A single state medical licence costs $700 to $1,900 in total, and credentialing with one insurance payer costs $100 to $500. Most states split the licence cost into a non-refundable application fee and a separate initial licence fee: California is $674 plus $1,176, Texas is $895 at submission, Florida is $350 plus $355. The Interstate Medical Licensure Compact adds a flat $700 per Letter of Qualification on top of each state's own fee.
Medicare charges a $750 enrollment application fee for 2026. Commercial payer applications are free; what you pay for is the work of preparing and chasing them. A telehealth practice covering 10 to 20 states should budget $8,000 to $15,000 per clinician before any specialist's fee.
How much does a state medical licence cost?
Most states charge between $700 and $1,900 in total, but almost no state charges it as a single fee. Nearly every board splits the cost into a non-refundable application fee and a separate initial licence fee due only once the application is approved, plus surcharges.
This is why published figures for the same state disagree so widely. One source quotes the application fee, another the licence fee, a third the combined total. The figures below are the boards' own, decomposed.
| State | Application fee | Initial licence fee | Total at issuance | Source |
|---|---|---|---|---|
| Florida | $350 | $355 | $705 plus NICA | Board of Medicine |
| Texas | $867 | Included | $895 with surcharges | TMB |
| Nevada | $600 | $375 to $750 | $1,050 to $1,425 | NSBME |
| California | $674 | $1,176 | $1,850 | MBC |
California: $1,850
$674 application including $49 fingerprinting, then $1,176 before issuance including a mandatory $25 Thompson Loan Repayment contribution. Postgraduate trainees qualify for roughly 50% off the licence fee.
Texas: $895
Raised to $867 on 1 September 2025, inclusive of the Jurisprudence Exam, plus a $21 NPDB surcharge and a $7 Physician Health Program fee, all due at submission.
Florida: $705 + NICA
$350 non-refundable at application, $355 for the initial licence. The NICA assessment is separate: $250 or $5,000 depending on participation.
Nevada: $1,050 to $1,425
$600 application processing, a $375 to $750 registration fee that depends on issuance date, and a $75 criminal background investigation.
Budget the total, not the application fee. The most common error is planning around the number on the application page and being surprised by an initial licence fee that is often larger. In California the second payment is nearly double the first.
Across the states participating in the Interstate Medical Licensure Compact, individual licence fees range from $35 to $895. For a full cross-state comparison, the Federation of State Medical Boards maintains a licensure fees and requirements table.
How much does the Interstate Medical Licensure Compact cost?
The IMLC charges a flat $700 per Letter of Qualification, on top of each state's own licence fee. The Compact removes duplicated primary source verification; it does not remove the per-state licence or its fee.
Pay the $700 LOQ fee
Your State of Principal Licence verifies eligibility and issues a Letter of Qualification valid for a set window.
Select member states
Each state's own fee applies, from $35 to $895. Licences issue without repeating verification.
Do the maths
For one additional state the saving is marginal. For four or more, the Compact is usually clearly worth it.
How much does credentialing cost per payer?
Market rates for credentialing support run $100 to $500 per payer per provider. The payer applications themselves are generally free; you are paying for preparation, submission and follow-up.
Medicare is the exception with a real government fee: the CMS enrollment application fee is $750 for calendar year 2026, set annually and adjusted for inflation. CAQH ProView, which most commercial payers draw from, is free for providers.
Ongoing costs are real. Commercial payers re-credential every two to three years, Medicare revalidates every five, and CAQH must be re-attested every 120 days. A practice with ten clinicians across six payers is running re-credentialing continuously.
What does a multi-state telehealth practice actually spend?
A telehealth clinician needing 10 to 20 state licences should budget $8,000 to $15,000 in board fees alone, before any specialist's service fee. Add payer enrollment in each state on top.
| Scenario | Board fees | Credentialing | Realistic range |
|---|---|---|---|
| Solo therapist, 1 state, 5 payers | $300 to $700 | $500 to $2,500 | $800 to $3,200 |
| Physician, 3 states via IMLC | $700 + $105 to $2,685 | $300 to $1,500 | $1,100 to $4,900 |
| Telehealth clinician, 15 states | $8,000 to $15,000 | $1,500 to $7,500 | $9,500 to $22,500 |
| Group of 8, entering 3 new states | $12,000 to $30,000 | $4,000 to $20,000 | $16,000 to $50,000 |
How long does each step take?
Plan for 90 to 150 days handling credentialing yourself, and 60 to 120 days with someone who does it daily. State licensure varies from a few weeks to several months by board.
State licence
Four to sixteen weeks depending on the board. The IMLC's own figure is roughly 19 days once the Letter of Qualification is issued.
CAQH profile
Days to set up. The risk is neglect: a missed 120-day re-attestation silently stalls every application attached to it.
Commercial payer
60 to 150 days. The variance is almost entirely responsiveness to document requests, not review time.
Medicare
30 to 60 days through PECOS when the application is complete. Retroactive billing up to 30 days in defined circumstances.
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Juney Ham is the founder and CEO of Telesure, the marketplace that matches clinicians with independent licensing and credentialing specialists. Previously co-founder of Upside and CMO at Hired. Every regulatory figure on this page is taken from the issuing state board, compact commission or CMS and was verified on 14 September 2026. Fees and compact status change; confirm with the relevant board before relying on them.
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