Consent & Established Relationship for Audio-Only Telemedicine



Consent for Audio-only Telemedicine Substitute House Bill 1196 was passed during the 2021 legislative session and requires the following regarding the practice of telemedicine:

  • Beginning July 25th, 2021, providers who bill a patient or the patient’s health plan for audio-only telemedicine services must receive patient consent for the billing prior to rendering the service. The patient consent requirement is applicable to PEBB/SEBB plans, private health plans, behavioral health administrative services organizations and managed care organizations contracted with the Health Care Authority, and Medicaid managed care plans contracted with the Health Care Authority.

  • Beginning January 1st, 2023, the provider must have an established relationship with a patient for an audio-only telemedicine service to be compensated at the same rate as an in-person visit. Established Relationship is defined as a prior in-person visit within the last year with the provider, another provider at the same clinic, or with the referring provider.

  • The bill also amends RCW 18.130.180(21) – unprofessional conduct, to include as unprofessional conduct a pattern of violations for failing to receive consent prior to billing for audio-only telemedicine services.

For more telehealth related information and resources, please visit The Washington State Department of Health Telehealth Resources webpage.


Definition of Established Relationship


HB 1821 Concerning the definition of established relationship for purposes of audio-only telemedicine was signed into law on 3/30/22 and defines the “established relationship” requirement for audio-only telemedicine that goes into effect on 1/1/23.

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