Tennessee Telemedicine Laws: Licensure, Prescribing, Parity

Tennessee is a full-license state with a permissive practice act and a fussy insurance statute. The Board of Medical Examiners lets a physician-patient relationship form entirely by telemedicine, has no separate telehealth registration, and joined the Interstate Medical Licensure Compact early. The catch sits on the payer side: a state-regulated plan owes coverage for "provider-based telemedicine" only when the provider, practice group, or health system can show a prior in-person encounter with the patient — an exception for initial behavioral health evaluations arrived in 2023. Payment parity exists and was made permanent in 2022, with a ceiling at the in-person rate.

Licensure: full license, compact on-ramp

Rule 0880-02-.16 opens with the rule that governs everything else: no person may practice medicine on a patient within Tennessee, in person or remotely, unless licensed by the Board. Tenn. Code Ann. § 63-1-155(g) says the same thing for every Title 63 profession, and the Board's telemedicine FAQ puts it in one sentence — the practice of medicine occurs where the patient is located.

Tennessee once had a distinct telemedicine license, and § 63-6-209(b) still authorizes the Board to issue special licenses based on licensure in another state for the limited purpose of telemedicine. The Board stopped using that authority. Under Rule 0880-02-.16(2), it "will no longer issue" telemedicine licenses; the holders who never converted are limited to medical interpretation within their board-certified specialty and hold no prescriptive authority in Tennessee. Do not read the statute as an open door.

The exemptions are narrow: out-of-state physicians called in consultation by a Tennessee-licensed physician, military physicians, uncompensated physician-to-physician dialogue, and rare-disease specialists consulting to research hospitals (Rule 0880-02-.16(4)). Section 63-1-155(g)(3) adds volunteers at free clinics. A physician contractually obligated to deliver medical services in Tennessee must be licensed regardless of how payment flows.

The practical route for multi-state groups is the Interstate Medical Licensure Compact; Tennessee's membership took effect January 1, 2019. It also participates in the Physical Therapy Compact. Tennessee is also a Nurse Licensure Compact state, a PSYPACT participating state, and one of the nine states where Counseling Compact privileges are live.

Prescribing: the relationship can start online; the database check cannot be skipped

Section 63-1-155(b) says a provider-patient relationship for telehealth is created by "mutual consent and mutual communication," express or implied, and the statute's definition contemplates encounters "where there may be no in-person exchange." Rule 0880-02-.16(6) makes that concrete for physicians: a telemedicine encounter can establish or maintain the relationship, with or without a facilitator, provided the physician verifies identity and location, receives clinical information at the level of store-and-forward or secure video, and discloses name, practice location, degree, and specialty. Two limits: the Board's definition of telemedicine excludes audio-only telephone, email, and fax, and a patient under eighteen must have a facilitator present unless another law says otherwise.

The prescribing floor is Rule 0880-02-.14(7). Before prescribing any drug "in person or by electronic means or over the Internet or over telephone lines," the physician must have documented an appropriate history and physical examination, a diagnosis, a therapeutic plan discussed with the patient, and follow-up availability. Prescribing "based solely on answers to a set of questions" is a prima facie violation. The telemedicine rule allows the video encounter to satisfy the examination step, and if transmitted information is not good enough to form an opinion, the physician must say so and refer.

No Tennessee statute or board rule we reviewed bars a controlled-substance schedule from telehealth prescribing, and the state duties below apply to a telehealth prescription exactly as in person. The duties:

• Telehealth statute. Under § 63-1-155(j), a provider authorized to prescribe buprenorphine under federal law may not prescribe a buprenorphine product for recovery or medication-assisted treatment via telehealth unless the provider is employed by or contracted with a licensed nonresidential office-based opiate treatment facility or licensed nonresidential opioid treatment program, a community mental health center, a federally qualified health center, a hospital licensed under Title 68 or 33, or TennCare's comprehensive enhanced buprenorphine treatment network, and the telehealth is delivered on behalf of that entity. Section 63-1-155(c)(3) excludes pain management clinics and chronic nonmalignant pain treatment from the telehealth section entirely; verify with the Board how the state's chronic pain guidelines currently treat telemedicine before building a pain program around it.
• Buprenorphine prescribers. Separately, § 53-11-311(j), added by Public Chapter 295 (2025, effective July 1, 2025), makes a physician licensed under Title 63, chapter 6 or 9 the only healthcare provider authorized to prescribe a buprenorphine product for an FDA-approved use in recovery or medication-assisted treatment, "except as otherwise provided in this section." Other prescribers, including nurse practitioners and physician assistants, may prescribe it for opioid use disorder only under that section's listed conditions. The path added in 2025 requires, among other things, a DEA registration, work for the Department of Correction or a county or municipal jail, no more than fifty buprenorphine patients at a time, a collaborating physician who reviews every chart, a daily dose no higher than sixteen milligrams, and prescribing only to patients treated through the correctional facility. Telepsychiatry groups that staff buprenorphine care with nurse practitioners or physician assistants should read the full section first.
• CSMD registration and checks. Section 53-10-305(a) requires every practitioner who prescribes or dispenses controlled substances to patients in Tennessee on more than fifteen days in a calendar year, and who must hold a DEA registration, to register in the Controlled Substance Monitoring Database within thirty days of receiving a DEA number. Under § 53-10-310(e), the prescriber or an authorized delegate must check the database before prescribing an opioid or benzodiazepine at the beginning of a new episode of treatment (a controlled substance that prescriber has not prescribed in the previous six months), before each new prescription during the first ninety days, and at least every six months while the drug stays in the plan. The commissioner may add other Schedule II–V drugs by rule, and the Department of Health says the check also covers Schedule II amphetamines. Exemptions include hospice patients, supplies of three days or less, and inpatient administration (§ 53-10-310(e)).
• Opioid limit. Section 63-1-164(b) bars treating a patient with more than a three-day supply of an opioid or more than a total of 180 morphine milligram equivalents, except as that section provides. A longer supply, up to ten days and 500 morphine milligram equivalents (and up to thirty days and 1,200 morphine milligram equivalents in the rare cases subsection (d) describes), requires one opioid prescription per encounter, a thorough evaluation the prescriber personally conducts, documented consideration of non-opioid and non-pharmacologic treatment, the ICD-10 code in the chart and on the prescription, and informed consent. Exemptions, which require the ICD-10 code and the word "exempt" on the prescription, include active or recent cancer treatment, palliative care and hospice, sickle cell disease, administration in a licensed facility or hospital, pain management specialists and those collaborating with them, certain long-term opioid patients, methadone for opioid use disorder, FDA-approved products for opioid use disorder, opioid antagonists, and severe burns or major physical trauma. The section also does not apply to opioids the FDA has approved to treat upper respiratory symptoms or cough, which are instead capped at a fourteen-day supply.
• E-prescribing. Since January 1, 2021, § 63-1-160(c) has required any prescription for a Schedule II, III, IV, or V controlled substance to be issued as an electronic prescription to the pharmacy, and an APRN's or PA's electronic prescription must include the collaborating physician's name, address, and telephone number. Subsection (d) lists the exceptions, including technological or electrical failure, a prescription to be dispensed by a pharmacy outside Tennessee, a prescriber who is also the dispenser, a waiver from the Commissioner of Health for economic hardship, technological limits, or other exceptional circumstances, a prescriber's reasonable determination that the delay of an electronic prescription would adversely affect the patient's condition, and a prescriber who issues fifty or fewer Schedule II prescriptions a year. Medicare Part D separately requires at least 70 percent of Part D Schedule II–V prescriptions to be electronic under 42 CFR 423.160, subject to exceptions and waivers.
• State registration. We found no separate state controlled-substance registration for physicians. Section 53-11-302(a) requires anyone who dispenses controlled substances in Tennessee to hold an annual registration issued by the Board of Pharmacy and the appropriate licensing board "in accordance with the licensing board's rules," and the Board of Medical Examiners' Chapter 0880-02 rules and fee schedule set up no separate controlled-substance registration. The requirements we found are a Tennessee license with prescriptive authority, a DEA registration, and CSMD registration; APRNs and PAs should confirm their own board's rules before prescribing.

Federal law adds a separate layer for controlled substances. Under the temporary rule DEA and HHS published December 31, 2025 (90 FR 61301), which runs through December 31, 2026, a DEA-registered practitioner may prescribe Schedule II–V controlled substances after a real-time audio-video telemedicine encounter without a prior in-person evaluation, when the rule's other conditions are met; audio-only encounters qualify only for Schedule III–V narcotic medications approved by the FDA to treat opioid use disorder. See our guide to federal telehealth laws.

Consent: mutual consent, not a mandated form

Tennessee has no stand-alone telehealth consent statute for physicians. Section 63-1-155(b) treats the patient's express or implied consent as what forms the relationship, and the Board's rule adds disclosure and identity-verification duties rather than a signature requirement. Two consent-adjacent obligations do exist. For an audio-only visit for services other than behavioral health billed to a state-regulated plan, § 56-7-1003(k) requires documenting why video was unavailable and notifying the patient beforehand that cost-sharing matches an in-person or video visit. And behavioral health crisis providers working under Department of Mental Health and Substance Abuse Services standards must explain the telehealth process and offer an in-person assessment, according to CCHP's summary of those standards.

Medicaid: managed care all the way down

TennCare is fully managed care, and its March 2025 memo says the operative telehealth guidance lives in each MCO's reimbursement policy — BlueCare, UnitedHealthcare Community Plan, and Wellpoint — with TennCare aligning changes across the three. The 2022 memo that preceded it confirmed the MCOs pay telehealth "in the same manner as face-to-face interactions," including visits originating outside an office, and directed them to keep reimbursing audio-only permanently. Bill with place of service 02 or 10 or the modifier each MCO specifies (95, GT, GQ, or G0). The parity statutes bind TennCare MCOs directly because "health insurance entity" includes them. Public Chapter 4 (2020) lets a health insurance entity treat remote patient monitoring as a covered service when Medicare covers it, at negotiated rates, subject to utilization review.

Private insurance: two definitions, one parity rule

Tennessee's insurance code splits telehealth in two. Section 56-7-1002 "telehealth" runs between qualified sites — provider office, hospital, RHC, FQHC, or school clinic — excludes audio-only, and carries an originating site fee tied to 42 C.F.R. § 410.78. Section 56-7-1003 "provider-based telemedicine" reaches the patient at a location the patient deems appropriate, but only if three conditions are met. The provider must be at a qualified site other than the patient's location with access to the patient's medical record: the provider's primary or satellite office, a hospital licensed under Title 68, a rural health clinic, an FQHC, a facility licensed under Title 33, or any other location the insurer accepts. The provider, practice group, or health system must have submitted to the insurer evidence of an in-person encounter with the patient before the visit. And it must be able to render the service in person (§ 56-7-1003(a)(6)–(7)). Public Chapter 201 (2023) exempted initial behavioral health evaluations and assessments from the prior-encounter requirement, and Public Chapter 1027 (2024) deleted the old sixteen-month window while keeping that exemption. The definition excludes email, text, fax, remote patient monitoring, and services delivered under a contract between an insurer and an entity whose substantial business is facilitating provider-based telemedicine, so a platform's own insurer contract does not trigger the mandate, and a purely virtual practice with no in-person footprint still falls outside it. Audio-only conversation counts when real-time video and store-and-forward are unavailable, for behavioral health and other services alike (§ 56-7-1003(a)(6)(C)). For audio-only services other than behavioral health, subsection (k) requires the provider to confirm and document that the patient lacks the video technology, is where video service is unavailable, or has a physical disability that inhibits video use, and to tell the patient beforehand that cost-sharing will match an in-person or video visit.

Payment parity is § 56-7-1012: reimbursement "consistent with what the health insurance policy or contract provides for in-person encounters for the same service," regardless of geography. Enacted in 2020 with an April 2022 repeal date, it became permanent when Public Chapter 766 deleted that date. Section 56-7-1003(f) caps the obligation at the in-person amount. The provider-based telemedicine mandate is not limited to network providers: a provider who joins an insurer's network is subject to the same requirements and contract terms as any other network provider (§ 56-7-1003(c)), and the insurer must pay out-of-network providers for provider-based telemedicine under the same policies that apply to other out-of-network providers (§ 56-7-1003(d)(4)). Telehealth, provider-based telemedicine, and parity payments are all subject to utilization review under the Health Care Service Utilization Review Act, and §§ 56-7-1002 and 56-7-1003 do not require coverage of services that are not medically necessary or that the policy would not cover in person. The mandates exclude ERISA self-funded plans and several limited-benefit policy types. Model revenue accordingly — the broader picture is in our reimbursement guide.

What to watch

Three items: how MCO reimbursement policies absorb federal coding changes, since TennCare now routes telehealth guidance through them; how plans interpret the initial-behavioral-health exception to the in-person encounter rule; and the federal side, where the DEA's telemedicine prescribing framework and Medicare's telehealth flexibilities change what Tennessee's permissive practice act is worth — verify current status before building on them. The 114th General Assembly has adjourned, so state changes before 2027 would come from rulemaking or a special session. Verify current requirements with the Board of Medical Examiners and TennCare before acting, and compare Tennessee with its neighbors in the national overview.