Payments · Telehealth7 min readUpdated November 3, 2026

How to Start a Telehealth Company Online

Starting a telehealth company: structure, clinician licensing, prescribing, merchant account, ads and data, in the order to settle them before launch.

Nick Bonnassies, CMO at Tagada · checked against 14 sources

Article summary

TL;DR

Before your first payment, settle seven things in this order: what you sell and who charges for it, the legal structure, clinicians licensed in your patients' states, prescribing rules, a checkout that charges only after clinical review, a merchant account that accepts telemedicine, and ad certification. Launch payment problems almost always trace back to the first four.

Stripe lists "Telemedicine and telehealth services" as restricted and asks for "license numbers and information on your processes".
Clinicians must be licensed in the patient's state; the licensure compact covers 44 states, the District of Columbia and Guam.
As of November 2, 2026, the DEA's temporary telemedicine flexibilities run through December 31, 2026.
Visa and Mastercard risk programs target pharmacies (MCC 5122, 5912), not telemedicine.
Google and Meta require LegitScript certification before telehealth ads; Stripe doesn't.

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On this page

This guide is part of our hub on telehealth payment processing. The general guide, for any business: merchant accounts for startups with no processing history. The full launch, from offer to growth: how to start and scale a telehealth company. General information, not legal advice.

Launch steps in order

Decide what you sell and who charges for it: visit, care plan, membership, medication.
Set up the legal structure with a healthcare attorney: who can own a telehealth practice.
Contract clinicians licensed in your launch states: telehealth rules by state.
Write your prescribing rules, including controlled substances.
Design the checkout: terms, consent, charge after review, online cancellation.
Apply for a merchant account with the full file: getting approved.
Get certified for ads if you'll run Google or Meta: advertising rules.
Keep health data out of payments and ad pixels.

Fig. 1Eight launch steps, and who checks each one

What you sellVisit, plan, membership or medication
StructureHealthcare attorney
CliniciansLicensed in your launch states
Prescribing rulesControlled substances included
CheckoutTerms, consent, charge after review
Merchant accountProcessor review
AdsLegitScript, then Google or Meta
Health dataOut of payments and ad pixels

The merchant account comes late because underwriters read everything before it.

Decide what you sell, and who charges for it

A consultation and a medication are two different businesses for the card networks. The first fits medical codes; the second is a pharmacy, with network registration6 7 8.

Fig. 2Consultation or medication: two businesses for the card networks

You sell	Closest MCC	Card network rules	Processor view
Visit or care plan	8011 or 8099 6	NoNamed program7 8	Stripe: restricted, approval required1
Membership (messaging, visits)	8011 or 80996	Subscription rules (ROSCA, Visa)	Same, plus billing terms review
The medication itself	5912 6	Visa Tier 1 registration; Mastercard registration7 8	Stripe: "Card-not-present prescription-only products" restricted1

Many brands leave the medication with a licensed pharmacy.

Visa Merchant Data Standards Manual; Visa Integrity Risk Program; Mastercard Security Rules; Stripe.

Your acquirer assigns the code. Many brands keep the medication with a licensed pharmacy that charges for it, so the brand stays on medical codes. How to split the two: charging the consultation and the medication separately. The pharmacy side: online pharmacy payment processing.

Structure and clinician licensing

Many states don't let a non-physician company practice medicine. Under this "corporate practice of medicine" doctrine, a common setup is a physician-owned medical practice plus a management services organization (MSO) owned by the founders, as law firms describe it. California added limits on private equity's control over physician practices from January 1, 2026 (SB 351), as reported by Foley & Lardner13.

The clinician must be licensed where the patient is. The Interstate Medical Licensure Compact offers "a voluntary, expedited pathway to licensure" across 44 states, the District of Columbia and Guam3. It speeds up state licenses; it isn't a national license.

Example

You launch in five states. Your clinicians hold licenses in those five; your checkout asks for the patient's state first and stops patients from the other states before payment. That's what processors expect to see.

Prescribing rules to settle before launch

Controlled substances follow federal law, everything else follows state rules. The Ryan Haight Act requires "at least 1 in-person medical evaluation" before a controlled substance is dispensed online4.

Watch out

As of November 2, 2026, the DEA's temporary flexibilities that waive the in-person visit run through December 31, 20265. A model that depends on them needs a plan for January 2027. Processors ask about controlled substances at underwriting.

States in the licensure compact, plus the District of Columbia and Guam

In-person evaluation required before a controlled substance is dispensed online

Dec 31, 2026

End of the DEA's temporary flexibilities, as of November 2, 2026

Getting a merchant account

Expect a review, not an instant account. Stripe reviews telemedicine "on a case-by-case basis", and its approval "may be modified or revoked by Stripe at any time"1 2. Stripe doesn't require LegitScript for telemedicine2.

What underwriters ask for	Why
Entity documents, owners' IDs	Who is behind the business
Clinician license numbers, by state	Stripe: "license numbers and information on your processes"2
Prescribing process and clinical scope	Controlled substances, medication sales
Live site with checkout, terms, refund policy	Billing clarity, ROSCA12
Expected volume, ticket size, billing model	Reserve and limits

Without processing history: merchant accounts for new telehealth companies. Stripe's policy in detail: does Stripe allow telehealth services?.

Keep health data out of payments from day one. Stripe's agreement says users "must not provide Protected Health Information to Stripe"11. Use your brand name in the descriptor, and no condition or treatment in product names or metadata: HIPAA and your payment processor.

Build or run on a stack

Option	What you handle	Contracts to sign	Control
Build your own	Entity, clinicians, pharmacy contracts, checkout, merchant account, LegitScript	Clinicians, pharmacy, processor, LegitScript	Full
Telehealth platform plus your own payments	Brand, ads, merchant account, billing rules	Platform, processor, often clinicians	High on payments
Run on a full stack such as Tagada Rx	Brand and ads	Tagada Rx, after your application is accepted	Brand and offer

Pre-launch checklist

Entity
Entity and ownership reviewed by a healthcare attorney.
Clinicians
Clinicians licensed in every launch state; checkout limited to those states.
Prescribing
Prescribing rules written, with the DEA date checked.
Terms
Terms, price, frequency and cancellation shown before the card field12.
Charge after approval
Charge for treatment only after clinician approval.
Merchant account
Merchant account approved for telemedicine; medication sales declared.
Ads
LegitScript and Google or Meta authorization, if you run ads9 10.
Health data
No health data in descriptors, metadata or ad pixels.

How Tagada helps

Payments for a new telehealth brand

TagadaPay handles the payment side of a new telehealth brand, with "enhanced review for regulated verticals"14 and "24/7 human support on Slack Connect".

Routing across TagadaPay and processors such as Stripe, NMI and Airwallex, with a cascade to another processor when one is down or times out
Your vault, portable: "Switch processors without re-onboarding customers. No vendor lock-in."
Fraud filters: "Native 3DS2, device intelligence, and rules engine: approve real customers, block the rest"
Integrations: "Already on Shopify, WooCommerce, ClickFunnels or BigCommerce? Drop TagadaPay in."

Building the whole telehealth brand from scratch? Tagada Rx runs storefront, doctors, pharmacy and payments in one stack: "US-licensed clinicians in the patient's state, e-prescribing, pharmacy routing", a "Licensed US pharmacy" that "ships direct to the patient", and a store on tgdcare.com, which is LegitScript certified (ad approval still depends on Google and Meta). US patients only, by selection.

Tagada follows Visa and Mastercard rules and the laws that apply to payments.

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Updated on November 3, 2026

Nick Bonnassies

CMO at Tagada

CMO at Tagada. Before Tagada, Nick built direct-to-consumer brands that generated over $115M in sales, raised over $25M in crowdfunding and sold two of them. He also works as a fractional CMO on marketing operations and AI systems.

Frequently asked questions

What licenses do I need to start a telehealth company?

Your clinicians need licenses in each state where patients are; the compact speeds that up in 44 states, the District of Columbia and Guam. Prescribers of controlled substances need DEA registration, and the business may need a structure that complies with state corporate practice rules. A healthcare attorney should review your setup.

Can a non-doctor own a telehealth company?

Often through a split structure: a physician-owned practice delivers care, and a management company owned by founders runs the business. Whether that's needed depends on each state's corporate practice of medicine doctrine. See who can own a telehealth practice.

Do I need LegitScript to start a telehealth company?

Not for Stripe: "Telemedicine businesses don't need certification from LegitScript". You do need it to advertise telehealth on Google in the US and on Meta. Visa uses it as a waiver for pharmacies, not for telemedicine.

Will Stripe accept a new telehealth company?

It may. Telemedicine is restricted, not prohibited, in the US; Stripe reviews each case and asks for license numbers and process details. Approval "may be modified or revoked by Stripe at any time", so plan a second processor.

How long does it take to start a telehealth company?

It depends on licensing, contracts and approvals, not on the website. State licenses, the merchant account review and ad certification each run on their own timeline. A full stack such as Tagada Rx removes the clinician and pharmacy contracts from your list.