Does Tennessee require telehealth payment parity?

Tennessee's reimbursement protections remain in effect: 2022 Public Chapter 766 removed the April 2022 sunset. Section 56-7-1012 requires reimbursement consistent with the policy or contract's in-person terms for encounters meeting the statutory telehealth or provider-based telemedicine definitions. The required rate and applicability to an encounter or plan need contract and legal review; an 835 modifier alone doesn't resolve them.

How can I tell if telehealth is being paid less?

Compare what each payer allows for a telehealth visit with what it allows for the same code in person. Owed does this automatically from your remittances.

Telehealth paid less.

A telehealth gap is a telehealth service paid below the same payer's in-person rate for the same code and clinician tier.

Why it happens

Some payers pay telehealth visits less than office visits. Tennessee has coverage and reimbursement protections for encounters meeting its statutory telehealth or provider-based telemedicine definitions (Tenn. Code Ann. §§ 56-7-1002, 56-7-1003, 56-7-1012). Check the encounter, plan and provider agreement before deciding whether a lower rate is allowed.

How Owed checks

01
Owed recognizes telehealth lines by their modifiers (95, GT, GQ, FQ, 93).
02
For commercial claims with no contracted rate on file, it compares the allowed amount with the payer's typical in-person rate for the same code and tier over the preceding 180 days, and flags gaps of at least $2 and 3%.
03
The comparison is a review flag. An 835 telehealth modifier alone doesn't establish that the encounter meets Tennessee's statutory definitions or prove the rate the law requires.
04
Tennessee's telehealth sections include TennCare managed care organizations and the state and local government plans authorized under title 8, chapter 27. They don't apply to plans governed by ERISA or to grandfathered plans, and Medicare follows federal rules. Owed runs this check on commercial claims only, including self-funded claims, as a payment-gap review flag.

What you'll see

The in-person typical rate and how many lines it's based on
The telehealth allowed amount and the difference

Rules check your remittances against the rates, settings and history available. Each finding shows its evidence; AI does not decide the result.

What to do

Check the encounter's statutory eligibility, plan and telehealth terms of your provider agreement. Ask the payer which term or reimbursement rule supports the lower rate, and have the legal basis reviewed before appealing.

Questions

Does Tennessee require telehealth payment parity?: Tennessee's reimbursement protections remain in effect: 2022 Public Chapter 766 removed the April 2022 sunset. Section 56-7-1012 requires reimbursement consistent with the policy or contract's in-person terms for encounters meeting the statutory telehealth or provider-based telemedicine definitions. The required rate and applicability to an encounter or plan need contract and legal review; an 835 modifier alone doesn't resolve them.
How can I tell if telehealth is being paid less?: Compare what each payer allows for a telehealth visit with what it allows for the same code in person. Owed does this automatically from your remittances.