South Carolina Telehealth Regulations: 2026 Compliance Guide for Providers

Definition of Telehealth

South Carolina law defines telehealth as the use of electronic communications, information technology, or other means to deliver clinical health care when you and the patient are not in the same place. This definition applies across licensed health professions and sits alongside, but distinct from, physician “telemedicine.” ([scstatehouse.gov](https://www.scstatehouse.gov/Acts%26JointResolutions/2024/2024Acts%26JointResolutionsVolumeI.pdf))

Under the Telehealth practice act, you may only provide services within your licensed scope, and your licensing board retains oversight of telehealth delivered under your credential. Training and competence with the technology used are expressly required. ([scstatehouse.gov](https://www.scstatehouse.gov/Acts%26JointResolutions/2024/2024Acts%26JointResolutionsVolumeI.pdf))

Standard of Care Requirements

Telehealth care must meet the same standard of care as in-person care. You are evaluated according to your specialty’s standard, and failure to meet it constitutes unprofessional conduct subject to discipline by your South Carolina medical licensing board. ([scstatehouse.gov](https://www.scstatehouse.gov/Acts%26JointResolutions/2024/2024Acts%26JointResolutionsVolumeI.pdf))

Before diagnosing or treating, provide an appropriate evaluation, verify the patient’s identity and physical location, disclose your name, location, and credentials, ensure availability of follow-up care, and, when applicable, discuss the value of a primary care medical home. These steps are hard-coded into South Carolina’s telemedicine/telehealth statute. ([scstatehouse.gov](https://www.scstatehouse.gov/code/t40c047.php))

Medical Records Management

You must generate and maintain a telehealth record that is complete and accessible to the patient and other practitioners upon lawful request. South Carolina expressly requires compliance with HIPAA telehealth requirements and HITECH Act standards, including privacy and security safeguards appropriate to remote care. ([scstatehouse.gov](https://www.scstatehouse.gov/code/t40c047.php))

Best practice: document modality (synchronous/asynchronous), patient location, informed consent, identity verification, clinical findings sufficient to support your diagnosis and plan, and any coordination with the patient’s primary care or medical home. These data points map directly to the statute’s recordkeeping and care coordination duties. ([scstatehouse.gov](https://www.scstatehouse.gov/code/t40c047.php))

Prescribing Practices via Telehealth

State rules allow telehealth prescribing when you meet South Carolina’s prerequisites for a legitimate physician–patient relationship and comply with prescribing rules in Section 40-47-113 (for example, no prescribing solely from an online questionnaire). You must also participate in South Carolina’s prescription drug monitoring program (SCRIPTS) as required. ([scstatehouse.gov](https://www.scstatehouse.gov/code/t40c047.php))

South Carolina restricts telehealth prescribing of Schedule II-narcotic and Schedule III-narcotic medications, permitting it only in specified circumstances (e.g., when the patient is physically in a hospital and treated in the usual course of practice; when buprenorphine is prescribed for opioid use disorder for a patient enrolled in MAT with an established physician–patient relationship; patients in palliative care or hospice; or other board-authorized programs). Abortion-inducing drugs may not be prescribed via telemedicine. ([scstatehouse.gov](https://www.scstatehouse.gov/code/t40c047.php))

At the federal level, Controlled Substances Act telemedicine exceptions created during COVID remain in force through December 31, 2026, extending the Ryan Haight Act’s temporary flexibilities for initiating certain controlled substances via telemedicine when federal criteria are met. Your prescriptions must still satisfy legitimate medical purpose, state law, and all DEA requirements. ([hhs.gov](https://www.hhs.gov/press-room/dea-telemedicine-extension-2026.html?utm_source=openai))

Behavioral Telehealth Registration

Out-of-state independent clinical social workers with an LISW-CP–equivalent license may provide behavioral telehealth to South Carolina clients by registering with the South Carolina Board of Social Work Examiners. To register, you must hold an active, substantially similar license, have no recent discipline, pay a $10 fee, and display a hyperlink on your website to the board’s registrant listing that shows your out-of-state license and your South Carolina behavioral telehealth registration number. Registered providers consent to South Carolina jurisdiction and discipline. ([scstatehouse.gov](https://www.scstatehouse.gov/code/t40c063.php))

Parallel registrations exist for out-of-state professional counselors, marriage and family therapists, addiction counselors, and psycho-educational specialists. Registrants may not open a South Carolina office or provide in-person services, and the registration is valid only while the out-of-state license remains active and in good standing. ([llr.sc.gov](https://www.llr.sc.gov/cou/PDFs/Counselors_Telehealth_Registration_Complete.pdf))

Occupational Therapy Telehealth Services

South Carolina permits occupational therapists and occupational therapy assistants licensed in the state to deliver services via telehealth, so long as services remain within scope and ethical standards and you comply with applicable payer and documentation rules. ([llr.sc.gov](https://llr.sc.gov/ot/faq.aspx?utm_source=openai))

For Medicaid, the Rehabilitative Therapy and Audiological Services Provider Manual requires synchronous audio–video technology for most covered telehealth services, and it specifies eligible providers, allowable originating sites (including the patient’s residence), presenter requirements, and HIPAA-compliant platforms. Verify coverage and codes before billing. ([scdhhs.gov](https://www.scdhhs.gov/sites/default/files/manuals/Rehabilitative%20Therapy%20and%20Audiological%20Services%20Provider%20Manual%2001-01-2025.pdf))

If you practice across state lines, South Carolina participates in the Occupational Therapy Licensure Compact, which can streamline cross-border telehealth by granting compact privileges to eligible OTs/OTAs. Confirm your compact status and privileges before serving South Carolina patients. ([otcompact.gov](https://otcompact.gov/wp-content/uploads/2025/11/OTCC-FY25-Annual-Report-2025.pdf?utm_source=openai))

Telehealth in Schools

School-based telehealth in South Carolina continues under Medicaid flexibilities and guidance coordinated by the Department of Education (SCDE) and SCDHHS. Districts may partner with third-party providers, use the telehealth originating site facility fee (Q3014) when applicable, and must align documentation and billing with state Medicaid policy. ([ed.sc.gov](https://ed.sc.gov/districts-schools/medicaid/medicaid-services-newsletters/monthly-newsletters/2025-newsletters/june-2025-newsletter/))

The SCDE maintains a telehealth page for districts and has communicated that certain school-based telehealth flexibilities are extended through December 31, 2026, subject to SCDHHS bulletins. Always confirm current codes, place-of-service rules, consent, and presenter requirements. ([ed.sc.gov](https://ed.sc.gov/districts-schools/medicaid/telehealth-telemedicine/?utm_source=openai))

When schools bill Medicaid for therapy via telehealth, sessions generally must use synchronous audio–video, and documentation must show medical necessity, student presence, setting, and adherence to privacy rules. Coordinate HIPAA and FERPA responsibilities when services occur on school grounds. ([scdhhs.gov](https://www.scdhhs.gov/sites/default/files/manuals/Rehabilitative%20Therapy%20and%20Audiological%20Services%20Provider%20Manual%2001-01-2025.pdf))

Telehealth and Telemedicine Modernization Act Updates

South Carolina’s 2024 Telehealth and Telemedicine Modernization Act updated multiple statutes. Key changes include: a uniform definition of “telehealth” applicable across licensed professions; explicit training and competence requirements for telehealth technology; clarified authority for APRNs and PAs to provide telehealth/telemedicine within their agreements and scopes; and comprehensive updates to physician telemedicine rules (evaluation, identity/location verification, records, PDMP participation, and limited tele-prescribing allowances). ([scstatehouse.gov](https://www.scstatehouse.gov/Acts%26JointResolutions/2024/2024Acts%26JointResolutionsVolumeI.pdf))

Conclusion

To stay compliant in 2026, anchor your program to South Carolina’s Telehealth practice act, match the in-person standard of care, maintain HIPAA/HITECH-grade records, follow state and federal tele-prescribing rules, use behavioral telehealth registration where required, and align school-based and therapy services with SCDHHS and SCDE guidance. Build workflows that verify patient location/identity, capture consent, document thoroughly, and confirm payer rules before each encounter. ([scstatehouse.gov](https://www.scstatehouse.gov/Acts%26JointResolutions/2024/2024Acts%26JointResolutionsVolumeI.pdf))

FAQs.

What are the documentation requirements for telehealth services in South Carolina?

Document the mode of service, patient identity and location, your credentials and location, an evaluation sufficient for diagnosis, the care plan and follow-up, and all communications. Your telehealth record must comply with HIPAA and HITECH and be accessible to the patient and other practitioners upon lawful request. ([scstatehouse.gov](https://www.scstatehouse.gov/code/t40c047.php))

How does the standard of care apply in telehealth versus in-person care?

It’s identical: you are held to the same specialty-specific standard you would meet in person. The Telehealth practice act and the medical practice statute make failure to meet this standard unprofessional conduct subject to board discipline. ([scstatehouse.gov](https://www.scstatehouse.gov/Acts%26JointResolutions/2024/2024Acts%26JointResolutionsVolumeI.pdf))

Can controlled substances be prescribed through telehealth in South Carolina?

Yes, but with limits. State law permits telehealth prescribing only under strict conditions, with added restrictions on Schedule II/III narcotics (e.g., hospital inpatients, MAT with buprenorphine for OUD, hospice/palliative, or board-authorized programs) and a bar on abortion-inducing drugs. Federally, DEA/HHS extended COVID-era Ryan Haight telemedicine flexibilities through December 31, 2026; you must still meet all state and federal requirements and check the PDMP. ([scstatehouse.gov](https://www.scstatehouse.gov/code/t40c047.php))

What registration is required for out-of-state behavioral telehealth providers?

Out-of-state LISW-CP–equivalent social workers must register with the South Carolina Board of Social Work Examiners and display a board link on their website listing their out-of-state license and SC behavioral telehealth registration number. Similar telehealth registrations exist for out-of-state LPCs, LMFTs, addiction counselors, and psycho-educational specialists; these registrants may not provide in-person services or open a South Carolina office. ([scstatehouse.gov](https://www.scstatehouse.gov/code/t40c063.php))