State licensing for teleradiology
Where you need a medical license to read remotely, how the Interstate Medical Licensure Compact speeds up extra licenses, and why hospital privileges are a separate step.
Last reviewed November 2026.
The license follows the patient
Medical boards treat the practice of medicine as taking place where the patient is. The Federation of State Medical Boards says so in its telemedicine policy, and the American College of Radiology's white paper on teleradiology applies the same idea to reading images: a radiologist generally needs a license from the state where the patient was imaged.
The rules for the state you read from vary. Check with that state's medical board before you start reading from a new location.
What a listing tells you
Each listing on Telerad.jobs names the state licenses the work requires. A remote job that covers several states lists each one, and it appears under each of those states when you browse jobs by state. On your profile you can record each license you hold and the date it expires, and we email you a reminder before that date.
The Interstate Medical Licensure Compact
The compact is a faster way to get a full license in other member states. It is not one license that covers many states. You apply once, and each state you choose issues its own license.
To use it you need a State of Principal License: a member state where you hold a full, unrestricted license and that is at least one of your primary residence, the state where at least 25 percent of your practice takes place, the state where your employer is located, or your state of residence for federal income tax. You must also:
- have graduated from an accredited medical school, or one listed in the International Medical Education Directory;
- have completed graduate medical education accredited by the ACGME or the AOA;
- have passed each component of the USMLE, COMLEX-USA or an equivalent in no more than three attempts;
- hold a current specialty certification, or a time-unlimited certification, from an ABMS or AOABOS board;
- have no history of disciplinary action on a medical license, no criminal history and no history of controlled-substance actions on a license, and not be under investigation.
As of October 31, 2026, the compact's commission counted 44 member states, the District of Columbia and Guam. Not every state is a member, and a few members have passed the compact but do not issue licenses through it yet. The commission's site shows each state's status.
The commission lists a $700 application fee, plus each state's own license fee. Adding a state later costs $100 plus that state's fee. Fees change, so check the commission's fee page before you apply.
How long a license takes
Processing time differs by state and by how complete the application is. As one example, the North Carolina Medical Board reported in June 2026 that its traditional applications averaged about 70 days, and that licenses through the compact averaged nine days once the board had the application.
Privileges are a separate step
A license lets you practice in a state. Each hospital whose studies you read also has to grant you privileges. Federal rules let a hospital's governing body rely on the credentialing and privileging decisions of the distant hospital or telemedicine entity you work through, under a written agreement. This is often called credentialing by proxy. The hospital still grants the privileges, and you still need a license issued or recognized by the state where that hospital is.
Reading from outside the United States
Medicare does not pay for services furnished outside the United States. Its manual gives the example of a radiologist abroad reading studies performed here: neither the radiologist nor the U.S. facility is paid for that work. For this rule the United States includes the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands and American Samoa.
Sources
- Federation of State Medical Boards, The Appropriate Use of Telemedicine Technologies in the Practice of Medicine (April 2022)
- American College of Radiology, ACR White Paper on Teleradiology Practice (2013)
- Interstate Medical Licensure Compact Commission, Do I qualify?
- Interstate Medical Licensure Compact Commission, What does it cost?
- Interstate Medical Licensure Compact Commission, Frequently asked questions
- North Carolina Medical Board, IMLC: a faster path to NC licensure (June 2026)
- Code of Federal Regulations, 42 CFR 482.22(a)(3) and (a)(4), medical staff: telemedicine credentialing and privileging
- Centers for Medicare & Medicaid Services, Medicare Benefit Policy Manual, chapter 16, section 60: services not provided within the United States
This guide is general information, not legal, tax or insurance advice. Rules and figures change; the sources above are the place to check them.