the PC, the MSO, and the physician owner.