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TN · STATE RULES

Telehealth rules in Tennessee

Tennessee writes its telehealth rules in two places and they pull in different directions. The statute is permissive, since store-and-forward counts and the provider-patient relationship forms through mutual consent and mutual communication. The board rule is where the constraints live, closing an old telemedicine license to new applicants, excluding plain phone calls from the definition, and telling a physician exactly what to do when the transmitted data cannot support a diagnosis. One drug carries an employment test of its own.

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Rules checked September 2026 · 22 sources cited

ONLY IN TENNESSEE

What is different about Tennessee

Each rule here is true of Tennessee and of none of the states that border it. Beside each one: what the neighbours do instead.

  1. 01 · Prescribing

    Only some clinics may prescribe buprenorphine

    T.C.A. 63-1-155 ties one medication to the prescriber's employer. Buprenorphine may be ordered through telehealth only by a provider employed by or contracted with a licensed nonresidential office-based opiate treatment facility, a community mental health center, a federally qualified health center, a hospital, or the TennCare buprenorphine network. A prescriber outside those settings falls outside the allowance no matter how carefully the visit itself is conducted.

    Source: T.C.A. 63-1-155

    Across the border

    • Kentucky

      Kentucky places no employer test on a particular medication and aims its controlled-substance rule at transmission, requiring Schedules II through V to travel electronically with only short hardship and technology waivers.

      Source: 902 KAR 55:130

    • Virginia

      Virginia draws its line by schedule and geography, letting a Schedule II through V prescription go out remotely only where the prescriber keeps a practice location in the state or can send the patient to a local practitioner for an examination.

      Source: Va. Code 54.1-3303

    • North Carolina

      North Carolina bars no controlled substance from remote practice outright, and instead makes the prescription electronic and requires a reporting-system check before a first targeted drug and at three-month intervals after it.

      Source: N.C.G.S. 90-113.74C

    • Georgia

      Georgia forbids a controlled prescription resting on an electronic consultation alone, and shuts remote practice out of chronic pain treatment with controlled drugs altogether.

      Source: Ga. Comp. R. & Regs. 360-3-.07

    • Alabama

      Alabama measures the relationship rather than the clinic, asking for live contact plus an in-person visit inside the previous twelve months before a controlled prescription, subject to a short list of exceptions.

      Source: Alabama Board of Medical Examiners: telemedicine

    • Mississippi

      Mississippi puts the weight on modality, treating store-and-forward as something that may enhance a real-time interaction but never stand in for it before a prescription is written.

      Source: 30 Miss. Code R. 2635-5.5

    • Arkansas

      Arkansas blocks the front door instead, refusing to let a questionnaire, an email or a text create the relationship and asking for a live audio-video examination or a record kept by a clinician.

      Source: Ark. Code 17-80-403

    • Missouri

      Missouri moved the opposite way, opening questionnaire-based care through an entity licensed in the state and asking that a report reach the patient's primary care provider within fourteen days.

      Source: RSMo 191.1146

  2. 02 · Licenses

    A license class closed to new doctors

    Board rule 0880-02-.16 says the Board will no longer issue what was previously termed a telemedicine license, leaving earlier holders to keep theirs only while they maintain specialty board certification. The same rule adds that those license holders do not possess prescriptive authority here, so the surviving credential cannot carry a prescription at all.

    Source: Tenn. Comp. R. & Regs. 0880-02-.16

    Across the border

    • Kentucky

      Kentucky issues no telehealth-only credential and instead forbids a state agency from blocking care delivered to a resident by a clinician practicing under a recognized interstate compact.

      Source: Center for Connected Health Policy: Kentucky

    • Virginia

      Virginia sits outside the physician compact, so a remote clinician holds an ordinary state license, and scheduled drugs additionally demand a local practice site or a referral path for an examination.

      Source: Va. Code 54.1-3303

    • North Carolina

      North Carolina opened its compact pathway at the start of January 2026 and governs remote care through a board position statement rather than through a separate class of license.

      Source: NCMB: Interstate Medical Licensure Compact

    • Georgia

      Georgia still issues a telemedicine license to a physician who holds a full unrestricted license elsewhere, although that license cannot be used to see the patient in person except in an emergency.

      Source: O.C.G.A. 43-34-31.1

    • Alabama

      Alabama folded cross-border remote practice into ordinary licensure and spends its rulemaking on visit counting, sending a patient in person or to a referral after four visits in a year for one unresolved complaint.

      Source: Alabama Board of Medical Examiners: telemedicine

    • Mississippi

      Mississippi asks a remote physician for the same full license a resident physician holds and reserves its distinctive requirement for the encounter, which has to be interactive.

      Source: 30 Miss. Code R. 2635-5.5

    • Arkansas

      Arkansas has enacted the physician compact but is not yet issuing licenses through it, so a remote clinician works from a state license and satisfies the statutory test for forming a relationship.

      Source: Ark. Code 17-80-403

    • Missouri

      Missouri points its newest provision at the organization rather than at the credential, permitting questionnaire-based treatment only where a licensed entity delivers it.

      Source: RSMo 191.1146

  3. 03 · Practice

    When the pictures are not good enough

    The board rule tells a physician what to do when the material sent across is not of sufficient quality or does not contain adequate information to form an opinion. The physician must declare that no opinion can be formed to make an adequate diagnosis, then request a direct referral for inspection and actual physical examination, request additional data, or recommend evaluation by the patient's own physician or another local provider. Because the duty is affirmative, an inconclusive asynchronous review ends in writing rather than in silence.

    Source: Tenn. Comp. R. & Regs. 0880-02-.16

    Across the border

    • Kentucky

      Kentucky answers the same problem at the level of the form, ruling that an online or telephonic evaluation by questionnaire will not serve for a first assessment or for any later one.

      Source: KRS 311.597

    • Virginia

      Virginia expects a store-and-forward review to rest on an available history plus an examination or testing where the standard of care calls for it, and keeps audio-only encounters for follow-up work.

      Source: Center for Connected Health Policy: Virginia

    • North Carolina

      North Carolina works from a board position holding that a prescription resting on a static online questionnaire alone is not acceptable, with informed consent documented in the chart.

      Source: NCMB: telemedicine position statement

    • Georgia

      Georgia requires a new patient to be examined with technology equal to an in-person examination, and its Board has said asynchronous review does not clear that bar.

      Source: Ga. Comp. R. & Regs. 360-3-.07

    • Alabama

      Alabama tolerates asynchronous first contact and turns instead to frequency, forcing an in-person visit or a referral once the same unresolved complaint has been handled remotely four times inside a year.

      Source: Alabama Board of Medical Examiners: telemedicine

    • Mississippi

      Mississippi insists on a real-time exchange by video, or by audio where that is clinically appropriate, and treats a bare questionnaire without an examination as a violation of Board policy.

      Source: 30 Miss. Code R. 2635-5.5

    • Arkansas

      Arkansas lists the ways a relationship may lawfully begin and excludes a patient-written history, a fax and a text message from that list.

      Source: Ark. Code 17-80-403

    • Missouri

      Missouri now lets an intake form carry the encounter, provided a licensed entity stands behind the care and the patient's regular physician receives a report on it.

      Source: RSMo 191.1146

PRACTICE RULES

How telehealth works in Tennessee

Practice requirements come from one statute and one board rule. The statute supplies the definitions and the benchmark; the rule supplies the machinery, covering who may stand beside the patient, what technology counts, and what a physician owes when the data is thin.

  1. 01

    Same benchmark as the room

    A provider using telehealth is held to the same standard of professional practice as a similar licensee delivering the service in person, so the screen changes the setting and leaves the benchmark untouched.

    Source: T.C.A. 63-1-155

  2. 02

    A facilitator confirms who is there

    The board rule describes a facilitator physically present with the patient, often tied to a local system of care or a parent or guardian, responsible for verifying identity and location and for originating, collecting and transmitting images and clinical data.

    Source: Tenn. Comp. R. & Regs. 0880-02-.16

  3. 03

    A phone call is not telemedicine

    Ordinary audio-only conversations, email and fax sit outside the definition used by the board rule and by the insurance provisions alike, with a narrow allowance for audio-only behavioral health when interactive means are unavailable.

    Source: Center for Connected Health Policy: Tennessee

  4. 04

    The record carries the technology

    Medical records must hold all pertinent data and information gleaned from the encounter and must document the technology used, and those records remain open to Board inspection.

    Source: Tenn. Comp. R. & Regs. 0880-02-.16

FIRST VISIT

Can a first visit happen without a live call in Tennessee?

Yes, with conditions

Yes, within limits. The statute forms the relationship through mutual consent and mutual communication rather than through a face-to-face meeting, and the board rule stops an asynchronous encounter the moment the transmitted material is too thin to support a diagnosis.

No statute here orders a face-to-face visit before a first prescription. What the rules describe instead is the moment an asynchronous review runs out of road, and they place the burden on the physician to say when that has happened.

  1. 01

    Mutual consent, mutual communication

    Outside emergencies the relationship begins when patient and provider reach mutual consent and mutual communication, and when the provider affirmatively undertakes to diagnose or treat, or affirmatively participates in diagnosis or treatment.

    Source: T.C.A. 63-1-155

  2. 02

    Store-and-forward sits inside the definition

    Asynchronous computer-based communication, including the transfer of images between a patient and a provider at distant sites without in-person contact, is written into the statutory definition rather than excluded from it.

    Source: T.C.A. 63-1-155

  3. 03

    The physician must be able to form an opinion

    Where the material supplied cannot support a diagnosis, the treating physician is obliged to say so on the record and to route the patient to an examination, to further data, or to a local provider, which is the practical ceiling on asynchronous care.

    Source: Tenn. Comp. R. & Regs. 0880-02-.16

  4. 04

    Behavioral health is treated differently

    For coverage purposes an initial behavioral health evaluation is carved out of the prior in-person encounter that provider-based telemedicine otherwise expects, and audio-only contact may stand in where interactive means are unavailable.

    Source: Center for Connected Health Policy: Tennessee

PRESCRIBING

Prescriptions and controlled drugs in Tennessee

Two features shape remote prescribing. One is an employment test resting on a single medication; the other is a set of general prescribing limits that apply whether the visit happened in an office or on a screen.

  1. 01

    The buprenorphine employment test

    A clinician who wants to treat opioid use disorder remotely has to sit inside one of the named settings, which turns an employment or contracting relationship into a prescribing prerequisite rather than a billing detail.

    Source: T.C.A. 63-1-155

  2. 02

    Three days on a first opioid supply

    An opioid prescription starts at a three-day supply, with documented exceptions reaching ten days at 500 morphine milligram equivalents and thirty days at 1,200, each conditioned on recorded reasons and the patient's informed consent.

    Source: T.C.A. 63-1-164

  3. 03

    A closed credential cannot prescribe

    Since the retained telemedicine license carries no prescriptive authority, the credential a clinician holds decides whether a prescription can be written at all, and a remote prescriber therefore needs the ordinary state license.

    Source: Tenn. Comp. R. & Regs. 0880-02-.16

  4. 04

    Federal conditions sit on top

    Any scheduled drug also answers to the federal telemedicine conditions, which run alongside the state requirements rather than replacing them, and the federal allowances for remote scheduled prescribing carry an expiry date.

    Source: Center for Connected Health Policy: Tennessee

Federal rules apply on top of every state's. Prescribing controlled substances by telehealth without an in-person visit runs on DEA flexibilities currently extended through December 31, 2026, with a permanent rule still pending.

LICENSES

Who can treat patients in Tennessee

Licensing runs through the Board of Medical Examiners, and physicians may come in through the Interstate Medical Licensure Compact. The unusual parts are the credential the Board stopped issuing and the volume of physician oversight a nurse practitioner still carries.

  1. 01

    One live pathway for physicians

    A physician reaches patients here through a full state license or through the medical compact, and the board rule requires anyone practicing medicine remotely to be duly licensed by the Board under the current statutes and rules.

    Source: Tenn. Comp. R. & Regs. 0880-02-.16

  2. 02

    No office lease required

    A provider delivering services exclusively by telehealth need not maintain a physical address in the state, which takes the question of a local office out of a remote practice's setup.

    Source: Center for Connected Health Policy: Tennessee

  3. 03

    One chart in five, every month

    A supervising physician personally reviews at least twenty percent of the charts a certified nurse practitioner writes every thirty days and visits each remote practice site at least that often, which is heavy oversight by national standards.

    Source: Tenn. Comp. R. & Regs. 0880-06-.02

  4. 04

    Supervision does not mean presence

    Continuous physical presence is not required, but the supervising physician must be available for consultation at all times or arrange a named substitute, and must share expertise in the nurse practitioner's area of medicine.

    Source: Tenn. Comp. R. & Regs. 0880-06-.02

  5. 05

    Two hours of prescribing coursework

    Prescribers complete two hours of continuing education every two years drawn from the Department of Health's guidelines covering opioids, benzodiazepines, barbiturates and carisoprodol.

    Source: T.C.A. 63-1-402

How Tessic Health's providers are licensed in Tennessee

ADVERTISING

Marketing to patients in Tennessee

There is no comprehensive state privacy statute, so promotional claims answer to the consumer protection act and to the discipline grounds in the Medical Practice Act. Two telehealth rules also constrain what a marketing page can honestly promise.

  1. 01

    Triple damages need willfulness

    A court may award up to three times actual damages only where it finds a willful or knowing violation of the Consumer Protection Act, and punitive damages are then barred for the same practice.

    Source: T.C.A. 47-18-109

  2. 02

    Claims reach the license

    Advertising medical business in which untrue or misleading statements are made is listed among the grounds on which the Board may act against a physician's license, so the treating clinician carries the exposure created by a brand's copy.

    Source: T.C.A. 63-6-214

  3. 03

    Opioid treatment claims are narrow

    A page offering opioid use disorder medication remotely describes a service only a clinician inside a listed treatment setting may deliver, so the offer has to match the prescriber's actual employment.

    Source: T.C.A. 63-1-155

  4. 04

    Do not sell a call as a video visit

    Since an ordinary audio call, an email and a fax fall outside the definition of the service, marketing that presents a telephone consultation as a telemedicine visit misdescribes it beyond the narrow behavioral health allowance.

    Source: Center for Connected Health Policy: Tennessee

TESSIC HEALTH IN TENNESSEE

How Tessic Health's providers cover Tennessee

Two rules shape how the provider network runs here: the employment test on one medication, and the affirmative duty to halt an asynchronous review that cannot support a diagnosis.

  1. 01

    Opioid treatment is referred out

    Because remote buprenorphine prescribing is confined to clinicians inside named treatment settings, patients here who need that medication are referred to a qualifying local program instead of being treated on the platform.

  2. 02

    An inconclusive review is written down

    Where intake photographs or records cannot support a diagnosis, the clinician records that no opinion can be formed and routes the patient to further data, an examination, or a local provider, which is what the board rule demands.

  3. 03

    Video rather than a phone call

    Real-time encounters with patients here run on secure video instead of audio alone, since a telephone conversation does not meet the state's definition of the service outside the narrow behavioral health allowance.

  4. 04

    Prescribers hold the full license

    Clinicians serving patients here hold a full state license rather than the older remote-practice credential, which carries no prescriptive authority and would not support writing a prescription.

  5. 05

    Dispensing and price

    Medication for patients here is dispensed at 0% markup through pharmacies permitted to ship into the state, and cold-chain handling covers any product that requires it.

COMMON QUESTIONS

Questions about telehealth in Tennessee

  • Sometimes. Store-and-forward is inside the statutory definition and no statute orders a prior face-to-face meeting, so an asynchronous first encounter is possible. It fails the moment the material supplied cannot support a diagnosis, because the physician then has to say so and send the patient elsewhere.

  • Only a provider employed by or contracted with one of the named settings: a licensed nonresidential office-based opiate treatment facility, a community mental health center, a federally qualified health center, a hospital, or the TennCare buprenorphine network. The test looks at where the prescriber works, not at how good the visit was.

  • Not as a general matter. An audio-only conversation, an email and a fax fall outside the definition the board rule and the insurance provisions use. The exception is behavioral health, where audio-only contact may be used when interactive means are unavailable.

  • Not for new applicants. The Board stopped issuing what it previously called a telemedicine license, and earlier holders keep theirs only while maintaining specialty board certification. Those holders have no prescriptive authority here, so a prescribing clinician needs the ordinary license or a compact license.

  • Closely. The supervising physician personally reviews at least a fifth of the certified nurse practitioner's charts every thirty days and visits each remote site at least as often. Constant presence is not required, but consultation must be available at all times or a substitute physician arranged.

  • The physician has to declare that no opinion can be formed to make an adequate diagnosis. From there the rule offers three routes: request a direct referral for inspection and actual physical examination, request additional data, or recommend the patient be evaluated by their own physician or another local provider.

SOURCES

Rules checked September 2026 · 22 sources cited. A planning summary, not legal advice. Statutes, board rules and enforcement priorities change; a brand's own counsel should review its model and marketing before launch.

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