Telehealth went from a niche delivery model to a mainstream expectation almost overnight. And for OTPs looking to build or expand an independent practice, telehealth offers something powerful: the ability to serve clients beyond your geographic footprint without the overhead of a physical clinic.
But launching a telehealth OT practice involves more than downloading Zoom. Licensure rules, HIPAA compliance, technology selection, and payer policies all require careful attention. This guide walks through the practical steps to set up a telehealth practice that's compliant, professional, and sustainable.
State Licensure: The Non-Negotiable Starting Point
Here's the rule that trips up most OTPs new to telehealth: you must hold an active license in the state where the client is physically located at the time of the session, not the state where you're located.
This means if you're licensed in Texas but your client is sitting in their living room in Ohio during your session, you need an Ohio license. There's no national telehealth OT license (yet), and practicing across state lines without proper licensure puts your career at risk.
The OT Licensure Compact
The Occupational Therapy Licensure Compact (OT Compact) is an interstate agreement that allows OTPs to practice across member states under a single compact privilege. As of this writing, over 20 states have joined the Compact with more pending. Check the OT Compact Commission's website for the current list of member states.
If the states where you and your clients are located are both Compact members, you can obtain a compact privilege without going through full licensure in each state.
Choosing Your Telehealth Platform
Not all video platforms are created equal for healthcare. The platform you use must be HIPAA-compliant, meaning it meets federal requirements for protecting patient health information.
What HIPAA Compliance Means in Practice
The platform provider must sign a Business Associate Agreement (BAA) with you, the platform must use end-to-end encryption, there must be access controls (password-protected sessions), and the platform must have audit logging capabilities.
Platforms Commonly Used by OTPs
Several platforms are designed for or compatible with healthcare telehealth: Doxy.me (free tier available, HIPAA-compliant, browser-based with no download required for clients), SimplePractice (combines telehealth with scheduling, documentation, and billing), Zoom for Healthcare (not regular Zoom — the healthcare version includes a BAA), and TheraPlatform (built specifically for therapists with interactive tools).
When evaluating platforms, consider cost (monthly subscription vs. per-session fees), ease of use for clients (especially older adults or those with limited tech experience), integration with your EMR and scheduling systems, screen-sharing and annotation capabilities (useful for home exercise programs and cognitive interventions), and connection reliability and video quality.
Setting Up Your Virtual Clinical Space
Your Physical Environment
Your background matters. Choose a quiet, private space with good lighting, a neutral or professional background, and no interruptions. Clients are trusting you with their health information — a session conducted from a coffee shop or shared workspace erodes that trust and may violate HIPAA.
Equipment Essentials
At minimum, you need a reliable high-speed internet connection (wired Ethernet is more stable than WiFi), a computer with a quality webcam (built-in laptop cameras are usually sufficient but an external HD webcam improves the experience), a good microphone or headset (audio quality matters more than video quality for therapeutic communication), and adequate lighting (a ring light or desk lamp positioned in front of you eliminates shadows).
Client-Side Considerations
Your clients also need adequate technology. Build a simple "getting started" guide that you send before the first session covering how to access the platform, minimum internet speed and device requirements, tips for positioning their camera so you can observe functional activities, and a test link to verify their setup before the appointment.
Documentation and Consent
Telehealth-Specific Informed Consent
Beyond your standard informed consent, telehealth requires additional disclosures. Your telehealth consent form should address the nature and limitations of telehealth services, that the session will be conducted via audio and video, privacy risks inherent in electronic communication, the client's right to decline telehealth and request in-person services, your plan if technology fails mid-session (phone call backup), and the client's physical location at the time of each session (this is required for licensure compliance and should be documented at every visit).
Documentation Standards
Most payers and state boards require that your clinical documentation for telehealth visits mirrors in-person documentation, with the addition of the modality used (synchronous audio/video), the platform used, the client's physical location at time of service, the start and end times of the session, and confirmation that the client consented to telehealth.
Billing for Telehealth OT Services
Telehealth billing uses the same CPT codes as in-person services, with modifiers to indicate the service was delivered via telehealth.
Common Modifiers
Modifier 95: Synchronous telehealth service (real-time audio and video). Place of Service code 10: Telehealth provided in patient's home. These modifiers vary by payer, so verify with each insurance company you're credentialed with.
Payer-Specific Policies
Medicare, Medicaid, and commercial payers each have different telehealth coverage rules. Medicare's telehealth OT policies have expanded but still have limitations on certain service types. Medicaid telehealth policies vary by state. Commercial payers have their own rules and some require prior authorization for telehealth visits. Check each payer's current telehealth policy before delivering services.
Building a Telehealth-Friendly Caseload
Not every OT intervention translates well to telehealth, but many do. Strong telehealth candidates include caregiver training and coaching, cognitive rehabilitation, home exercise program instruction and progression, home safety assessments (client-guided virtual walkthrough), self-management education for chronic conditions, mental health and wellness interventions, ergonomic assessments (screen-guided workspace evaluation), and executive function coaching.
Interventions that require hands-on facilitation, manual techniques, or physical assist are generally not appropriate for telehealth delivery.
Telehealth expands your reach without expanding your overhead. OT Connected helps you build a practice that works for your life — wherever your clients are.