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01 / TELEMEDICINE

Telemedicine merchant accounts, without the guesswork.

We match telemedicine and telehealth merchants with processors whose underwriting actually fits the business - the billing model, the licensing footprint, the fulfillment chain, the geography. Then we walk you through the application, the pricing, the reserve and the contract terms.

A telemedicine merchant account is not a retail account with a different label on it. It gets underwritten by a processor that carries a written telehealth policy, an acquiring bank willing to board the category, and pricing built for recurring billing, prescribing and a licensure footprint that gets riskier with every state you add.

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Free to use · Team responds ASAP · We’re paid by the processor, not you.

Tell us about the business.

A short form. We’ll come back with processors that fit, not a list of everyone who says they support high risk.

We use this to match you. We don’t sell it. Please don’t send card numbers or bank details.

02 / WHY TELEMEDICINE GETS DECLINED

Why telemedicine gets declined.

Most telemedicine merchants who get turned down assume the problem is them. It usually isn’t. It’s a mismatch between what the business actually is and what the processor’s underwriting model was built to price.

Telehealth sits in a category most banks classify as high-risk or specialty. Not because the care is worse - because four things travel together in almost every telemedicine file, and each one adds a layer of exposure the processor has to carry.

Recurring subscription billing. If you charge members monthly, you’re running a negative-option billing model. The cardholder authorized it once and gets charged again every month after that. Card network rules for recurring transactions are specific about how those charges are described, disclosed and cancelled, and a dispute over an auto-renew is the most common complaint pattern we see in telehealth. A $59 monthly membership that renews quietly for eight months before the patient notices is a $472 chargeback, not a $59 one.

Prescription fulfillment. The moment your platform touches a prescription - writing it, routing it to a pharmacy, or dispensing it - you stop being only a service business. Card networks classify pharmacies and pharmaceutical sales under their own merchant category codes, and both Mastercard and Visa require the acquiring bank to register qualifying merchants before the first transaction runs. Processors want pharmacy agreements and prescriber documentation before they’ll board you, because the liability sits with the bank when the relationship isn’t documented.

Regulatory uncertainty. Telehealth prescribing rules are not settled. The Ryan Haight Act’s in-person examination requirement is still the default, the DEA and HHS have been extending flexibilities in temporary blocks - the current one runs to the end of 2026 - and state medical boards set their own rules on top. Underwriters don’t price today. They price the chance that the rule changes mid-contract and your chargeback profile moves with it.

Chargeback exposure from subscription fatigue. A patient who keeps paying for a service they stopped using eventually disputes several months at once, and often as one complaint filed with the bank rather than a refund request sent to you. In a per-visit consultation business, one unhappy patient is one transaction. In a subscription telehealth business, one unhappy patient can be six.

So the processor isn’t asking “is telehealth legitimate.” It’s asking “can I underwrite this specific business - this billing model, this licensing footprint, this fulfillment chain - at a price that covers the risk.” A lot of processors can’t. The ones that can are the ones we work with.

The decline reasons we see most often:

  1. 01
    Recurring billing with no clear disclosure. The checkout never states the renewal amount and frequency, and there’s no consent record. Underwriting reads the checkout flow before it reads anything else, and declines there.
  2. 02
    Prescription fulfillment the processor wasn’t told about. The application says “telehealth consultations.” The website sells a treatment plan with medication shipped to the patient. That’s a different category, and the mismatch kills the file.
  3. 03
    Licensing that doesn’t match the marketing. You advertise nationwide but hold licenses in a handful of states. Underwriting notices, and the answer changes.
  4. 04
    Controlled substances. Schedule II–V prescribing via telemedicine carries an entirely different risk profile under federal and state rules, and many processors won’t board it at all.
  5. 05
    MCC mismatch. The business gets coded as generic health services when the transactions are subscriptions, or as a pharmacy when it’s a consultation. Wrong code, wrong pricing, wrong monitoring program.
  6. 06
    A prior decline with no explanation attached. The merchant applied to a bank or a mainstream processor that doesn’t board telehealth, got declined, and now carries a decline with no context attached to it.

None of these are permanent. Most are a matter of applying to the right place with the right documentation, in the right order.

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03 / UNDERWRITING

What processors actually look at.

Eight things decide a telemedicine underwriting file. Everything else is conversation.

01

MCC assignment

The merchant category code isn’t paperwork - it decides interchange, which network rules apply, and which monitoring program watches the account. Telehealth consultation businesses typically land under 8011 (doctors and physicians) or 8099 (medical services and health practitioners, not elsewhere classified). When medication is dispensed or sold, the code moves to 5912 (drug stores and pharmacies) or 5122 (drugs, drug proprietaries and druggist sundries). A processor that codes a subscription telemedicine platform as generic medical services is guessing, and it will guess again when the monitoring thresholds get set.

02

Chargeback ratio and monitoring thresholds

Most processors work to an internal tolerance somewhere between 0.9% and 1.5% of transactions. That range isn’t arbitrary. Visa’s Acquirer Monitoring Program counts fraud reports and disputes against settled transactions, and Mastercard runs its own excessive-chargeback programs with different counting rules. A business running 0.5% is a different conversation from one running 1.4%. A ratio you don’t disclose that surfaces during underwriting is worse than a high ratio you explain upfront.

03

Business model: subscription or per-visit

A per-visit charge is a single transaction with a defined service attached to it. A subscription is an open-ended authorization. Same vertical, different risk. If you bill monthly, expect questions about renewal disclosure, the cancellation flow and the descriptor that lands on the patient’s statement.

04

What’s being sold

Consultation only. Consultation plus a compounded prescription. A program with supplements attached. Weight management, dermatology, men’s health, behavioral health. Each prices differently. A supplement component can pull a file into a separate product category entirely, even when the clinical service is unchanged.

05

State licensure footprint

Five states is not fifty. This moves rates and reserves more than almost anything else in the file, so it gets its own section below.

06

Pharmacy relationships

Which pharmacy, what licenses it holds, how prescriptions are transmitted, and who holds the dispensing relationship. Underwriting wants the agreement, not a description of it.

07

Geography

Where you’re incorporated, where your clinicians are licensed, where your patients are, and where you ship. A business licensed in 12 states and honest about it is easier to underwrite than one marketing nationwide with a footnote.

08

HIPAA documentation

Covered entities and their vendors generally need a business associate agreement where a third party creates, receives, maintains or transmits protected health information. Underwriting asks for the BAA with your telehealth platform, your EHR and your pharmacy partner, because those relationships define who can be breached and who can be named in a complaint.

04 / THE REGULATORY LAYER

The regulatory layer underwriters care about.

Under the Ryan Haight Act, passed in 2008, a practitioner generally must conduct at least one in-person medical evaluation before prescribing a controlled substance via the internet, unless a statutory exception applies. That in-person default has been suspended by a series of DEA and HHS temporary flexibilities. The most recent extension runs from January 1 through December 31, 2026, and it keeps the current flexibility in place: a DEA-registered practitioner may generally prescribe Schedule II–V controlled substances via telemedicine without a prior in-person exam, provided the prescription is for a legitimate medical purpose in the usual course of professional practice and the encounter meets the applicable conditions.

The flexibility is temporary, and the temporary part is what changes your risk profile.

A telemedicine business that never writes controlled substances is a service business with recurring billing. A telemedicine business that does is a service business with recurring billing, a DEA registration, state prescribing rules to follow, diversion risk, and a federal rule with a hard end date printed on it. That’s why the question sits on the application. It isn’t an accusation. It’s the line between two underwriting models.

Most processors will ask:

  • Do you prescribe, or facilitate prescribing of, any controlled substances?
  • Which schedules, and for which conditions?
  • Who holds the DEA registration - the platform, the prescriber, or both?
  • How is the prescription transmitted, and by whom?
  • What happens to the subscription if the federal flexibility lapses?

We treat those answers as fact-finding, not disqualification. Most processors that board controlled-substance telehealth at all will price it at the top of the range, hold a reserve at the higher end, and review the file more often. Several won’t board it under any terms, and finding that out in week one is better than finding it out after you’ve signed.

This section is general information, not legal or medical advice. Rules change, they differ by state, and they apply differently to different business models. Talk to a healthcare attorney about your own footprint.

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05 / STATE LICENSING

State licensing: the question that decides your file.

A telemedicine business licensed in five states and one licensed in fifty do not get underwritten the same way, even when the revenue, the average ticket and the chargeback ratio are identical.

Here’s why. Every state you operate in is a separate set of licensing rules, a separate medical board, a separate consumer-protection regime and, if you prescribe, a separate set of pharmacy and prescribing rules. For a processor, the count is a proxy for how much can go wrong at once. Five states means five regulators, five complaint channels and a bounded blast radius if something breaks. Fifty means fifty of each - and a compliance failure in one state doesn’t stay in that state. It becomes a news item, and news items become chargeback waves.

The practical gap in most telehealth files is that licensing is per-patient-location, not per-company. A clinician generally needs to be licensed in the state where the patient is when the visit happens. The Interstate Medical Licensure Compact gives eligible physicians an expedited path to licensure across 44 member states plus DC and Guam - 46 jurisdictions - but it is not one telemedicine license, and states outside the compact still have to be handled individually.

What that means at underwriting:

The fix is simple and it isn’t marketing. State your footprint accurately, list the licenses, and restrict the funnel to states you can legally serve. A 14-state footprint that’s documented and honest prices better than a 50-state claim that can’t be evidenced.

06 / RATES AND RESERVES

What telemedicine processing actually costs.

These are the ranges we see across the telehealth merchants we place. Your number depends on the eight factors above - treat this as a benchmark to sanity-check a quote against, not a price list.

Ranges reflect what we see in live telemedicine and telehealth placements. Per-visit consultation businesses sit at the low end of both rate and reserve. Subscription billing, prescription fulfillment and controlled substances push toward the high end.
Business typeTypical discount rateTypical rolling reserveTypical hold
Consultation-only, per-visit billing3.0% – 4.5%5% – 10%90 – 120 days
Membership telehealth, recurring subscription3.5% – 5.5%5% – 15%90 – 180 days
Telemedicine with prescription fulfillment4.5% – 6.5%10% – 15%120 – 180 days
Controlled-substance prescribing5.0% – 7.0%10% – 15%180 days
Program with supplement or OTC component4.0% – 6.5%10% – 15%90 – 180 days
Prior decline or elevated chargeback ratio5.5% – 7.0%+15%180 days

Chargeback thresholds. Most processors will flag an account somewhere between 0.9% and 1.5% of transactions, which is where the card networks’ monitoring programs start paying attention. Sit under that and pricing stays stable. Cross it and you’re looking at a reserve increase, a fee program or a shutdown.

Where prescriptions are dispensed. Both Visa and Mastercard require the acquiring bank to register qualifying pharmacy and non-face-to-face pharmaceutical merchants before transactions are submitted, and to monitor them afterward. Registration is the acquirer’s obligation, not yours - but ask your processor to confirm in writing that it’s completed before you run your first transaction, and which MCC will be used. A merchant account that boards without the registration in place tends to come apart later.

A telemedicine quote under 3% usually means the processor hasn’t underwritten the vertical properly. That surfaces later - as a sudden reserve, a shutdown, or a hold on your funds.

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07 / RECURRING BILLING

Recurring billing is the hard part.

Subscription telehealth attracts more scrutiny than any other billing model in the vertical, and most of the problem is avoidable.

The issue isn’t that subscriptions are risky. It’s that a subscription makes it possible for a patient to be charged for something they forgot they bought. Subscription fatigue is the slow version - the patient who meant to cancel in month three and disputes in month nine. Involuntary churn is the fast version - the card that declines, the retry that fails, the subscriber who never notices until the renewal lands on a statement they don’t recognize.

Both of them land on your chargeback ratio, and your chargeback ratio is what the processor is watching.

What keeps the ratio down:

We’ve watched telehealth merchants move from a ratio that put them into a monitoring program to one that sits comfortably under the threshold with those seven changes and nothing else. It’s operational work, not a pricing problem.

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08 / HOW IT WORKS

How the application works.

Five steps. A complete file typically gets a decision in 2 to 3 weeks, and the variable is documentation, not the processor.

  1. 1

    You submit the form.

    Six fields. We read it and come back with questions, usually the same day.

  2. 2

    We scope the business.

    A short conversation about billing model, licensing footprint, prescribing, pharmacy relationships and processing history. Fifteen minutes, not a sales call.

  3. 3

    We prepare the documents.

    This is where most telemedicine applications stall, and it’s where we add the most value. The full list is below.

  4. 4

    We send you matched processors.

    Two to four options with the reasoning attached - why each one fits, what they’ll likely price you at, and what they’ll ask for. Then you apply.

  5. 5

    Onboarding and the first reserve review.

    We stay available through boarding, the first reserve review and any underwriting follow-up. If something moves in month two, you have someone to call.

Expect to provide:

  • Business license and entity formation documents
  • EIN confirmation
  • Government ID for the signer
  • Bank statements - typically the last three to six months
  • Tax returns - typically the last one to two years
  • HIPAA documentation, including your business associate agreement with the telehealth platform, EHR and any vendor handling protected health information
  • State licensure for every clinician and every state you serve
  • Pharmacy agreements, where prescriptions are dispensed
  • Processing statements from your current or previous processor, if you have one
  • Website and checkout screenshots, including the subscription disclosure and refund policy

Timeline in practice: 2 to 3 weeks from complete application to live account. Files with prescription fulfillment or controlled substances sit at the longer end, mostly because the supporting documents take longer to assemble.

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09 / GOOD QUESTIONS

Telemedicine merchant account questions.

Can telemedicine businesses get a merchant account?

Yes, but not from a standard retail processor. A telemedicine merchant account needs a processor with a written telehealth policy, an acquiring bank that will board the category, and pricing built for card-not-present and recurring transactions. A mainstream account will either decline the application or approve it and shut it down once the subscription billing and prescription side of the business becomes clear.

Why is telemedicine considered high-risk?

Four things, usually together: recurring subscription billing with negative-option risk, prescription fulfillment that pulls the business into pharmacy territory and network registration rules, regulatory uncertainty around prescribing, and chargeback exposure that runs higher than in categories with a fixed, one-time product. Underwriters price the combination, not the word “telehealth.”

What rates should a telemedicine merchant expect?

Most telemedicine merchants land between 3% and 7% per transaction. Consultation-only, per-visit businesses sit near the bottom of that range. Subscription billing, prescription fulfillment and controlled-substance prescribing push toward the top. A quote under 3% for a telehealth business usually means the processor hasn’t underwritten the vertical properly, and that shows up later.

What is a rolling reserve, and why do I have to hold one?

A rolling reserve is a percentage of your monthly volume that the processor withholds to cover potential chargebacks. Typical telemedicine reserves run 5% to 15% held for 90 to 180 days, then released on a rolling basis. Reserves are standard in this vertical, they’re negotiable at review, and most processors will reduce or release them after a clean processing period.

Can I bill patients on a recurring subscription?

Usually yes, and it’s the most common telemedicine billing model - but it’s also the reason your file gets extra attention. Expect to document renewal disclosure, billing descriptor and cancellation flow. Clear disclosure and an easy cancel path are the difference between a subscription account that stays stable and one that trips a monitoring threshold in month six.

Do I need a medical license in every state I serve?

A clinician generally needs to be licensed in the state where the patient is located during the visit. The Interstate Medical Licensure Compact covers 44 states plus DC and Guam, but it isn’t a single telemedicine license - it’s an expedited path to individual state licenses, and states outside the compact have to be handled separately. For underwriting purposes, what matters is that your stated footprint matches the licenses you actually hold.

What if I prescribe controlled substances?

It narrows the field considerably. Only some processors board controlled-substance telehealth, and those that do typically price at the top of the range, hold a reserve at the higher end and review the account more often. Federal flexibilities that allow telemedicine prescribing without a prior in-person exam currently run through December 31, 2026, and state rules can be stricter. Disclose it on the application - a controlled-substance program that surfaces during underwriting after being left off is a guaranteed decline.

My application was declined. Can I still get an account?

Usually, yes - most declines are a fit problem, not a permanent record. The two most common causes are applying to a processor without a telehealth policy and applying with incomplete documentation. Tell us what was submitted and who declined it, and we’ll figure out which processors can actually board your specific model. If your account was declined or shut down, start there.

How long does approval take?

A complete application typically gets a decision in 2 to 3 weeks. The variable is documentation, not the processor. If your entity documents, EIN, bank statements, tax returns, HIPAA agreements, state licenses and pharmacy agreements are assembled before you apply, you sit at the fast end. If underwriting has to chase paperwork, you sit at the slow end.

Do I need LegitScript certification?

It depends on what you do and who you process with. Many processors require LegitScript healthcare merchant certification for telemedicine businesses that prescribe or facilitate prescriptions, and LegitScript is one of the accepted certifying organizations under the card networks’ healthcare merchant rules. Consultation-only services are sometimes treated differently. Ask your processor in writing whether certification is required, which organization is accepted, and which MCC will be assigned before you pay for anything.

10 / NEXT STEP

Let’s find your processor.

Tell us about the business - billing model, states you’re licensed in, what you prescribe and how you fulfill it. We’ll come back with the processors that fit, and tell you plainly when one doesn’t.

Find my processor Call 312-219-4855

Telemedicine is one of several verticals we cover - browse the full list of high-risk payment processing industries.

Free to use · Team responds ASAP · We’re paid by the processor, not you.

This page is general information about payment processing. It is not legal, medical or tax advice, and it is not a promise of approval. Ranges are benchmarks, not offers.

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