Starting a virtual clinic in South Carolina: 2026 telehealth requirements

Yes. S.C. Code 40-47-37(A) requires a licensee who practices medicine by telemedicine to be licensed to practice medicine in South Carolina, and the same provision confirms that a nonresident physician satisfies the rule by holding a valid, current South Carolina license. The statute treats care as occurring where the patient is located when the telehealth service is received. The Telehealth and Telemedicine Modernization Act at S.C. Code 40-42-20 repeats the licensure requirement for all licensed professions and notes that South Carolina residents who treat patients in other states must comply with those states' boards.

South Carolina is not a member of the Interstate Medical Licensure Compact. CCHP's compact list for the state covers nursing, counseling, psychology, physical therapy, occupational therapy, EMS, audiology and speech-language pathology and social work, but not the IMLC. A physician who wants to treat South Carolina patients applies to the Board of Medical Examiners through the standard process regardless of how many compact licenses they hold elsewhere.

The exceptions are narrow. An out-of-state physician may provide an informal consultation or second opinion at the request of a South Carolina-licensed physician who keeps responsibility for the patient. The continuity-of-care exception in 40-47-37 applies where an in-person physician-patient relationship was established in another state for specialty care; telehealth follow-up in South Carolina under the existing treatment plan, between in-person visits, is treated as incidental to the out-of-state care and needs no South Carolina license. It does not cover episodic care from an out-of-state provider, new unrelated conditions or extended care without intervening in-person visits. Separately, S.C. Code 40-42-20 recognizes electronic communication within existing patient relationships, physician-to-physician discussions and on-call or cross-coverage situations.

For a brand, none of this substitutes for a licensed roster. Every clinician who sees South Carolina patients needs a South Carolina license, and because the compact is unavailable, lead times for new licenses matter more here than in neighboring Georgia or Tennessee. MyOrbitHealth's 2,400+ provider network covers all 50 states, so South Carolina coverage usually comes from providers who already hold the license.

South Carolina is classified as a moderate corporate practice of medicine state. The doctrine comes from case law rather than an explicit statutory ban. Permit Health's guide cites three decisions: Ezell v. Ritholz, 188 S.C. 39, 198 S.E. 419 (1938), where an unlicensed optical shop employing optometrists was held to be practicing optometry illegally; Wadsworth v. McRae Drug Company, 203 S.C. 543, 28 S.E.2d 417 (1943), which barred corporations from practicing medicine even through licensed employees; and a footnote in McMillan v. Durant, 312 S.C. 200, 439 S.E.2d 829 (1993), stating that a hospital entity cannot practice medicine. The MedPath guide likewise lists Ezell v. Ritholz as the basis, with the professional corporation as the entity and non-physician ownership limited. Permit Health anchors the licensing side in S.C. Code 40-47-10.

Because the rule is judge-made and the leading cases are old, South Carolina lands in the moderate tier: the prohibition is real, but there is no modern statute spelling out MSO limits, ownership percentages or reporting duties, and neither guide identifies a fee-splitting statute specific to medicine. The licensing laws, the Board's authority over telemedicine under 40-47-10(I) and the unlicensed-practice rules still apply to any arrangement.

The structure that works is the standard one. The brand owns a management services organization that supplies the platform, intake, marketing, billing and administrative staff under a management agreement. A professional corporation owned by a South Carolina-licensed physician employs or contracts the clinicians and makes every clinical decision. Keep management fees at fair market value for the services provided, avoid percentage-of-revenue compensation and leave hiring, supervision and treatment decisions with the physician owner.

MyOrbitHealth operates under an MSO and friendly professional corporation model with a flat platform fee and no revenue share, which fits South Carolina's doctrine. Have South Carolina counsel review the management agreement and the professional entity's ownership before launch.

AANP classifies South Carolina as a restricted practice state (map data dated May 2026). In AANP's definition, a restricted state requires career-long supervision, delegation or team management by another health provider for at least one element of NP practice. In South Carolina the mechanism is the practice agreement: S.C. Code 40-33-34(I) allows an APRN to perform medical acts by telemedicine under a practice agreement without holding a South Carolina medical license, and it permits Schedule II through V prescribing only pursuant to that agreement, with medications restricted under 40-47-37(C)(6) needing approval from a joint committee of the medical and nursing boards.

For telehealth staffing, each South Carolina NP on the roster needs a written practice agreement with a South Carolina physician that covers the services and prescribing in your program, and the brand's clinical entity should keep those agreements current. The physician does not have to join each encounter, so asynchronous workflows remain practical, but physician availability is a cost input. Our sources do not state a transition-to-practice hour requirement, so confirm current practice agreement rules with the South Carolina Board of Nursing.