In response to the COVID-19 pandemic, many music therapists in the United States turned to telehealth music therapy sessions as a strategy to continue services with older adults. However, the nature and perception of telehealth music therapy services for this age group are unknown. The purpose of this study was to describe music therapy telehealth practices with older adults in the United States including information related to session implementation, strengths and challenges, and adaptations to clinical practice. Of the 110 participants in the United States who responded to the survey (25.2% response rate), 69 reported implementing telehealth music therapy services with older adults and responded to a 32-item survey. Quantitative and qualitative analyses were conducted. Results indicated that while all participants had provided telehealth music therapy for no more than 6 months, their experiences with telehealth varied. Based on participant responses, telehealth session structure, strengths, challenges, and implemented changes are presented. Overall, 48% of music therapists reported that they planned to continue telehealth music therapy with older adults once pandemic restrictions are lifted. Further study on the quality, suitability, and acceptability of telehealth services with older adults is recommended.