Teletherapy for SLPs Across State Lines

Teletherapy feels location-free. Licensing is not. For SLPs and audiologists, the practice of the profession happens where the client is when the session takes place. An SLP in Ohio treating a child in Texas by video is practicing speech-language pathology in Texas, and needs Texas authority to do it.

Where does a teletherapy session legally take place?

In the client's state. The ASLP Compact says it outright: an audiologist or SLP practicing in a member state "must comply with the state practice laws of the state in which the client is located at the time service is provided" (model law Section 3.H). The CompactConnect scope-of-practice attestation repeats it in the first person: "Practice in a state occurs when I am providing services to a client/patient located in that state at the time services are rendered."

State boards say the same for their own licenses. The Texas Department of Licensing and Regulation's telehealth page for SLPs and audiologists: "If the clients receiving the services are located in Texas, then you must hold an appropriate Texas license." It adds that you must provide "the same standard of care as you would for an in-person visit."

ASHA's telepractice guidance goes a step further. It tells clinicians to verify licensure requirements "in the state from which the clinician provides services as well as the state in which the client receives services prior to initiating services," and notes that ASHA guidelines assert telepractitioners must be licensed in both. State law controls; ASHA notes that state statutes and regulations take precedence over its guidance.

Can a compact privilege cover teletherapy?

Yes, between issuing states. Section 5 of the model law requires member states to recognize an audiologist's or SLP's right to practice "via telehealth under a privilege to practice." The model law defines telehealth as "the application of telecommunication technology to deliver audiology or speech-language pathology services at a distance for assessment, intervention and/or consultation."

The catch is the same as for in-person work. As of October 2026, only Louisiana, West Virginia, Ohio and Tennessee issue privileges, so a teletherapy SLP can use a privilege only if they live in one of those states and the client is in another of them. A West Virginia SLP can see Ohio, Louisiana and Tennessee clients on privileges; a client in Kentucky, Pennsylvania or California needs a license in that state. See which states issue privileges.

A privilege also brings that state's rules with it. The scope-of-practice attestation says you have reviewed and will abide by the state's practice act, and that a violation can lead to action against your privilege and a bar of at least two years on obtaining others.

What happens when a client travels?

The license follows the client's location at the time of the session, not their home address. ASHA's guidance specifically tells clinicians to verify requirements for "temporary location changes such as vacations and college attendance." A college student who goes home for the summer to another state, or a family that spends winters elsewhere, can take a session out of your licensed footprint without anyone noticing. Ask where the client is at the start of each session and document it.

The reverse also matters. If you are the one traveling, ASHA notes that clinicians should consider how their own location affects licensure, liability coverage and reimbursement. For a clinician outside the United States serving U.S. clients, ASHA says to hold legal authorization to work in the country where they live and to follow the licensing laws of the state where the client is.

Does teletherapy in schools add anything?

Often. A school may require an education department credential on top of the license, and a compact privilege does not replace it where the state requires one. ASHA advises clinicians planning school telepractice in another state to contact the U.S. Department of Education and the licensure entity in the state where the service is provided. See school SLP credentials beyond the state license.

How does Medicare treat SLP and audiology telehealth?

On a deadline. The CMS Telehealth FAQ, updated February 26, 2026, says that through December 31, 2027, "an extended range of practitioners may bill for Medicare telehealth services," and that starting January 1, 2028, "speech-language pathologists, and audiologists can no longer furnish Medicare Telehealth services," along with the other therapy professions in the same list. The same FAQ says that through December 31, 2027, beneficiaries can receive Medicare telehealth anywhere in the United States, and that starting January 1, 2028, outside behavioral health, they will generally need to be in a medical facility in a rural area.

That is a Medicare payment rule, not a licensing rule. It does not change where you need a license, and commercial payers and Medicaid set their own telehealth policies. ASHA's guidance tells clinicians to verify coverage, payment, coding and modifiers with each payer before starting. If Medicare is a large share of your teletherapy caseload, plan for the 2028 change now. See Medicare enrollment for SLPs and audiologists.

Which setup works for a multi-state teletherapy caseload?

1. Map your clients by state, not by where you are.
2. Use privileges for clients in issuing states if your home state is issuing.
3. Get state licenses for clients everywhere else. California, Texas and New York, for example, are not in the compact.
4. Add school credentials where an education department requires them.
5. Check each payer's telehealth rules, and watch the Medicare December 31, 2027 date.
6. Track every renewal. Privileges expire with your home license; each state license has its own cycle and CE.

Occupational therapists can see the sister guide at White Glove OT, and practices building a broader telehealth program can read about patient location checks at White Glove Telemedicine.

We build the license side of a teletherapy practice. License by Endorsement is $599 per state and a Full State License Application is $749 per state. For issuing states, the ASLP Compact Readiness Review ($149 one time) and the Compact Privilege Concierge ($299 for the first privilege, $149 for each additional) get you ready and guide a session in which you apply, attest and pay yourself. Annual Renewal and CE Compliance ($299 per license, per year) tracks the dates. See the state license index.