Statutory & financial benchmarks
| Item | Typical benchmark | Notes |
|---|---|---|
| Pay-per-exam telehealth GFE | $27–$35 per completed clearance | Network NP, PA or physician; billed to the practice, often passed through in the ticket. |
| Exam length | 5–15 minutes | Longer for complex histories, NAD+ or high-dose vitamin C candidates. |
| Turnaround | Minutes to same day | On-demand networks; scheduled exams for group events the day before. |
| Renewal, unchanged wellness protocol | 6–12 months | Earlier on any change in health history, medications or pregnancy status. |
| Renewal, prescription add-ons | Commonly per encounter | Ondansetron, ketorolac and similar agents are usually ordered for the specific visit. |
| Group event pre-clearance | 24–72 hours before the event | Avoids on-site bottlenecks and lets the prescriber decline candidates in advance. |
What a Good Faith Exam is, legally
“Good Faith Exam” is industry shorthand, not a term defined the same way in every statute. It describes the evaluation a licensed prescriber performs to establish a practitioner-patient relationship before ordering treatment: a health history, medication and allergy review, a focused assessment and a documented decision. Medical boards generally treat prescribing without that evaluation as unprofessional conduct.
For IV therapy the exam answers three questions. Is this person a candidate for IV fluids and the requested additives? Are there contraindications such as heart failure, advanced kidney disease, pregnancy without obstetric clearance or known G6PD deficiency for high-dose vitamin C? And exactly what is the nurse authorized to give, at what dose and how often?
Who can perform the exam, prescribe and administer
The RN is the most visible person at the visit but has the narrowest legal role in the clearance. RNs perform nursing assessments and can stop an infusion for safety, but they cannot diagnose a medical condition or originate an order, so they cannot clear a patient on their own.
| Role | Perform GFE | Write the order | Start the IV and administer | Notes |
|---|---|---|---|---|
| MD / DO | Yes | Yes | Yes | Licensed in the patient’s state |
| Nurse practitioner | Yes | Yes, within state authority | Yes | Collaboration or supervision required in reduced and restricted states |
| Physician assistant | Yes | Yes, under state PA rules | Yes | Supervision or collaboration agreement required |
| Registered nurse | No (nursing assessment only) | No | Yes, on a valid order | May act on standing orders after a prescriber has cleared the patient |
| LPN / LVN | No | No | Varies widely by state | Many states limit LPN IV push and IV therapy without certification |
Synchronous video vs asynchronous screening by state
Synchronous means a live, real-time audio-video encounter. Asynchronous means the patient completes a questionnaire that a prescriber reviews later. Telehealth laws in most states accept synchronous video for establishing a relationship; acceptance of questionnaire-only screening for a first IV order is far less consistent, and several boards have signalled they expect a real exam before elective IV therapy.
| GFE strictness (our data) | States | Practical standard |
|---|---|---|
| Strict | California, Texas, New York, Illinois, North Carolina, New Jersey, South Carolina, Alabama, Kentucky | Synchronous exam by an MD, DO, NP or PA before every new patient and every prescription drip; document it before the needle goes in |
| Standard | The other 21 states in our data, including Florida, Arizona, Nevada, Colorado and Ohio | Prescriber order plus a documented GFE; telehealth accepted; renewal per medical director protocol |
The prescriber must be licensed in the state where the patient is physically located at the time of the exam, not where the company is based. Federal Ryan Haight Act rules on in-person exams concern controlled substances, which standard IV menus avoid, but state telehealth and board rules still apply in full. Texas passed elective IV hydration legislation in 2025 (widely reported as Jenifer’s Law); review the current statute and Texas Medical Board rules for the exact assessment and supervision requirements before you finalize a Texas workflow.
When in doubt, choose synchronous video for every first exam. It satisfies the strict states and costs the same on most networks.
A clearance workflow that holds up
- Intake at booking: history, medications, allergies, pregnancy status, prior IV reactions, and red-flag conditions (heart failure, dialysis, uncontrolled hypertension, G6PD deficiency).
- Synchronous exam: the prescriber reviews intake on video, asks follow-up questions and records findings.
- Order: the prescriber approves specific protocols, dose ceilings and any prescription add-ons, or declines with a reason.
- Chart transfer: the GFE note and order land in your charting system before the visit, not in an email inbox.
- Bedside check: the RN confirms identity, reviews interval changes and takes vitals against protocol cutoffs; any change goes back to the prescriber.
- Renewal tracking: the system flags expiring clearances and any patient whose history changed.
Pair the workflow with clear standing orders and vital sign cutoffs so the nurse knows exactly when to hold an infusion.
What the GFE record must show
When a complaint reaches a board, the GFE note is the first document requested. A one-line “cleared for IV” entry protects no one. The record should let a reviewer reconstruct who examined the patient, from where, and what they decided.
| Element | Why reviewers look for it |
|---|---|
| Prescriber name, credential and licence state | Confirms the exam was done by someone licensed where the patient was located |
| Date, time and modality (video, audio, in person) | Shows whether the exam was synchronous and precedes the infusion |
| Patient location at the time of the exam | Determines which state’s rules and licence apply |
| History, medications, allergies, pregnancy status | Shows contraindications were screened |
| Assessment and decision | Approved protocols, dose ceilings, exclusions or a documented decline |
| Prescription add-ons ordered | Links any ondansetron, ketorolac or similar agent to a specific order |
| Renewal date | Lets staff and software block expired clearances |
Keep the GFE record in the same chart as the infusion record. A note stored only on the telehealth vendor’s platform may be hard to retrieve years later, and state medical record retention periods are often measured in years after the last visit.
Renewal intervals and economics
There is no national renewal rule. Most medical directors set 6–12 months for a patient receiving an unchanged wellness protocol and require a new exam whenever something material changes. Prescription agents such as ondansetron or ketorolac are usually ordered for the specific encounter.
| Scenario | Typical requirement | Cost impact at $30/GFE |
|---|---|---|
| New patient, any drip | Full GFE before first infusion | $30 once |
| Returning patient, same protocol, no history change | Renew every 6–12 months per protocol | ≈ $2.50–$5 per monthly member visit |
| Returning patient adds a new protocol (for example NAD+) | New or updated exam | $30 |
| Prescription add-on (ondansetron, ketorolac) | Encounter-specific order | $30 per visit unless the prescriber is on site |
| New medication, diagnosis, pregnancy or prior reaction | New exam before next drip | $30 |
At $27–$35 per exam, the GFE is usually 10%–15% of a first-visit ticket and a small fraction of repeat visits. Model it for your state and volume in the provider calculator, or request a GFE network through the partner intake.
Step-by-step GFE program setup
- Confirm your state standardCheck whether your board expects a synchronous exam before every new patient and every prescription drip.
- Choose a GFE networkPrescribers licensed in every state you serve, synchronous video, documented turnaround times.
- Sign a business associate agreementThe network handles protected health information on your behalf.
- Align with your medical directorThe director approves the screening questions, decline criteria and renewal interval.
- Integrate the recordExam notes and orders should flow into the chart and be visible to the RN before the visit.
- Set renewal rules in softwareAutomatic flags for expiry and for any change in history, medications or pregnancy status.
- Train nurses on the boundaryRNs reassess and can hold, but never clear a patient or add an unordered component.
- Issue Good Faith EstimatesGive self-pay patients a written estimate of expected charges where the No Surprises Act requires it.
- Audit monthlySample charts to confirm every infusion had a valid, unexpired exam and order.
Common regulatory audit traps
Questionnaire-only clearance
A form reviewed hours later, or never, does not satisfy boards that expect a real exam. Use synchronous video for every first clearance unless counsel confirms otherwise for your state.
Prescriber licensed in the wrong state
Telehealth networks sometimes route exams to the next available clinician regardless of licence. Require proof that the prescriber was licensed where the patient sat.
RN clearing patients
Charts that show the nurse deciding a patient was fit, or adding ondansetron because the patient felt nauseated, describe practice beyond RN scope. Escalate to the prescriber and document the new order.
Expired clearances
Repeat clients drift past the renewal date unnoticed. Build an automatic hold into scheduling when a GFE expires.
Confusing the two GFEs
Practices that assume the exam covers price disclosure miss the No Surprises Act Good Faith Estimate. Keep a template estimate for self-pay patients booking ahead.
Run your state’s compliance and margin model
Pick your state, licence, model and volume to see the required entity structure, medical director retainer, GFE and 503B supply costs, and net margin, then get matched with the network.
State rules that matter most here
Frequently asked questions
What is a Good Faith Exam for IV therapy?
It is an evaluation by a licensed prescriber, typically an MD, DO, NP or PA, that reviews the patient’s history and decides whether IV therapy is appropriate. It establishes the practitioner-patient relationship that makes the nurse’s administration lawful.
Can a registered nurse perform the GFE?
No. An RN can do a nursing assessment and can hold an infusion for safety, but cannot diagnose or originate an order. Clearance has to come from a prescriber.
Is a telehealth GFE valid?
In most states a synchronous audio-video exam by a prescriber licensed where the patient is located is accepted. Questionnaire-only screening is less consistently accepted, especially in the strict states in our data.
How long is a GFE valid?
Commonly 6–12 months for an unchanged wellness protocol, as set by the medical director. A new exam is needed for new protocols, prescription add-ons and any change in health history.
How much does a GFE cost?
Pay-per-exam telehealth networks typically charge $27–$35 per completed clearance. Many practices build the cost into the first-visit price rather than itemizing it.
Do group events need individual exams?
Yes. Each participant needs their own exam and order, ideally completed 24–72 hours before the event so declined candidates are known in advance.
Sources & standards reviewed
- No Surprises Act: Good Faith Estimates for uninsured and self-pay individuals Centers for Medicare & Medicaid Services
- Telemedicine policy and appropriate use of telemedicine technologies Federation of State Medical Boards
- Ryan Haight Online Pharmacy Consumer Protection Act of 2008 U.S. Drug Enforcement Administration
- Texas House Bill 3749 (2025), elective IV hydration Texas Legislature
- Nursing scope of practice resources National Council of State Boards of Nursing
Reviewed under the IVConnection clinical and regulatory review policy. Report a correction to clinical@ivconnection.com.