How to keep prescribing controlled substances by video after Dec. 31
Book each video-only patient one in-person medical evaluation, for any medical concern. Then you can prescribe to that patient by video with no time limit.
Co-founder, JotPsych
If you prescribe stimulants or benzodiazepines by video to patients you've never met in person, those prescriptions depend on a temporary DEA rule. The rule ends December 31, 2026.
Stimulant prescribed by video
No in-person visit with the prescriber
One in-person visit by December 31
Stimulant prescribed by video
One in-person visit with the prescriber
Video prescribing continues
An illustration, not a measurement. The first patient needs one in-person visit with the prescriber before the rule ends, and the second patient's video prescriptions do not depend on the rule under federal law.
The Ryan Haight Act, a federal law, requires an in-person medical evaluation before you prescribe a controlled substance by video. Temporary rules have let you skip that visit since March 2020. The DEA's fourth extension set the current end date.
Four steps before December 31
- Find your video-only patients on a controlled substance. Start with your stimulant and benzodiazepine prescriptions. Then check whether each patient has had an in-person visit with you. Visits from years ago count.
- Book each one an in-person visit with you. One visit is enough. The Ryan Haight requirements then "no longer apply to that specific practitioner-patient relationship," the DEA writes. You can keep prescribing to that patient by video with no time limit.
- Make the visit a medical evaluation. You can keep prescribing by video even if "that evaluation was for a separate medical concern," the DEA writes.
- Treat December 31 as the temporary DEA rule's end date. The DEA's final rule on special registrations reached White House review on August 25, 2026, and was still there on October 2, per the review record. Don't wait for that rule.
Under the DEA's 2025 proposal, special registrations would replace the in-person visit. One registration would cover Schedule III to V drugs, such as benzodiazepines. For Schedule II stimulants, you'd need the advanced registration. Psychiatrists could hold it. So could nurse practitioners board certified in treating psychiatric disorders.
Dates from the DEA's fourth extension, the White House review record, and the Consolidated Appropriations Act, 2026. The DEA's temporary rule ends a year before Medicare's telehealth flexibilities.
Once Medicare's telehealth flexibilities end, established Medicare patients will need an in-person visit at least every 12 months. Without one, Medicare won't pay for their mental health video visits. You'll find a few exceptions in the telehealth questions and answers from the Centers for Medicare & Medicaid Services (CMS).
Book the visit in JotPsych with Session set to In-person, and the appointment records place of service 11.
See JotPsych- DEA and Department of Health and Human Services, Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, 90 Federal Register 61301, December 31, 2025; the in-person evaluation passage is on page 61302.
- DEA, Special Registrations for Telemedicine and Limited State Telemedicine Registrations, proposed rule, 90 Federal Register 6541, January 17, 2025: the three registrations and who could hold each; read October 20, 2026.
- 21 CFR 1308.12, Schedule II, paragraph (d), stimulants, via the Legal Information Institute, Cornell Law School; read October 20, 2026.
- Office of Information and Regulatory Affairs, review record for the DEA special registration final rule (Regulation Identifier Number 1117-AB40), received August 25, 2026, still under review when read October 2, 2026.
- Public Law 119-75, Consolidated Appropriations Act, 2026, Division J, section 6209.
- CMS, Medicare telehealth frequently asked questions, updated October 8, 2026, answer 5 on in-person visits for mental health services; read October 20, 2026.