Telehealth Parity Law

State or federal legislation requiring insurance payers to cover and reimburse telehealth services at the same rate as equivalent in-person services.

Telehealth parity laws require payers to treat telehealth visits the same as in-person visits for coverage and reimbursement purposes. If a payer covers a service when delivered in person, and that service can be appropriately delivered via telehealth, the payer must cover it at the same rate via telehealth. Parity laws vary significantly by state. Some states have comprehensive parity laws that cover all health plans and all telehealth modalities (video, audio-only, remote monitoring). Others have limited parity that only covers certain services or certain plan types. Some states mandate payment parity (same reimbursement rate) while others only mandate coverage parity (must cover the service but can pay a lower rate). The federal level has its own telehealth rules. Medicare expanded telehealth coverage dramatically during the COVID-19 public health emergency. Some of those expansions have been made permanent while others are temporary and subject to congressional reauthorization. The Consolidated Appropriations Act of 2023 extended many flexibilities through 2024, and subsequent legislation has continued extensions. For credentialing, parity laws affect how you enroll for telehealth services. If your state has parity, payers cannot create separate, more restrictive credentialing requirements for telehealth providers versus in-person providers. They must credential you the same way regardless of how you deliver care. Parity laws also affect coding and billing for telehealth. Under parity, you bill the same CPT code for a telehealth visit as you would for an in-person visit, with the appropriate place of service code and any required modifiers (like modifier 95 for synchronous telehealth). The payer must adjudicate it at the same rate. If you provide telehealth services, know your state's parity law. The Center for Connected Health Policy maintains a database of state telehealth laws at cchpca.org. Understanding what your state requires helps you advocate for proper reimbursement and push back when payers try to pay less for telehealth than for in-person services.