Licensure compacts and multistate telehealth ads

A telehealth practice can reach a patient in any state with a search ad. Its clinicians can only see patients in the states where they hold a license or a legal privilege to practice. The gap between those two facts is where multistate marketing goes wrong: an ad shown in the wrong state, a landing page that says “nationwide”, or an intake form that books a visit nobody on staff can legally take.

This guide covers licensure compacts, the agreements between states that make multistate practice easier, and how to turn your licensure map into ad targeting, page copy and intake rules. The wider picture of telehealth marketing, including Medicare telehealth dates and Google’s prescription drug policy, is in our telehealth marketing guide. App and direct-to-consumer startups should also read our health app and telehealth startup guide, and mental health practices our psychiatric practice marketing guide.

This is general information, not legal or licensing advice. Sources cited were checked on October 30, 2026: the Interstate Medical Licensure Compact Commission’s site and FAQ, the Nurse Licensure Compact site and FAQ, the PT Compact map and process page, the Counseling Compact map and FAQ, the DEA and HHS fourth temporary extension of telemedicine flexibilities (published December 31, 2025), Google Ads location targeting help, and 15 U.S.C. 45. Compact membership changes as states pass and implement laws, and each state board sets its own rules. Confirm each clinician’s status with the state board before you advertise in a state.

The rule underneath: the patient’s location

Each compact source we checked starts from the same point. The IMLC FAQ says that under the compact the location of medical practice is the state where the patient is located, and that all laws and regulations of the patient’s state apply. The Nurse Licensure Compact FAQ says nurses are required to be licensed in the state where the patient is located at the time service is provided. The Counseling Compact FAQ says counselors must have a license or a privilege to practice in the state where the client is located.

For marketing, this means the unit that matters is not where your office is, and not where the patient lives, but where the patient is at the time of the visit. A patient who lives in your state but is on a work trip in another one is, for that visit, a patient in the other state.

How the main compacts work

Compacts are not national licenses. They differ in what they give a clinician, and the difference changes what you can say in an ad.

Interstate Medical Licensure Compact (physicians). The IMLC Commission describes a voluntary, expedited pathway: an eligible physician completes one application and receives separate licenses from each state in which they intend to practice. The Commission says it does not issue a “Compact license” or a nationally recognized medical license; the licenses are issued by the states. On October 30, 2026 its site said the compact includes 44 states, the District of Columbia and the Territory of Guam.
Nurse Licensure Compact (RNs and LPN/VNs). A nurse whose primary state of residence is a member and who meets the uniform licensure requirements can hold a multistate license. The NLC site says nurses with a multistate license can practice in other NLC states and territories without obtaining additional licenses, and its FAQ says that practice may also be via telehealth. On October 30, 2026 the site said 43 jurisdictions are part of the NLC, with additional implementation status details per state.
PT Compact (physical therapists and assistants). A clinician licensed in a member state buys a compact privilege for each other member state. The PT Compact process page says each state has different fees and may require passing a jurisprudence exam, and that failing to take a required exam can lead to termination of the privilege and discipline. On October 30, 2026 its map listed 38 member states actively issuing and accepting compact privileges, 3 with enacted legislation not yet issuing or accepting privileges, and 10 non-members.
Counseling Compact (licensed professional counselors). The FAQ says passing the compact in a state does not automatically approve a license for use in other states, and counselors must apply for the privilege to practice in each state. On October 30, 2026 the map page listed the member states and said the compact is live for licensees in Arizona, Minnesota and Ohio, with privileges currently available only between those states.
Other professions. Psychologists, advanced practice nurses and other professions have their own compacts or compact efforts, each at its own stage. Check the compact’s own site and the state board before relying on one.

Two practical points follow. First, a state on a compact map is not the same as a state where your clinician can practice: the clinician still has to obtain the license or privilege. Second, a compact passed into law can still be months away from issuing anything. The PT and Counseling Compact maps both separate member states that are live from those that are not.

What to say in ads and on pages

The safest claim is the specific one: name the states where a named clinician can see patients now. The FTC Act, 15 U.S.C. 45, prohibits deceptive acts or practices in commerce, and an ad that offers a service to people who cannot get it is a fair candidate for that word.

Use: “Video visits for patients located in [State A], [State B] and [State C] at the time of the visit.”
Use: “Dr. [Name] is licensed in [State A] and [State B].”
Use: a states list on the service page that matches the booking system.
Avoid: “Nationwide”, “all 50 states” or “anywhere in the US” unless it is literally true for the service on offer.
Avoid: “Compact licensed” or “licensed through the compact” as a claim of national reach. IMLC licenses are state licenses, and compact privileges are state by state.
Avoid: a states list copied from a compact map. List the states where your clinicians hold a license or privilege today.

Keep a dated licensure roster behind the states list. When a clinician leaves, a license lapses or a privilege is added, the page, the ads and the booking rules change on the same day. A states list that is right in January and wrong in June is still wrong in June.

Ad targeting by state

Search and social platforms let you choose where ads run, but the defaults do not match licensure. Google’s location targeting help page says broad targeting (“Presence or interest”) can reach people who are in your targeted locations and also people who have shown an interest in them. It lists “Presence” as the option for when you only want to target users in specific locations.

Use: “Presence” targeting set to the states on your licensure roster.
Use: one campaign or ad group per state group if your clinicians differ by state, so a pause in one state does not affect the others.
Use: a monthly check that the targeting list still matches the roster.
Avoid: “Presence or interest” for a telehealth service that is legally limited by state.
Avoid: radius targeting around your office that crosses a state line you are not licensed in.

Targeting is a filter, not a final check. Location signals are imperfect, and people travel. That is why the intake step below matters as much as the ad settings.

Intake: ask where the patient will be

The booking flow is where licensure turns into a yes or no. Ask the question that matches the rule: where will you be at the time of the visit? A home address field alone does not answer it.

Ask for the state the patient will be in during the visit, before showing appointment times.
Show only clinicians licensed or privileged in that state.
If no clinician can take the visit, say so plainly and point to finding care locally, instead of letting the booking go through.
Confirm the location again at the start of the visit and record it.
Keep the location question out of any third-party tracking on the page. Our online intake forms guide covers what form data should and should not reach ad platforms.

The same logic applies to AI chat and phone tools. A front desk tool that books visits needs the same state check as the web form, and should hand off to staff when the answer is unclear.

Prescribing across state lines

Licensure is one gate; prescribing controlled medications by telemedicine has its own federal rules. The DEA and HHS fourth temporary extension, published December 31, 2025, extends the COVID-19 telemedicine flexibilities for prescribing controlled medications through December 31, 2026. As of October 30, 2026 we did not find a later extension or a final rule in the Federal Register. That date is close, and the rules after it may differ.

Do not build multistate ads around prescribing a controlled medication without an in-person visit unless counsel has confirmed what applies after the current extension, and be ready to change the pages on short notice. State prescribing rules apply on top of the federal ones. Our telehealth marketing guide covers Google’s restrictions on prescription drug ads.

Profession by profession

Physician practices. IMLC licenses are full state licenses, so once issued they can be listed state by state. Our functional medicine and second opinion guides cover two models that draw patients from other states.
Nurse practitioner practices. The NLC covers RNs and LPN/VNs. Advanced practice authority is set by each state, so check the state’s own rules for the role on offer. See our nurse practitioner practice marketing guide.
Physical therapy. Compact privileges are per state and may require a jurisprudence exam. See our physical therapy marketing guide.
Counseling and mental health. Counseling Compact privileges were not yet available in each member state when we checked. Psychiatric and therapy practices should list states per clinician. See our psychiatric practice marketing guide.

Where practices go wrong

Advertising telehealth across a region by radius from the office, ignoring state lines.
Listing compact member states as service states.
Taking the home address as the visit location.
Leaving a departed clinician’s states on the page and in the ads.
Running “Presence or interest” targeting for a state-limited service.
Building a funnel around a prescribing rule with a fixed end date.

An example states block

The following is an invented illustration, not a real practice or clinician.

Video visits at [Practice name] are available to patients located in [State A], [State B] or [State C] at the time of the visit. Dr. [Name] is licensed in [State A] and [State B]; [Name], PT, holds a license in [State A] and compact privileges in [State B] and [State C]. If you will be in another state, we cannot see you by video. Please contact a local clinician, and call 911 in an emergency. Updated [date].

It names the rule, maps clinicians to states, gives a clear no for other states, and carries a date so staff can see when it was last checked.

Checklist

Keep a dated roster of each clinician’s licenses and compact privileges, from the state boards.
Write the service page states list from the roster, not from a compact map.
Set ad targeting to “Presence” in roster states only.
Ask where the patient will be at the time of the visit before showing times.
Route each booking only to clinicians licensed or privileged in that state.
Confirm and record the patient’s location at the start of each visit.
Update the page, ads and booking rules the same day a license changes.
Recheck the DEA telemedicine status before December 31, 2026 if any service depends on it.

How we help

We build websites, local search, Google Ads and lead generation and AI front desk tools for independent practices and health businesses. For multistate telehealth, that means state lists that match your licensure roster, campaigns targeted by state, and booking flows that ask where the patient will be before a visit is offered. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or licensing advice. For the wider rules, see our healthcare marketing rules hub.

Does a licensure compact let a clinician practice in each member state?

No. Under the IMLC, a physician still receives a separate license from each state through the expedited pathway. Under the PT and Counseling Compacts, the clinician applies for a privilege in each state. The NLC multistate license is the closest to a single license, and it depends on the nurse’s home state being a member.

Which state’s rules apply to a telehealth visit?

The compact sources we checked point to the patient’s location. The IMLC FAQ says the location of practice is the state where the patient is located and its laws apply; the NLC and Counseling Compact FAQs say the same for licensure.

Can we say “licensed nationwide” if our physicians use the IMLC?

Only if each physician is in fact licensed in each state you name. The IMLC Commission says it does not issue a compact license or a nationally recognized medical license. List the states instead.

Should telehealth ads use Presence or interest targeting?

For a service limited by state licensure, Google’s help page describes “Presence” as the option for reaching only people in your targeted locations. Pair it with a location question at booking, since targeting is not exact.

What if a patient books from a state where we are not licensed?

Do not hold the visit there. Ask for the visit location at booking, decline politely when no clinician is licensed there, and suggest local care. Confirm the location again at the start of the visit.

Can we keep advertising controlled substance prescribing by telehealth?

The current DEA and HHS extension runs through December 31, 2026. We did not find a later extension as of October 30, 2026. Ask counsel what applies after that date before building ads on it.

Licensure compacts and multistate telehealth ads: what practices can say and where