Tennessee Telemedicine & Telehealth Reimbursement Overview

Provider Reimbursement Eligibility
Consent for Telemedicine Live Video Reimbursement Store & Forward Reimbursement Originating Site & Transmission Fees Eligible Practitioners
State Law

No Reference Found

Tenn. Code Ann. § 56-7-1002 states that “Telehealth”  includes the use of real-time, interactive audio, video telecommunications.

Tenn. Code Ann. § 56-7-1002 states that “Telehealth”  includes store-and-forward telemedicine services that are defined as:

(A)the use of asynchronous computer-based communications between a patient and healthcare services provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients; and
(B)  Includes the transferring of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image that is sent or forwarded via telecommunication to another site for consultation;

Tenn. Code Ann. § 56-7-1002 requires that both originating sites and distant sites be a “Qualified site”, defined as the office of a healthcare services provider, a hospital licensed under Title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, any facility licensed under Title 33, or any other location deemed acceptable by the health insurance entity;

Tenn. Code Ann. § 56-7-1002. states that “Healthcare services provider” means an individual acting within the scope of a valid license issued pursuant to Title 63 or any state-contracted crisis service provider employed by a facility licensed under Title 33;

Medicaid

No Reference Found

Tenn. Code Ann. § 56-7-1002 includes managed care organizations under the definition of “Health Insurance Entities” and TennCare is Tennessee’s Medicaid program that is administered through various managed care organizations.  This law states that “Telehealth”  includes the use of real-time, interactive audio, video telecommunications.

Tenn. Code Ann. § 56-7-1002 includes managed care organizations under the definition of “Health Insurance Entities” and TennCare is Tennessee’s Medicaid program that is administered through various managed care organizations.  This law states that “Telehealth”  includes store-and-forward.

Tenn. Code Ann. § 56-7-1002 includes managed care organizations under the definition of “Health Insurance Entities” and TennCare is Tennessee’s Medicaid program that is administered through various managed care organizations.  These organizations are required to comply with state law.

Due to TennCare being administered through Managed Care Organizations.  Each insurer that offers a TennCare plan has a unique policy, but it is required to comply with Tenn. Code Ann. § 56-7-1002. 

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Provider Reimbursement Eligibility
Consent for Telemedicine
State Law

No Reference Found

Medicaid

No Reference Found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Tenn. Code Ann. § 56-7-1002 states that “Telehealth”  includes the use of real-time, interactive audio, video telecommunications.

Medicaid

Tenn. Code Ann. § 56-7-1002 includes managed care organizations under the definition of “Health Insurance Entities” and TennCare is Tennessee’s Medicaid program that is administered through various managed care organizations.  This law states that “Telehealth”  includes the use of real-time, interactive audio, video telecommunications.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Tenn. Code Ann. § 56-7-1002 states that “Telehealth”  includes store-and-forward telemedicine services that are defined as:

(A)the use of asynchronous computer-based communications between a patient and healthcare services provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients; and
(B)  Includes the transferring of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image that is sent or forwarded via telecommunication to another site for consultation;

Medicaid

Tenn. Code Ann. § 56-7-1002 includes managed care organizations under the definition of “Health Insurance Entities” and TennCare is Tennessee’s Medicaid program that is administered through various managed care organizations.  This law states that “Telehealth”  includes store-and-forward.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

Tenn. Code Ann. § 56-7-1002 requires that both originating sites and distant sites be a “Qualified site”, defined as the office of a healthcare services provider, a hospital licensed under Title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, any facility licensed under Title 33, or any other location deemed acceptable by the health insurance entity;

Medicaid

Tenn. Code Ann. § 56-7-1002 includes managed care organizations under the definition of “Health Insurance Entities” and TennCare is Tennessee’s Medicaid program that is administered through various managed care organizations.  These organizations are required to comply with state law.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

Tenn. Code Ann. § 56-7-1002. states that “Healthcare services provider” means an individual acting within the scope of a valid license issued pursuant to Title 63 or any state-contracted crisis service provider employed by a facility licensed under Title 33;

Medicaid

Due to TennCare being administered through Managed Care Organizations.  Each insurer that offers a TennCare plan has a unique policy, but it is required to comply with Tenn. Code Ann. § 56-7-1002. 

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Telemedicine CPT Codes

Unique CPT codes do not exist specifically for telemedicine or telehealth. Instead a modifier is applied to existing codes.

  • For interactive audio and video sessions, place a GT modifier in front of the CPT codes you typically use for in person services.
  • For services provided via an asynchronous telecommunication system, simply add a GQ modifier in front of the CPT codes you typically use for in person services.

Telehealth Parity

Yes. Telehealth services shall be reimbursed for at least the same rate as an in-person session. See TN House Bill 2331

Definitions

Telehealth Parity

Telehealth services are equal to in person services and reimbursed at the same rate.

Asynchronous Communication

The exchange of messages, such as among the hosts on a network or devices in a computer, by reading and responding as schedules permit rather than according to some clock that is synchronized for both the sender and receiver or in real time. Email, chat and text messaging are primary examples of asynchronous communication.

Distant or Hub Site

The location or site where the practitioner or provider is located while utilizing telemedicine services to meet with patients.

Originating Site

The location of the patient at the time services are provided. An originating site can be the client's home or a public facility like a rural hospital or physician's office. Many payors will reimburse for an originating site fee if it meets specific requirements. Rural use cases provide an applicable example for an eligible originating site fee where the patient will go to a local medical facility like a primary care physician's office and meet with a specialist located in distant urban health facility.

Additional Telemedicine Resources

Telehealth and telemedicine are fast growing and changing segments. Both state licensure and state legislation are changing rapidly along with federal legislation and for this reason the information provided cannot be considered legal advice. We make every attempt to keep state specific information up to date, but encourage you to validate this information through the following sites: