Tennessee

At A Glance

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MEDICAID REIMBURSEMENT

Live Video: Yes
Store-and-Forward: No
Remote Patient Monitoring: No
Audio Only: Yes

PRIVATE PAYER LAW

Law Exists: Yes
Payment Parity: No

PROFESSIONAL REQUIREMENTS

Licensure Compacts: ASLP-IC, CC, DLC, EMS, IMLC, NLC, OT, PA, PSY, PTC, SW
Consent Requirements: Yes

STATE RESOURCES

Medicaid Program: TennCare
Administrator: Dept. of Human Services
Regional Telehealth Resource Center: South Central Telehealth Resource Center

Private Payer

Last updated 08/27/2024

Definitions

“Telehealth”:

Means the use of real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:
- Such provider is at a qualified site other than the site where the patient is located; and
- he patient is at a qualified site, at a school clinic staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section, or at a public elementary or secondary school staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section; and
Does not include:
- Audio only conversation;
- An electronic mail message; or
- Facsimile transmission;

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Aug. 2024).

“Provider-based telemedicine”:

Means the use of Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant real-time, interactive audio, video telecommunications, or electronic technology, or store-and-forward telemedicine services, used over the course of an interactive visit by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:
- The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient;
- The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and
  - The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system and the patient prior to the interactive visit;
  - The healthcare services provider, the healthcare services provider’s practice group, or the healthcare system is able to render the healthcare services through an in-person encounter; and
  - The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system and the patient prior to the interactive visit does not apply to a patient who is receiving an initial behavioral health evaluation or assessment;

Does not include:
- An audio-only conversation;
- An electronic mail message or phone text message;
- A facsimile transmission;
- Remote patient monitoring; or
- Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity’s business.

Notwithstanding subdivisions (a)(6)(A) and (B), includes Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of:

Behavioral health services when the means described in subdivision (a)(6)(A) are unavailable; and
Healthcare services when the means described in subdivision (a)(6)(A) are unavailable;

SOURCE: TN Code Annotated, Sec. 56-7-1003 as amended by HB 2857 & SB 1881, (2024 Session), (Accessed Aug. 2024).

Workers Compensation

“Telehealth” means the distribution of health-related services and information via electronic information and telecommunication technologies.

“Telemedicine” means the use of telehealth by a telehealth provider to provide clinical health care.

SOURCE: TN Admin Code 0800-02-31.02, (Accessed Aug. 2024).

Telehealth: the definitions, licensing and processes for the purpose of these Rules shall be the same as adopted by the Tennessee Department of Health and Medicare. The maximum reimbursement for services provided via telehealth is the lesser of billed charges or the amounts listed in this fee schedule. Services that are eligible to be provided via telehealth are identified with a star (★) in the rate tables.

SOURCE: TN Admin Code 0800-02-17.05, (Accessed Aug. 2024).

Last updated 08/27/2024

Parity

SERVICE PARITY

Provider-based Telemedicine

A health insurance entity:

Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine;
Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and
Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Sec. 56-7-1003 (Accessed Aug. 2024).

Telehealth Services

A health insurance entity:

Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through telehealth;
Shall reimburse a healthcare services provider for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
Shall not exclude from coverage a healthcare service solely because it is provided through telehealth and is not provided through an in-person encounter between a healthcare services provider and a patient; and
Shall reimburse healthcare services providers who are out-of-network for telehealth care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002. (Accessed Aug. 2024).

Remote patient monitoring

A health insurance entity may consider any remote patient monitoring service a covered medical service if the same service is covered by Medicare. The appropriate parties may negotiate the rate for these services in the manner in which is deemed appropriate by the parties.

Reimbursement of expenses for covered remote patient monitoring services must be established through negotiations conducted by the health insurance entity with the healthcare services provider, healthcare system, or practice group in the same manner as the health insurance entity establishes reimbursement of expenses for covered healthcare services that are delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1011, (Accessed Aug. 2024)

Worker’s Compensation

Except when a medical fee waiver in accordance with Rule 0800-02-17-.18 is obtained from the bureau, nothing in this Chapter 0800-02-31 shall require an employer to pay a total reimbursement for a telehealth encounter for workers’ compensation, including the use of telehealth equipment, in an amount exceeding the amount that would be paid for the same service provided by a healthcare services provider during an in-person encounter under the medical fee schedule set forth in Chapters 0800-02-17, 18, and 19. The medical fee schedule, including but not limited to Tennessee specific conversion percentages, shall apply to the providers of telehealth services rendered pursuant to the workers’ compensation law.

Billing for telehealth services shall be by standard HCFA-1500 using modifier -95 and the appropriate place of service code as specified by CMS for the date of service or their successors as used by CMS. The provider shall append modifier -95 to the CPT® code with the place of service code -02 (telehealth) or -11 (office) as specified by CMS for the date of service. All other modifiers should also be added to the CPT® code as applicable.

When a procedure is provided using telemedicine, reimbursement shall be as follows: The procedure code is reimbursed at the non-facility Medicare maximum allowable payment or the billed charge, whichever is less, regardless of the practitioner’s physical location at the time of service.

Coding and billing regulations shall follow the Medicare guidelines in effect for the date of service with no geographic qualifier.

SOURCE: TN Admin Code 0800-02-31.05, (Accessed Aug. 2024).

SOURCE: TN Admin Code 0800-02-17.05, (Accessed Aug. 2024).

PAYMENT PARITY

Provider-based Telemedicine

This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.

This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

A health insurance entity:

Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

SOURCE: TN Code Annotated, Sec. 56-7-1003 (Accessed Aug. 2024).

Telehealth Services

Subject to subsection (c), a health insurance entity: …

Shall reimburse a healthcare services provider for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located …
Shall reimburse healthcare services providers who are out-of-network for telehealth care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002. (Accessed Aug. 2024).

SOURCE: TN Code Annotated, Sec. 56-7-1011 (Accessed Aug. 2024).

Last updated 08/27/2024

Requirements

Telehealth Services

“Qualified site” means 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.

“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.

A health insurance entity:

Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through telehealth;
Shall reimburse a healthcare services provider for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
Shall not exclude from coverage a healthcare service solely because it is provided through telehealth and is not provided through an in-person encounter between a healthcare services provider and a patient; and
Shall reimburse healthcare services providers who are out-of-network for telehealth care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

A health insurance entity shall provide coverage for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for Medicare and medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to August 20, 2020, by the federal centers for medicare and medicaid services.

For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, “medically necessary” means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5-144; and

For all other healthcare services, “medically necessary” means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are:

In accordance with generally accepted standards of medical practice;
Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury, or disease excluding any costs paid pursuant to subsection (j).

Subsection (j): A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for Medicare and Medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to August 20, 2020, by the federal centers for Medicare and Medicaid services.

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Aug. 2024).

Provider-Based Telemedicine

“Qualified site” means the primary or satellite 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, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

A provider-based telemedicine provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity’s network is subject to the same requirements and contractual terms as any other healthcare services provider in the health insurance entity’s network.

A health insurance entity:

Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine;
Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and
Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

In accordance with generally accepted standards of medical practice;
Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury, or disease.

This section does not apply to accident-only, specified disease, hospital indemnity, plans described in § 1251 of the Patient Protection and Affordable Care Act, Public Law 111-148, as amended and § 2301 of the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, as amended (both in 42 U.S.C. § 18011), plans governed by the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1001 et seq.), Medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Aug. 2024).

Notwithstanding § 56-7-1002(e), a health insurance entity shall provide reimbursement for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

Notwithstanding § 56-7-1003(e), a health insurance entity shall provide reimbursement for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

This section does not require a health insurance entity to provide reimbursement for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

In accordance with generally accepted standards of medical practice;
Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.

This section does not require a healthcare services provider to seek reimbursement from a health insurance entity for healthcare services provided by telehealth or provider-based telemedicine.

SOURCE: Tennessee Annotated Code Sec. 56-7-1012, (Accessed Aug. 2024).

Remote patient monitoring services are subject to utilization review under the Health Care Service Utilization Review Act, compiled in chapter 6, part 7 of this title.

This section does not apply to a health incentive program operated by a health insurance entity that utilized an electronic device for physiological monitoring.

SOURCE: TN Code Annotated, Sec. 56-7-1011, (Accessed Aug. 2024).

Workers Compensation

Telehealth for workers’ compensation is an available option for medically appropriate healthcare services to be provided with the voluntary consent and agreement of the injured worker and the willingness of the healthcare services provider as provided in these rules.

Medically appropriate healthcare services do not include treatment where an in-person physical examination is necessary (see rule for examples).

Telehealth providers shall be held to the same standard of care as healthcare services providers providing the same healthcare services through in-person encounters.

An employer shall provide coverage for workers’ compensation medical services provided during a telehealth encounter in a manner that is consistent with what the workers’ compensation law requires for in-person encounters for the same healthcare service(s). Payment shall be in accordance with the Tennessee workers’ compensation medical fee schedule in Rule 0800-02-18 and corresponding rules for medical payments in Rule 0800-02- 17 in effect on the date of service.

Records/recordings requirements for telehealth services shall be the same as if the visit with the provider were in person and face-to-face. A telehealth provider shall be compliant with all federal and state of Tennessee laws for records/recordings. A recording shall not substitute for a written record.

Telehealth services are subject to any and all appropriate utilization review protocols or other protocols for healthcare treatment adopted by the bureau, shall be based on evidence-based guidelines, and shall be in accordance with the Tennessee standards of medical practice.

All services shall be delivered to the eligible employee at no cost to the employee in accordance with the provisions of section 50-6-204.

The provision of medical services via telehealth does not change or in any way affect the requirements for causation, date of maximum medical improvement, or permanent impairment ratings required of an authorized treating physician pursuant to the workers’ compensation law. In all workers’ compensation claims, statements of causation, date of maximum medical improvement, permanent restrictions, and permanent impairment rating(s) must be provided by a medical doctor, doctor of osteopathy, or doctor of chiropractic in accordance with the workers’ compensation law.

SOURCE: TN Admin Code 0800-02-31.03, (Accessed Aug 2024).

SOURCE: TN Admin Code 0800-02-17.05, (Accessed Aug. 2024).

Medicaid

Last updated 08/27/2024

Consent Requirements

Privacy policies must be reviewed with the individual before beginning a telehealth assessment and the review must be documented in the patient record.

The individual will be informed that privacy policies contain standards that will protect the individual receiving services from being monitored through the video and/or through audio by unauthorized third parties without the individual’s prior knowledge.

The individual being evaluated via telehealth must be informed of the process and given an opportunity to request an in-person face-to-face assessment before conducting a telehealth assessment. This should be documented in his/her record.

The individual will be given the opportunity to request that the assessment be completed in person rather than by telehealth.

Explanation of the process shall include a statement that services will not be withheld if the telehealth encounter is refused, and the individual may terminate the telehealth assessment at any time.
Documentation must contain a statement that the telehealth process was explained to the individual and whether or not an objection was raised.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care. p. 50-51, (Apr. 2024) (Accessed Aug. 2024).

Explanation of the process shall include a statement that services will not be withheld if the telehealth encounter is refused and the individual may terminate the telehealth assessment at any time.
Documentation must contain a statement that the telehealth process was explained to the individual and whether or not an objection was raised.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 8, (2012) (Accessed Aug 2024).

Last updated 08/26/2024

Definitions

“Telehealth”:

Means the use of real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:
- Such provider is at a qualified site other than the site where the patient is located; and
- The patient is at a qualified site, at a school clinic staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section, or at a public elementary or secondary school staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section; and
Does not include:
- An audio-only conversation;
- An electronic mail message; or
- Facsimile transmission;

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Aug. 2024).

“Provider-based telemedicine”:

Means the use of Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant real-time, interactive audio, video telecommunications, or electronic technology, or store-and-forward telemedicine services, used over the course of an interactive visit by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:
- The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient;
- The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and
  - The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system and the patient prior to the interactive visit;
  - The healthcare services provider, the healthcare services provider’s practice group, or the healthcare system is able to render the healthcare services through an in-person encounter; and
  - The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system and the patient prior to the interactive visit does not apply to a patient who is receiving an initial behavioral health evaluation or assessment;
Does not include:
- An audio-only conversation;
- An electronic mail message or phone text message;
- A facsimile transmission;
- Remote patient monitoring; or
- Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity’s business.

Behavioral health services when the means described in subdivision (a)(6)(A) are unavailable; and
Healthcare services when the means described in subdivision (a)(6)(A) are unavailable

SOURCE: TN Code Annotated, Sec. 56-7-1003 as amended by HB 2857 & SB 1881, (2024 Session), (Accessed Aug. 2024).

TN Department of Mental Health and Substance Abuse Services

Telehealth is the use of electronic information and telecommunication technologies to support clinical care between an individual with mental illness and/or substance abuse issues and a healthcare practitioner.

Telehealth systems provide a live, interactive audio-video communication or videoconferencing connection between the individual in need of services and the crisis service delivery system.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care. p. 48, (Apr. 2024) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guideline. p. 4 (Accessed Aug. 2024).

Last updated 08/28/2024

Email, Phone & Fax

“Provider-based telemedicine” does not include:

- An audio-only conversation;
- An electronic mail message or phone text message;
- A facsimile transmission;
- Remote patient monitoring; or
- Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity’s business.

Behavioral health services when the means described in subdivision (a)(6)(A) are unavailable; and
Healthcare services when the means described in subdivision (a)(6)(A) are unavailable;

A healthcare provider, office staff, or party acting on behalf of the healthcare provider submitting for reimbursement of an audio-only encounter under subdivision (a)(6)(C)(ii) shall:

Confirm and maintain documentation that the patient:
- Does not own the video technology necessary to complete an audio-video provider-based telemedicine encounter;
- Is at a location where an audio-video encounter cannot take place due to lack of service; or
- Has a physical disability that inhibits the use of video technology; and
Notify the patient that the financial responsibility for the audio-only encounter will be consistent with the financial responsibility for other in-person or video encounters, prior to the audio-only telemedicine encounter.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Aug. 2024).

Telehealth does not include:

An audio-only conversation;
An electronic mail message; or
A facsimile transmission

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Aug 2024).

School-Based Services

All TennCare medically necessary, covered services provided on school grounds shall be billed with the place of service code (03), defined by CMS as any facility whose primary purpose is education. School-based services rendered via telehealth shall be billed with place of service code (02), indicating telehealth was provided other than the student’s home or place of service code (10) indicating telehealth was provided in the student’s home. Additionally, the appropriate modifier should be used to indicate whether the telehealth service was delivered via a televisual visit (append using the GT modifier) or delivered via audio-only (append using the 93 modifier or FQ modifier as appropriate).

See manual for additional information.

SOURCE: TennCare Biling Manual: Tennessee School Districts (July 2023), p. 11. (Accessed Aug. 2024).

Mental Health and Substance Abuse

Behavioral health crisis services can be activated by telephone contact or at a walk-in center. A tollfree number is available 24/7, 365 days a year and answered by trained crisis specialists. A triage screening determines the acuity of the crisis and determines the appropriate intervention needed to alleviate and/or stabilize the crisis. The triage screening can be completed via telephone assessment or, in the case of a walk-in service, via a face-to-face assessment (or telehealth).

Crisis Services Intervention – An intervention may be completed via telephone or face to face (which includes telehealth). Interventions include an assessment to determine the need(s) of the individual including but are not limited to active, supportive listening and the need for referrals to additional services and/or treatment. The intervention is intended to identify and provide resources specific to the needs of the caller. A face-to-face assessment shall always be conducted if there is a substantial likelihood of serious harm. All appropriate resources should be utilized in an effort to stabilize the individual and prevent escalation of the crisis. The intervention is intended to assess the need(s) of the individual for possible face to face contact with crisis services or a referral to the appropriate resource(s) in order to support and/or stabilize the individual and prevent escalation of the crisis.

A telephone intervention or consultation occurs between crisis staff and the individual and/or the family/health care providers, as appropriate. Title 33 requires physicians and psychologists to consult with a crisis service provider before initiating a certificate of need. Telephone triage personnel must be available to provide the required consultation which includes a review of the clinical information and provision of recommended alternatives as clinically appropriate.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services, Office of Crisis Services and Suicide Prevention, Minimal Standards of Care (Apr. 2024). (Accessed Sept. 2024).

Last updated 08/26/2024

Live Video

POLICY

Telehealth Services

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002, (Accessed Aug. 2024).

SOURCE: TN Code Annotated, Sec. 56-7-1012, (Accessed, Aug. 2024).

Provider-based Telemedicine

In accordance with generally accepted standards of medical practice;
Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury, or disease.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Aug. 2024).

SOURCE: TN Code Annotated, Sec. 56-7-1012, (Accessed Aug. 2024).

ELIGIBLE SERVICES/SPECIALTIES

This section does not require a health insurance entity to provide reimbursement [coverage] for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

In accordance with generally accepted standards of medical practice;
Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease, excluding any costs paid pursuant to subsection (j).

Section (j): A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for medicare and medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to August 20, 2020, by the federal centers for medicare and medicaid services.

SOURCE: TN Code Annotated, Sec. 56-7-1002 & Sec. 56-7-1012 [excludes reference to section (j)], (Accessed Aug. 2024).

A health insurance entity:

Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine;
Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and
Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

In accordance with generally accepted standards of medical practice;
Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury, or disease.

Any provisions not required by this section are governed by the terms and conditions of the health insurance policy or contract.

Provider-based telemedicine is subject to utilization review under the Health Care Service Utilization Review Act, compiled in chapter 6, part 7 of this title.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Aug. 2024).

School-Based Services

See manual for additional information.

SOURCE: TennCare Billing Manual: Tennessee School Districts (July 2023), p. 11. (Accessed Aug. 2024).

Mental Health & Substance Abuse Services

TennCare will reimburse for live video for crisis-related services or an assessment for emergency admission by an in-patient psychiatric facility.

Please see Telecommunications Guidelines for policy guidance.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 4 (2012) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care. p. 46 & 56, (Apr. 2024) (Accessed Aug. 2024).

Lactation Consultation

Telehealth appointments are available for prenatal and postpartum lactation sessions and any consults with International Board-Certified Lactaation Consultants (IBCLCs).

SOURCE: TennCare, Lactation Consultant Benefit Update (Jul. 24, 2024) Powerpoint. (Accessed Sept. 2024).

ELIGIBLE PROVIDERS

Provider based telemedicine

“Healthcare services provider” means an individual acting within the scope of a valid license issued pursuant to title 63 or title 68, chapter 24, part 6, or any state-contracted crisis service provider employed by a facility licensed under title 33

A health insurance entity: … Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Aug. 2024).

Telehealth Services

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Aug. 2024).

Lactation Consultation

Telehealth appointments are available for prenatal and postpartum lactation sessions and any consults with International Board-Certified Lactaation Consultants (IBCLCs).

SOURCE: TennCare, Lactation Consultant Benefit Update (Jul. 24, 2024) Powerpoint. (Accessed Sept. 2024).

ELIGIBLE SITES

Telehealth Services

“Originating site” means the location where a patient is located pursuant to subdivision (a)(7)(A) and that originates a telehealth service to another qualified site.

“Telehealth”:

Means the use of real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:

Such provider is at a qualified site other than the site where the patient is located; and
The patient is at a qualified site, at a school clinic staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section, or at a public elementary or secondary school staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section.

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Aug. 2024).

Provider-Based Telemedicine

“Qualified site” means the primary or satellite 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, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Aug. 2024).

“Healthcare provider” means a person who is licensed, certified, or authorized or permitted by the laws of this state to administer health care in the ordinary course of business or practice of a profession; and

“Telehealth provider group” means two (2) or more healthcare providers that share a common employer and provide healthcare services exclusively via telehealth.

This chapter does not require:

A vendor or healthcare provider who provides healthcare services exclusively via telehealth to maintain a physical address or site in this state in order to be eligible to enroll as a vendor or provider for the medical assistance program; or
A telehealth provider group to have a service address in this state in order to be eligible to enroll as a vendor or provider group for the medical assistance program, as long as the healthcare providers that comprise the telehealth provider group are licensed with the appropriate healthcare licensing authority in this state or are otherwise authorized by law to provide healthcare services in this state.

SOURCE: TN Code Annotated, Sec. 71-5-167, (Accessed Aug. 2024).

School-Based Services

See manual for additional information.

SOURCE: TennCare Biling Manual: Tennessee School Districts (July 2023), p. 11. (Accessed Aug 2024).

Mental Health & Substance Abuse Services

All telehealth sites shall ensure that telehealth equipment is located in a space conducive to a clinical environment and provides adequate comfort and privacy for the individual being evaluated. Both visual and audio privacy are important and placement and selection of the rooms used for conducting telehealth assessments should consider this. Proper lighting is required to keep shadows off the faces of the participants.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care. p. 52, (Apr. 2024) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 8, (2012) (Accessed Aug. 2024).

Lactation Consultation

Indicate the setting for the visit (office, telehealth, home visit, etc.) using the Place of Service Code on your claim.

Yes. Lactation consultation visits can occur in the outpatient office setting, at the patient’s home, or through telehealth. The setting of the visit should be indicated in the documentation of the visit and on the claim using the place of service code.

Lactation services are billable only in the outpatient setting. Lactation services provided inpatient are covered under the global maternity claim.

SOURCE: TennCare, Lactation Consultant Benefit Update (Jul. 24, 2024) Powerpoint. (Accessed Sept. 2024).

GEOGRAPHIC LIMITS

A health insurance entity … Shall reimburse a healthcare services provider for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002, (Accessed Aug. 2024).

Provider-Based Telemedicine

A health insurance entity: … Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Part 1003, (Accessed Aug. 2024).

FACILITY/TRANSMISSION FEE

A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for Medicare and Medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to August 20, 2020, by the federal centers for Medicare and Medicaid services.

SOURCE: TN Code Annotated, Sec. 56-7-1002 , (Accessed Aug. 2024).

Last updated 08/26/2024

Miscellaneous

No reference found.

Last updated 08/27/2024

Out of State Providers

“Telehealth provider group” means two (2) or more healthcare providers that share a common employer and provide healthcare services exclusively via telehealth.

This chapter does not require:

A vendor or healthcare provider who provides healthcare services exclusively via telehealth to maintain a physical address or site in this state in order to be eligible to enroll as a vendor or provider for the medical assistance program; or
A telehealth provider group to have a service address in this state in order to be eligible to enroll as a vendor or provider group for the medical assistance program, as long as the healthcare providers that comprise the telehealth provider group are licensed with the appropriate healthcare licensing authority in this state or are otherwise authorized by law to provide healthcare services in this state.

SOURCE: TN Code Annotated, Sec. 71-5-167, (Accessed Aug. 2024).

Last updated 08/28/2024

Overview

A law requires TennCare (Medicaid) reimbursement for telehealth services and provider-based telemedicine, which includes store-and-forward. Remote patient monitoring may be offered by health insurance entities. Audio-only conversation is allowed for provider based telemedicine for the provision of behavioral health services or healthcare services when other means are unavailable.

TennCare services are offered through managed care entities. Each MCO has its own telehealth policy. Coverage and reimbursement for live video and store-and-forward may vary between MCOs.

Last updated 08/26/2024

Remote Patient Monitoring

POLICY

“Remote patient monitoring services” means using digital technologies to collect medical and other forms of health data from a patient and then electronically transmitting that information securely to healthcare providers in a different location for interpretation and recommendation.

SOURCE: TN Code Annotated, Sec. 56-7-1011 , (Accessed Aug. 2024).

CONDITIONS

No later than December 31, 2024, the bureau of TennCare shall amend existing rules, or promulgate new rules, on fee-for-service and medicaid managed care plans regarding reimbursement to allow for the reimbursement of remote ultrasound procedures and remote fetal nonstress tests utilizing established CPT codes for such procedures when the patient is in a residence or other off-site location that is separate from the patient’s provider and the same standard of care is met.

SOURCE: TN Code Annotated, Sec. 71-5-168, (Accessed Aug. 2024).

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

Remote patient monitoring services are subject to utilization review under the Health Care Service Utilization Review Act, compiled in chapter 6, part 7 of this title.

This section does not apply to a health incentive program operated by a health insurance entity that utilized an electronic device for physiological monitoring.

SOURCE: TN Code Annotated, Sec. 56-7-1011 , (Accessed Aug. 2024).

When amending or promulgating rules pursuant to subsection (b), the bureau shall ensure that:

A remote ultrasound procedure or remote fetal nonstress test is only reimbursable when the provider uses digital technology:
- To collect medical and other forms of health data from a patient and electronically transmit that information securely to a healthcare provider who is in a separate location for the purpose of interpretation and making recommendations;
- That is compliant with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) (42 U.S.C. § 1320d et seq.); and
- That is approved by the federal food and drug administration; and

A fetal nonstress test is only reimbursable with a place of service modifier for at-home monitoring with remote monitoring solutions that are cleared by the federal food and drug administration for on-label use for monitoring fetal heart rate, maternal heart rate, and uterine activity.

SOURCE: TN Code Annotated, Sec. 71-5-168, (Accessed Aug. 2024).

Last updated 08/28/2024

Store and Forward

POLICY

“Store-and-forward telemedicine services”:

(A) Means 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.

SOURCE: TN Code Annotated, Sec. 56-7-1002 & 1003, (Accessed Aug 2024).

This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of telehealth if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.

This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of telehealth if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Aug 2024).

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Aug 2024).

Mental Health & Substance Abuse Services

TennCare will not reimburse for store-and-forward based upon definition of “telehealth systems” which describes it as “live interactive audio-video”.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care. p. 53, (Apr. 2024) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 4, (2012) (Accessed Aug 2024).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRPAHIC LIMITS

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002, (Accessed Aug 2024).

Provider-Based Telemedicine

SOURCE: TN Code Annotated, Title 56, Ch. 7 Part 1003, (Accessed Aug 2024).

TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 08/27/2024

Consent Requirements

For the purposes of this section, a healthcare provider-patient relationship with respect to telemedicine or telehealth is created by mutual consent and mutual communication, except in an emergency, between the patient and the provider. The consent by the patient may be expressed or implied consent; however, the provider-patient relationship is not created simply by the receipt of patient health information by a provider unless a prior provider-patient relationship exists. The duties and obligations created by the relationship do not arise until the healthcare provider:

Affirmatively undertakes to diagnose or treat the patient; or
Affirmatively participates in the diagnosis or treatment.

SOURCE: TN Code Sec. 63-1-155 (Accessed Aug. 2024).

SOURCE: TN Code Annotated 63-5-108 , (Accessed Aug. 2024).

Worker’s Compensation

Telehealth services providers must obtain electronic or written informed consent of an injured worker to accept telehealth services for any or all parts of the medical benefits to which the injured worker may be entitled under the workers’ compensation law. For authorized telephone visits, verbal consent given by the patient before the service shall be documented by the provider. This service shall be in accordance with applicable CMS guidelines at the time of service. See rule for additional detailed requirements.

SOURCE: TN Admin Code 0800-02-31.04, (Accessed Aug. 2024).

Optometry

Optometrist-patient relationship. Pursuant to T.C.A. 63-1-155(b), an optometrist- patient relationship with respect to telemedicine or telehealth is created by mutual consent and mutual communication, except in an emergency, between the patient and the optometrist. The consent by the patient may be expressed or implied consent; however, the optometrist-patient relationship is not created simply by the receipt of patient health information by an optometrist unless a prior optometrist-patient relationship exists.

The duties and obligations created by the relationship do not arise until the optometrist:1. Affirmatively undertakes to diagnose or treat the patient; or
Affirmatively participates in the diagnosis or treatment.

An optometrist shall not render telehealth services, ophthalmic prescribing and eye health services, advice and/or care using telehealth technologies without:

Fully verifying, to the extent possible, the requesting patient’s identity;
Disclosing the optometrist’s identity and applicable credential(s) to the patient; and
Obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telehealth technologies.

The consent by the patient may be expressed or implied consent; however, the optometrist-patient relationship is not created simply by the receipt of patient health information by an optometrist unless a prior optometrist-patient relationship exists.

SOURCE: TN Admin Code 1045-02-.18, (Accessed Aug. 2024).

Dentists

Informed consent forms shall be signed by the patient or parent/guardian describing the information to be transmitted and/or shared with a dentist who is at a different geographical location.

SOURCE: TN Rule Annotated, Rule 0460-01-.19 (Accessed Aug. 2024).

Board of Speech Pathology and Audiology

The client and/or the client’s family members or caregivers shall be informed of the available service delivery options and shall give consent to the use of telecommunications before that method of service delivery is utilized.

SOURCE: TN Rule Annotated, Rule 1370-01-.21, (Accessed Aug. 2024).

Chiropractic Examiners

Chiropractic physician-patient relationship – A chiropractic physician-patient relationship is created by mutual consent and mutual communication, except in an emergency, between the patient and the chiropractic physician. The consent by the patient may be expressed or implied consent; however, the chiropractic physician-patient relationship is not created simply by the receipt of patient health information by a provider unless a prior chiropractic physician-patient relationship exists. The duties and obligations created by the relationship do not arise until the healthcare provider:

Affirmatively undertakes to diagnose or treat the patient; or
Affirmatively participates in the diagnosis or treatment.

SOURCE: Section 1045-02-.18, (Accessed Aug. 2024).

Last updated 08/27/2024

Cross State Licensing

“Healthcare provider” means:

An individual acting within the scope of a valid license issued pursuant to this title;
A state-contracted crisis service provider that is employed by a facility licensed under title 33;
An alcohol and drug abuse counselor licensed under title 68, chapter 24, part 6; or
A graduate who has completed, or a student actively enrolled in, a professional training program the educational standards of which meet the training requirements for a license under this title or title 68, chapter 24, part 6, as long as the graduate or student:
- Is providing telehealth services for the purpose of obtaining hours required for licensure or of otherwise fulfilling the educational requirements to apply for licensure; and
- Is, at all times, supervised by an individual who is licensed under this title or title 68, chapter 24, part 6, with an unencumbered license

Except as provided in subdivisions (g)(2) and (3), to practice under this section a healthcare provider must be licensed to practice in this state or be a graduate or student meeting the requirements of subdivision (a)(1)(D).

A physician must be licensed to practice under chapter 6 or 9 of this title in order to practice telemedicine pursuant to § 63-6-209(b), except as otherwise authorized by law or rule.

An individual licensed in another state who would, if licensed in this state, qualify as a healthcare provider under subsection (a) may practice telehealth under this section while providing healthcare services on a volunteer basis through a free clinic pursuant to title 63, chapter 6, part 7.

Subdivision (a)(1)(A) does not prohibit a healthcare provider otherwise acting within the scope of practice of a valid license issued pursuant to this title from delivering services through the use of telehealth.

SOURCE: TN Code Sec. 63-1-155 (Accessed Aug. 2024).

The board also has the authority to issue locum tenens and/or conditional licenses as it deems appropriate after reviewing the qualifications of applicants. In addition to the authority granted the board in § 63-6-214, the board has the authority to issue restricted licenses and special licenses based upon licensure to another state for the limited purpose of authorizing the practice of telemedicine to current applicants or current licensees, or both, as it deems necessary, pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

SOURCE: TN Code Annotated Sec. 63-6-209(b). (Accessed Aug. 2024).

No person shall engage in the practice of medicine, either in person or remotely using information transmitted electronically or through other means, on a patient within the state of Tennessee unless duly licensed by the Board in accordance with the provisions of the current statutes and rules. Unless specifically set out in this rule, this rule is not intended to and does not supersede any pre-existing federal or state statutes or rules and is not meant to alter or amend the applicable standard of care in any particular field of medicine or to amend any requirement for the establishment of a physician-patient relationship.

As of the effective date of this rule, the Board will no longer issue what was previously termed a “telemedicine license.” Individuals previously granted a telemedicine license under the former version of this rule may apply to have the license converted to a full license. Such individuals must complete the application for a full license and provide all necessary documentation, though no new application fee will be required as long as application is made within two years of the effective date of this rule. See rule for details for individuals who do not convert to a full license.

SOURCE: TN Rule Annotated, Rule 0880-02.-16. (Accessed Aug. 2024).

The TN Osteopathic Board will still issue a telemedicine license. See rule for details.

SOURCE: TN Rule Annotated, Rule 1050.02.17.(2) (Accessed Aug. 2024).

Outpatient laboratory testing in Tennessee hospitals may be ordered by the following:

Any licensed Tennessee practitioner who is authorized to do so by T.C.A. Â§ 68- 29-121;
Any out-of-state practitioner who has a Tennessee telemedicine license issued pursuant to Rule 0880-02-.16; or
Any duly licensed out-of-state health care professional as listed in T.C.A. Â§ 68- 29-121 who is authorized by his or her state board to order outpatient laboratory testing in hospitals for individuals with whom that practitioner has an existing face-to-face patient relationship as outlined in Rule 0880-02-.14(7)(a)1., 2., and 3.

Outpatient diagnostic testing in Tennessee hospitals may be ordered by the following:

Any Tennessee practitioner licensed under Title 63 who is authorized to do so by his or her practice act;
Any out-of-state practitioner who has a Tennessee telemedicine license issued pursuant to Rule 0880-02-.16; or
Any duly licensed out-of-state health care professional who is authorized by his or her state board to order outpatient diagnostic testing in hospitals for individuals with whom that practitioner has an existing face-to-face patient relationship as outlined in Rule 0880-02-.14(7)(a)1., 2., and 3.

SOURCE: TN Rule Annotated, Rule 0720-14-.07 (Accessed Aug. 2024).

No person shall engage in the practice of dentistry, either in person or remotely using information transmitted electronically or through other means, on a patient within the state of Tennessee unless duly licensed by the Board in accordance with the provisions of the current statutes and rules. Teledentistry shall not alter or amend the supervision requirements or procedures that are authorized for licensed dental hygienists or registered dental assistants as stated by T.C.A § 63-5-115, 0460-03-.09 and 0460-04-.08.

SOURCE: TN Rule Annotated, Rule 0460-01-.19 (Accessed Aug. 2024).

Board of Speech Pathology and Audiology

This rule applies only to the delivery of services to patients physically located within the state of Tennessee, which requires a license under T.C.A. §§ 63-17-101, et seq., unless such services are being rendered by a volunteer under T.C.A. § 63-1-155(g). Any provider who is licensed by the Board and who wishes to deliver telecommunications services to a patient located in another state must comply with the applicable laws of the other state.

SOURCE: TN Rule Annotated, Rule 1370-01-.21, (Accessed Aug. 2024).

Optometry

An optometrist is a “healthcare services provider” under Tennessee law and shall be licensed and under the jurisdiction of the Tennessee Board of Optometry when utilizing telehealth technology to provide services to a patient located in the State of Tennessee.

Optometrists who treat or prescribe through online services sites are practicing optometry and are under the jurisdiction of the Tennessee Board of Optometry. Optometrists shall possess appropriate licensure through the Tennessee Board of Optometry. The optometrists shall abide by the established requirements for spectacle and contact lens prescription release pursuant to T.C.A. 63-8-101, et seq.

SOURCE: Section 1045-02-.18, (Accessed Aug. 2024).

Chiropractic Examiners

No person shall engage in the practice of chiropractic, either in person or remotely using information transmitted electronically or through other means, on a patient within the state of Tennessee unless duly licensed by the Board in accordance with the provisions of the current statutes and rules. Unless specifically set out in this rule, this rule is not intended to and does not supersede any pre-existing federal or state statutes or rules and is not meant to alter or amend the applicable standard of care in any particular healthcare field or to amend any requirement for the establishment of a chiropractic physician-patient relationship.

Effect of License – The issuance by the Board of a license to practice chiropractic subjects the licensee to the jurisdiction of the Board in all matters set forth in the Chiropractic Practice Act and implementing rules and regulations, including all matters related to discipline. The licensee agrees to produce patient medical records and materials as requested by the Board and to appear before the Board upon receipt of notice from the Board commanding such appearance. Failure of the licensee to appear and/or to produce records or materials as requested, after appropriate notice, shall constitute grounds to suspend or revoke the license at the Board’s discretion.

Chiropractic physicians who are contractually obligated to provide and/or deliver chiropractic services in Tennessee must be licensed to practice chiropractic in Tennessee, regardless of whether such services are in exchange for direct compensation.

See rule for parts of the exam that require a facilitator.

SOURCE: Section 1045-02-.18, (Accessed Aug. 2024).

Last updated 08/27/2024

Definitions

“Telehealth,” “telemedicine,” and “provider-based telemedicine” mean:

The use of real time audio, video, or other electronic media and telecommunication technology that enables interaction between a healthcare provider and a patient for the purpose of diagnosis, consultation, or treatment of a patient at a distant site where there may be no in-person exchange between a healthcare provider and a patient; or
Store-and-forward telemedicine services.

“Store-and-forward telemedicine services” means the use of asynchronous computer-based communications, which may include the transfer of medical data in an image captured or created by a camera or similar device, between a healthcare provider and patient for the purpose of diagnosis, consultation, or treatment of the patient at a distant site where there may be no in-person exchange between the healthcare provider and the patient.

SOURCE: TN Code Sec. 63-1-155. (Accessed Aug. 2024).

Telemedicine is the practice of medicine using electronic communication, information technology or other means, between a licensee in one location and a patient in another location. Telemedicine is not an audio only telephone conversation, email/instant messaging conversation or fax. It typically involves the application of secure video conferencing or store-and-forward to provide or support healthcare delivery by replicating the interaction of a traditional encounter between a provider and a patient.

SOURCE: TN Rule Annotated, 0880-02.-16(1)(g). (Accessed Aug. 2024).

Optometry

The definition of telehealth shall be defined as provided in T.C.A. § 63-1- 155(a)(2).

SOURCE: TN Rule annotated 1045-02-.18, (Accessed May 2024).

Dentistry

“Teledentistry” which, as used in this section, means the delivery of dental health care and patient consultation through the use of telehealth systems and technologies, including live, two-way interactions between a patient and a dentist licensed in this state using audiovisual telecommunications technology, or the secure transmission of electronic health records and medical data to a dentist licensed in this state to facilitate evaluation and treatment of the patient outside of a real-time or in-person interaction.

SOURCE: TN Code Annotated 63-5-108 , (Accessed Aug. 2024).

A teledentistry encounter entails the rendering of a documented dental opinion concerning evaluation, diagnosis, and/or treatment of a patient whether the dentist is physically present in the same room or in a remote location within the state or across state lines.

Teledentistry as practiced under T.C.A Â§ 63-5-108(b)(16) is not an audio-only telephone conversation, email/instant messaging conversation or fax. At a minimum it shall include the application of secure video conferencing or store-and-forward technology to provide or support dental care delivery by replicating the interaction of a traditional encounter between a provider and a patient.

If the information transmitted through electronic or other means as part of a patient’s encounter is not of sufficient quality or does not contain adequate information for the dentist to form an opinion, the dentist must declare they cannot form an opinion to make an adequate diagnosis and must request direct referral for inspection and actual physical examination, request additional data or recommend the patient be evaluated by the patient’s primary dentist or other local oral health care provider.

Store-and-forward technology as used in (1)(b) above is the use of asynchronous electronic communications between a patient and dentist at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients, including the transferring of dental data from one site to another through the use of a device that records or stores images that are sent or forwarded via electronic communication to another site for consultation.

SOURCE: TN Rule Annotated, Rule 0460-01-.19 (Accessed Aug. 2024).

Board of Speech Pathology and Audiology

For purposes of this rule, synchronous telecommunications and asynchronous telecommunications shall have the same definitions found in T.C.A. § 63-1-155(a)(3)(A) for “Telehealth” and 63-1-155(a)(2) for “Store-and-forward telemedicine services”, respectively.

Telecommunications shall include but not be limited to dedicated video systems, computers, and other similar electronic devices linked via hardwired or internet connections.

SOURCE: TN Rule Annotated, Rule 1370-01-.21, (Accessed Aug. 2024).

Chiropractic Examiners

Telehealth/Telemedicine – Defined by Tenn. Code Ann. 63-1-155(a)(3).

Telehealth Provider – Means a healthcare service provider engaged in the delivery of healthcare services through telehealth.

SOURCE: TN Rule 0620-02-.01, (Accessed Aug. 2024).

Last updated 08/27/2024

Licensure Compacts

Member of the Audiology and Speech-language Pathology Interstate Compact.

SOURCE: ASPL-IC Compact Map. (Accessed Aug. 2024).

Member of the Counseling Compact.

SOURCE: Counseling Compact Map. (Accessed Aug. 2024).

Member of Dietitians Compact

SOURCE: Dietitians Compact, Compact Map, & HB 1863 & SB 1862 (2024 Session) (Accessed Aug. 2024).

Member of Emergency Medical Services Compact.

SOURCE: Interstate Commission of EMS Personnel Services, Compact Member State, (Accessed Aug. 2024).

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. (Accessed Aug. 2024).

Member of the Nurses Licensure Compact.

SOURCE: Nurse Licensure Compact. (Accessed Aug. 2024).

Member of the Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Licensure Compact. (Accessed Aug. 2024).

Member of the Physical Therapy Compact.

SOURCE: Compact Map. Physical Therapy Compact. (Accessed Aug. 2024).

Member of Physician Assistant Compact

SOURCE: PA Compact, PA Compact Status, Map. (Accessed Aug. 2024).

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT, Map, (Accessed Aug. 2024).

Member of Social Worker Compact

SOURCE: Social Work Licensure Compact, Compact Map, & SB 2134 & HB 2405 (2024 Session), (Accessed Aug. 2024).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 08/27/2024

Miscellaneous

A speech language pathologist who uses an endoscope shall meet all of the following conditions: … Have protocols in place for emergency medical backup for every setting in which the speech language pathologist performs a procedure using an endoscope. A physician must provide general supervision and be readily available in the event of an emergency, including, but not limited to, physical presence at the setting or availability by telephone or telehealth, as defined in § 63-1-155.

SOURCE: TN Code Annotated Sec. 63-17-103 (Accessed Aug. 2024).

Last updated 08/27/2024

Online Prescribing

Affirmatively undertakes to diagnose or treat the patient; or
Affirmatively participates in the diagnosis or treatment.

A healthcare provider who is authorized to prescribe buprenorphine under federal law shall not prescribe via telehealth a buprenorphine product, as approved by the federal food and drug administration for use in recovery or medication-assisted treatment, unless:

The healthcare provider is employed by or contracted with:
- A licensed nonresidential office-based opiate treatment facility or licensed nonresidential opioid treatment program, as defined in § 33-2-402;
- A community mental health center, as defined in § 33-1-101;
- A federally qualified health center, as defined in§ 63-10-601;
- A hospital licensed under title 68 or 33; or
- The bureau of TennCare’s comprehensive enhanced buprenorphine treatment network; and
The delivery of telehealth is being provided on behalf of the entity that employs or contracts with the provider.

SOURCE: TN Code Sec. 63-1-155 , (Accessed Aug. 2024).

Prerequisites to Issuing Prescriptions or Dispensing Medications – In Person, Electronically, and Over the Internet

Except as provided in subparagraph (b), it shall be a prima facie violation of T.C.A. §63-6-214(b)(1), (4), and (12) for a physician to prescribe or dispense any drug to any individual, whether in person or by electronic means or over the Internet or over telephone lines, unless the physician, or his/her licensed supervisee pursuant to appropriate protocols or medical orders, has first done and appropriately documented, for the person to whom a prescription is to be issued or drugs dispensed, all of the following:

Performed an appropriate history and physical examination; and
Made a diagnosis based upon the examinations and all diagnostic and laboratory tests consistent with good medical care; and
Formulated a therapeutic plan, and discussed it, along with the basis for it and the risks and benefits of various treatments options, a part of which might be the prescription or dispensed drug, with the patient; and
Insured availability of the physician or coverage for the patient for appropriate follow-up care.

SOURCE: TN Rule Annotated, 0880-02-.14(7)(a). (Accessed Aug. 2024).

Except as provided under paragraphs seven (7) and eight (8) of this rule, the patient encounter to establish or maintain the physician-patient relationship via telemedicine between the physician in a remote location and the patient in Tennessee may occur with or without the use of a facilitator so long as such encounter is consistent with parts 1. and 2. of this Rule: Certain conditions apply in each case. See rule for details.

SOURCE: TN Rule Annotated, 0880-02.-16(6)(a). (Accessed Aug. 2024).

Optometry

Optometrist-patient relationship. Pursuant to T.C.A. § 63-1-155(b), an optometrist- patient relationship with respect to telemedicine or telehealth is created by mutual consent and mutual communication, except in an emergency, between the patient and the optometrist. The consent by the patient may be expressed or implied consent; however, the optometrist-patient relationship is not created simply by the receipt of patient health information by an optometrist unless a prior optometrist-patient relationship exists. The duties and obligations created by the relationship do not arise until the optometrist:

Affirmatively undertakes to diagnose or treat the patient; or
Affirmatively participates in the diagnosis or treatment.

The optometrist-patient relationship established via telehealth, shall at a minimum, meet the requirements of T.C.A. § 63-1-155(b).

SOURCE: TN Rule Annotated 1045-02-.18, (Accessed Aug. 2024).

Physician Assistant

A physician assistant authorized to prescribe drugs under this section who provides services in a free or reduced fee clinic under the Volunteer Health Care Services Act, compiled in chapter 6, part 7 of this title, may arrange for required personal review of the physician assistant’s charts by a collaborating physician in the office or practice site of the physician or remotely via HIPAA compliant electronic means rather than at the site of the clinic.

A physician assistant authorized to prescribe drugs under this section who provides services in a community mental health center as defined in § 33-1-101, or federally qualified health center as defined in § 63-10-601, may arrange for the required personal review of the physician assistant’s charts by a collaborating physician, with the same authority to render prescriptive services that the physician assistant is authorized to render, in the remote office or practice site of the physician, or any required visit by a collaborating physician to any remote site, or both, via HIPAA-compliant electronic means rather than at the site of the clinic.

Except as provided above:

A physician assistant licensed to prescribe drugs who provides services at a remote healthcare setting may arrange for any required personal review of the physician assistant’s charts by a collaborating physician either via HIPAA-compliant electronic means or in person; and
A physician assistant licensed to prescribe drugs may arrange for up to ten (10) of the required annual remote site visits by a collaborating physician by HIPAA-compliant electronic means rather than at the site of the clinic. All other of the required site visits by a collaborating physician to a remote site must take place in person at the site of the clinic. As used in this subdivision, “annual” means a rolling twelve-month period.

Protocols must also include, at a minimum, the following requirements: …

That if the advance practice registered nurse practices in a remote location site from the collaborating physician’s practice site, the collaborating physician conducts a remote site visit at least every thirty (30) days as described in § 63-7-126;

Collaborative agreements governing advance practice registered nurses who have six thousand (6,000) or more hours of documented postgraduate clinical experience and are endorsed by the board must include, at a minimum, the following: …

Requirements of patient chart review and remote site visits, if any, established at the practice level and commensurate with the level of training, experience, and competence of the advance practice registered nurse within the expected scope of practice of the advance practice registered nurse.

SOURCE: Section 63-19-107, & Title 63, Ch. 7, Part 1 as amended by HB 2318 & SB 2136, (Accessed Aug. 2024).

Optometry

Telehealth technologies, where prescribing medications and ophthalmic materials may be contemplated, shall require an optometrist to implement measures to uphold patient safety in the absence of a traditional in-person patient encounter. Such measures shall guarantee that the identity of the patient and provider is clearly established and that detailed documentation for the clinical patient encounter and resulting prescription is both enforced and independently kept.

Prescribing medications, in-person or via telehealth, is at the professional discretion of the optometrist based on licensure. The indication, appropriateness, and safety considerations for each telehealth visit prescription shall be evaluated by the optometrist in accordance with current standards of practice and consequently carry the same professional accountability as prescriptions delivered during an in-person patient encounter. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, optometrists may exercise their judgment and prescribe medications as part of telehealth encounters.

For telehealth ophthalmic prescriptions, the same requirements exist as for fixed fee in-person services as outlined in Tenn. Comp. R. & Regs. 1045-02-.08(3).

SOURCE: Section 1045-02-.18, (Accessed Aug. 2024).

Last updated 08/27/2024

Professional Board Standards

Board of Medical Examiners

SOURCE: TN Rule Annotated, Rule 0880-02. (Accessed Aug. 2024).

Board of Optometry

SOURCE: TN Rule Annotated, Rule 1045-02-.18 (Accessed Aug. 2024).

Board of Speech Pathology and Audiology

SOURCE: TN Rule Annotated, Rule 1370-01-.21, (Accessed Aug. 2024).

Board of Dentistry

SOURCE: TN Rule Annotated, Rule 0460-01-.19 (Accessed Aug. 2024).

Chiropractic Examiners

SOURCE: TN Rule 0620-02-.01, (Accessed Aug. 2024).

Teledentistry

Dentists who are licensed in this state and who deliver services using teledentistry shall establish protocols for the practice that should include proper methods of keeping the patient fully informed; proper safeguards ensuring that all state and federal laws and regulations relative to the privacy of health information are followed; proper documentation of all services or treatment rendered via teledentistry; proper procedures to ensure the referral of those patients requiring treatment beyond what can be provided via teledentistry to a dentist licensed in this state; and any such requirements as prescribed by the board of dentistry. Any and all services provided via teledentistry shall be consistent with the in-person provision of those services. Any and all services provided via teledentistry shall comply with this chapter and shall be provided in accordance with the rules of the board of dentistry.

SOURCE: TN Code Annotated 63-5-108 , (Accessed Aug. 2024).

“Practice of physical therapy” means, whether by in-person encounter or via telehealth, telemedicine, or provider-based telemedicine, [see code].

Occupational therapy practice may occur in a variety of settings, including, but not limited to: .. Telehealth, telemedicine, or provider-based telemedicine, as authorized by § 63-1-155

SOURCE: TN Code Annotated 63-13-103, (Accessed Aug. 2024).