Background : Despite high HCV prevalence, persons on opiate agonist therapy (OAT) rarely engage in HCV care. Although onsite HCV care has increased efficacy, most OAT programs refer patients offsite for HCV care. Telemedicine permits direct interaction between patients and specialists in distinct locations. We used telemedicine for HCV treatment of OAT patients. Methods: After HCV-related education, HCV RNA (+) patients are evaluated via telemedicine. During weekly telemedicine encounters, a physician assistant located onsite and a liver specialist located remotely both review and enter patient data directly into the patient's electronic health record. Direct acting antivirals (DAA) are ordered through a specialty pharmacy, delivered to the OAT program, and co-administered with methadone using directly observed therapy. Visit charges are submitted electronically . Patient satisfaction was assessed by the telemedicine satisfaction questionnaire (TSQ). Results: To date , 24 HCV RNA (+) patients received an evaluation via telemedicine. Mean age was 61 years, 71% were male, 79% were African-American, and 25% Hispanic. All patients were stable on methadone . Fibrosis was mild, stage 0 or 1 in 6/22 (27%); moderate, stage 1-2 or 2 in 10/22 (45%); and severe, stage ≥ 3 in 6/22 (27%) patients. To date, 15 patients have initiated treatment . Twelve patients have completed therapy all with undetectable HCV RNA, 3 of whom achieved virus cure. TSQ was completed by 22 patients. A majority (82%) agreed or strongly agreed that consultation via computer was easier and more convenient than going to an offsite clinic, all patients indicated the computer consultation met their medical needs, and the vast majority (95.5%) indicated that talking to the doctor over the computer was as satisfying as consultation in person. Conclusions: Telemedicine-based HCV care is a feasible, reimbursable model for HCV treatment delivery in an OAT program with excellent patient acceptance.