State Telehealth Parity Law: 8 Essential Claim Checks

A state telehealth parity law requires private health plans to treat telehealth visits like in-person visits in some way. The rule can be about whether the plan covers the visit, how much it pays, or both. Because states write these laws differently, check the rule before you bill, not after the denial.

Coverage parity and payment parity are not the same

A state telehealth parity law can mean two different things, and mixing them up causes bad forecasts. The Center for Connected Health Policy (CCHP) explains that coverage parity requires a service to be covered by telehealth if it would be covered in person, but does not guarantee the same payment. Payment parity, also called reimbursement parity, goes further and requires the same rate or amount. CCHP says payment parity is the less common of the two.

Type	What the plan must do	What it does not promise
Coverage parity	Cover a service by telehealth if it would cover it in person	The same payment amount
Payment parity	Pay the same rate for telehealth as for in-person	That every service or clinician type qualifies

CCHP’s policy trends page reports that 44 states, Puerto Rico, the District of Columbia and the Virgin Islands have a private payer law that addresses telehealth reimbursement, and 24 states plus Puerto Rico have an explicit payment parity requirement. Its researchers gathered that private payer data from late May to early September 2025, so check for changes.

Which plans a state telehealth parity law reaches

A state telehealth parity law reaches the plans the state regulates, which is not every plan your patients carry. Sort each patient’s coverage into the right bucket before you rely on it.

Private payers

State laws apply to fully insured plans. The Connecticut Insurance Department, for example, says state insurance laws do not apply to self-insured employer plans, which follow federal rules instead. That is one state’s statement about its own law, but the plan-type question is the same everywhere: ask whether the plan is fully insured or self-funded. Our insurance verification routine has a place to record it.

Medicare and Medicaid

State private payer laws do not set Medicare rules. Medicaid is run by each state under its own rules, and those rules can differ from the state’s commercial law. Florida, for instance, limits Medicaid telemedicine payment to live audio and video and requires modifier GT on fee-for-service claims, as our Florida Medicaid telemedicine post below explains.

State rules

No two states write the law the same way. One may require coverage, another payment parity, another neither for a given clinician type. Use your state insurance department’s site for the rule that applies to you.

Eight claim checks before you bill telehealth

Run these eight checks for each payer and write down the source. A state telehealth parity law may answer some of them and leave the rest to the plan.

Check	Question to ask the payer or the statute
1. Coverage	Is this service covered by telehealth for this plan?
2. Payment	Is the rate the same as in person, or lower?
3. Clinician type	Do psychotherapists, psychologists and psychiatrists all qualify?
4. Modality	Is live video required, or is audio-only allowed?
5. Coding	Which place of service code and modifier does the plan require?
6. Cost share	Does the same copay, deductible and coinsurance apply? See coinsurance vs copay vs deductible.
7. Documentation	Does the plan want locations, consent or times in the note?
8. Plan type	Is the plan fully insured, self-funded, Medicare Advantage or Medicaid?

Does a state telehealth parity law mean telehealth pays the same as in person?

Not automatically. A state telehealth parity law may require only that the visit be covered, which says nothing about the amount. Even where payment parity exists, it may apply to only some services or clinicians, and it does not reach self-funded plans. Treat any rate promise as unsettled until the payer’s fee schedule or your contract says so. Your remittance will show what was paid, and the CARC and RARC code guide explains adjustments.

What to do Monday morning

1. List your top five payers and mark each patient’s plan type: fully insured, self-funded, Medicare or Medicaid.
2. For each payer, ask the eight questions above and save the answer with the date and the representative’s name.
3. Compare telehealth payments against in-person payments for the same code on your last three remittances.
4. Watch your clean claim rate on telehealth lines separately from in-person lines.
5. Bookmark the billing terms glossary for staff who ask what a modifier or place of service code means.

The short version: state telehealth parity law

A state telehealth parity law can require coverage, payment, or both, and it reaches only the plans your state regulates. Check eight things per payer, record the source, and compare real remittances before you forecast telehealth revenue.

How MCM South helps

MCM South Medical Billing Service, LLC bills exclusively for mental and behavioral health, for psychotherapists and psychiatrists in solo and medium-size practices. We bill out-of-network claims for clients. If telehealth claims are denying and you cannot tell why, ask us to look at them.

Want help sorting telehealth claims? We can talk through your practice.

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Where MCM South works

MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.

This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.