§ 71-5-168 — CPT code updates to include reimbursement of remote ultrasound procedures and remote fetal nonstress tests - Qualifications for reimbursement

(a) As used in this section, "CPT code" means the unique numerical designations established by the American Medical Association for various medical, surgical, and diagnostic services used in billing healthcare services. (b) No later than December 31, 2024, the bureau of TennCare shall amend existing rules, or promulgate new rules, on fee-for-service and medicaid managed care plans regarding reimbursement to allow for the reimbursement of remote ultrasound procedures and remote fetal nonstress tests utilizing established CPT codes for such procedures when the patient is in a residence or other off-site location that is separate from the patient's provider and the same standard of care is met. (c) When amending or promulgating rules pursuant to subsection (b), the bureau shall ensure that: (1) A remote ultrasound procedure or remote fetal nonstress test is only reimbursable when the provider uses digital technology: (A) To collect medical and other forms of health data from a patient and electronically transmit that information securely to a healthcare provider who is in a separate location for the purpose of interpretation and making recommendations; (B) That is compliant with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA)( 42 U.S.C. § 1320d et seq.); and (C) That is approved by the federal food and drug administration; and (2) A fetal nonstress test is only reimbursable with a place of service modifier for at-home monitoring with remote monitoring solutions that are cleared by the federal food and drug administration for on-label use for monitoring fetal heart rate, maternal heart rate, and uterine activity.

Legislative History

Added by 2024 Tenn. Acts, ch. 674,s 1, eff. 4/11/2024.