State Telehealth Parity Laws and What They Mean for Billing

Telehealth parity sounds like one rule. It's actually two separate legal obligations, coverage parity and payment parity, and confusing them is how billing teams end up disputing a denial that was never a denial at all, just a payer exercising a right the state law never took away. Coverage parity says an insurer has to cover a service delivered by telehealth if that same service would be covered in person. It says nothing about the check size. Payment parity is the harder ask: the insurer has to pay the same rate for the telehealth visit as it would for the in-person equivalent. A state can require one, both, or neither, and that combination alone fixes whether a telehealth claim is paid at full rate or at whatever the payer feels like offering that quarter.

How broadly these obligations have spread across states

Coverage parity has become close to background law at this point. The CCHP Fall 2025 report states that 44 states, the District of Columbia, Puerto Rico, and the Virgin Islands all have private payer telehealth reimbursement laws on the books. If a service would be covered face-to-face, the insurer generally can't refuse to cover it over video or phone in most of the country.

Payment parity tells a different story. CCHP counts 24 states plus Puerto Rico with payment parity requirements, which makes it the most common add-on written into private payer telehealth laws, but it's still the minority position nationally. The Manatt Telehealth Policy Tracker lands close but not identical: 23 states with full payment parity, 5 with parity carrying caveats, and 22 with no payment parity requirement. The gap between the two counts comes down to timing and how each organization classifies edge cases, and billing teams should treat both trackers as live references rather than picking one and forgetting the other exists.

The trend line shows payment parity laws roughly doubling since before a widespread public health crisis, when roughly ten states had put payment parity into law. Before a widespread public health crisis, roughly ten states had put payment parity into law. That number has more than doubled since. This isn't a settled area of policy, it's one still very much in motion, and a billing rulebook built two years ago is probably already out of date.

The three-category state taxonomy billing teams need

Every state effectively sorts into one of three buckets, and the bucket a practice operates in should shape how contracts get negotiated and how claims get built.

Category 1: both coverage and payment parity. This is the best environment a billing team can work in. The insurer has to cover the telehealth visit and has to pay the in-person rate for it. The CCHP Policy Finder and Manatt Telehealth Policy Tracker identify the specific states in this category, and both should be consulted directly since state classifications shift as legislatures act. Any apparent discrepancies in DC's classification should be resolved against the current CCHP Policy Finder before the determination gets built into anyone's billing logic. In these states, if a payer discounts a telehealth claim below the in-person rate, that's not a negotiating position, it's a contract violation the practice has grounds to dispute.

Category 2: coverage parity only. The claim gets covered. The rate is anyone's guess. The CCHP Policy Finder and Manatt Telehealth Policy Tracker identify which states fall into this group, and those references should be consulted directly given how frequently individual state classifications change. (New Jersey's status shifted with its 2026 extension bill, covered below, so its category needs a fresh check before publication.) Here, the payer sets its own telehealth fee schedule unless the contract says otherwise, and telehealth visits can and often do pay less than an identical in-person service. Rate protection, if it exists, has to be written into the contract, because the law won't supply it.

Category 3: payment parity without full coverage parity. A small number of states fall into this category. When telehealth is covered, it pays at the in-person rate, but which services are covered by telehealth in the first place varies. The rate protection applies only after a billing team confirms the specific service in question actually qualifies as covered telehealth under Louisiana's rules.

Beyond the three categories sit a handful of states with no private payer telehealth law. In those, there's no statutory floor whatsoever, and everything comes down to what the payer contract says and what the payer's internal policy allows on any given day.

Recent state legislative changes that have already moved the map

Texas passed HB 1052, effective January 1, 2026, requiring health benefit plans to cover telemedicine, teledentistry, and telehealth services delivered from or to out-of-state sites on the same basis as in-state services, so long as the patient primarily resides in Texas and the provider is licensed (or otherwise authorized) in Texas and keeps a physical office there. That's a meaningful shift for any practice serving Texas patients who cross state lines for care.

New Jersey's pay parity mandate was set to expire on July 1, 2026. The legislature extended it through December 31, 2027, and kept existing coverage of audio-only behavioral health visits intact along with it. Billing teams in New Jersey should not have built any 2026 workflow around an assumed lapse, because the lapse never happened.

Maryland went further and removed the scheduled repeal date from its private payer telehealth coverage law entirely, making the mandate permanent. Mississippi took a more modest step, pushing its repeal date out to July 1, 2028, without making the law permanent. For billing teams in Maryland, that means contingency planning for a sunset is no longer a task on the calendar. For Mississippi, it's a deferral.

New Mexico broadened its Telehealth Act to widen the definition of who counts as an eligible provider and to push both commercial insurers and Medicaid toward incorporating telehealth coverage more fully.

How the federal Medicare framework interacts with state parity rules

State parity statutes bind private payers. Medicare runs on its own separate federal track and isn't subject to any state's payment parity mandate, so the two systems sit side by side rather than one governing the other. A biller who assumes a state's payment parity law reaches into Medicare claims is going to be wrong every time.

The federal timeline itself has been anything but stable. A 43-day government shutdown ended on November 12, 2025, when Congress passed a piece of legislation. 5371, which temporarily reinstated Medicare telehealth flexibilities that had lapsed on October 1, extending them through January 30, 2026. Then a separate spending bill, the Consolidated Appropriations Act, 2026, signed February 3, 2026, extended most of those Medicare telehealth flexibilities through December 31, 2027. Separately, DEA flexibilities around controlled substance prescribing via telehealth stay in effect through December 31, 2026, on their own clock.

Behavioral health gets the strongest federal protection of any category. CMS has confirmed patients can receive behavioral health services from home regardless of geography, and the in-person visit requirement for mental health telehealth is delayed until January 1, 2028.

One more federal change lands on October 1, 2026: Rural Health Clinics and Federally Qualified Health Centers have to bill distant-site non-behavioral-health telehealth using individual CPT or HCPCS Level II codes and modifiers, replacing the HCPCS Level II code G2025 that's been standard until now. Behavioral health services billed under revenue code 0900 are carved out of this change. This is a hard cutover on a fixed date, not something that phases in gradually, and RHC/FQHC billing teams need it on the calendar now.

The billing mechanics that determine whether parity rights translate into actual payment

A state can hand a practice every parity right in the book, and none of it matters if the claim itself is built wrong.

Start with the dual-track code issue: the AMA's new 98000-series codes and Medicare's separate rules don't align. The AMA's new 98000-series CPT codes (98000 through 98016) are accepted by a number of commercial payers, though adoption isn't uniform across the industry. Medicare does not accept codes 98000 through 98015 and assigns them an "I" (invalid) status. The one exception is 98016, which Medicare does reimburse, as the direct replacement for the old G2012. For everything else, Medicare still wants standard office visit codes 99202 through 99215, paired with a telehealth place-of-service code and modifier. A billing team working in a payment-parity state on the commercial side has to know, payer by payer, which code family that payer actually accepts, because guessing wrong doesn't get corrected by the parity law, it just gets denied.

There's also a flat trap waiting in old habits: CPT codes 99441 through 99443, the old telephone visit codes, were permanently deleted effective January 1, 2025. Any claim in 2026 still using them gets denied automatically. That's not a parity dispute or a negotiation point; it's a data-entry error dressed up as a claim.

Modifiers carry real weight here too. Modifier 95 signals synchronous audio-video telehealth and is the standard choice for most payers. Modifier 93 signals audio-only telehealth, and it's required whenever there's no video component, full stop. Using 95 on an audio-only visit isn't a technicality; it creates a compliance problem that an audit will catch. In states where audio-only coverage is explicitly written into the parity law, like Arizona's parity for behavioral health audio-only visits, the correct modifier is literally what unlocks the parity rate. Get the modifier wrong and the claim can underpay or deny even in a state where the law guarantees rate equivalence.

Place of service adds another layer most billing teams underweight. POS 10 marks telehealth delivered to the patient's home. POS 02 marks telehealth delivered somewhere else. Some payers pay the higher non-facility rate specifically when POS 10 is used, and that difference can occur even inside a payment-parity state, because parity requires matching the in-person rate, and the in-person rate itself is either the facility rate or the non-facility rate depending on how the visit counts. Defaulting to one POS code across every claim, without checking the specific payer's policy, either leaves money on the table or creates an overpayment risk that later triggers a recoupment demand.

How parity type shapes payer contract negotiation

The category a state falls into should directly change what a billing team fights for at the negotiating table.

In a payment-parity state, the in-person rate functions as a floor, and any contract language letting the payer pay less for telehealth is on shaky legal ground. Billing teams should flag those clauses during contract review, not months later when the remittance advice comes back short.

In a coverage-parity-only state, the contract is the whole game. Nothing in state law sets the telehealth rate. Negotiation has the most room to actually move the number. Practices that just accept the payer's default telehealth fee schedule are often taking a discount the law never required them to accept.

The Manatt tracker identifies states where parity comes with caveats, and those states deserve their own line of scrutiny. A blanket assumption of full rate protection doesn't hold where conditions attach. Billing teams there need to read the actual statutory carve-outs before walking into a negotiation assuming full coverage.

Audio-only remains the most persistent gap even inside otherwise strong payment-parity states. Unless a state's law explicitly names audio-only as covered, the way Arizona and New Jersey do, a practice billing audio-only visits is effectively operating in coverage-parity-only territory for those specific visits, no matter how favorable the state's overall classification looks on paper.

Building a state-by-state monitoring process rather than relying on a static lookup

Given how much has shifted just in the last two years, a chart printed once and pinned to a wall isn't a compliance tool, it's a liability. Texas's HB 1052 lands January 1, 2026. New Jersey's extension runs to December 31, 2027. Maryland made a significant legislative change to its private payer telehealth coverage law. Mississippi's repeal date was pushed out. The federal Medicare timeline alone has changed twice in the space of a few months, through a shutdown-driven stopgap and then a full-year appropriations extension. None of that holds still long enough for a static reference document to stay accurate.

The two trackers worth building a recurring check around are CCHP's Policy Finder and the Manatt Telehealth Policy Tracker, and given that their counts already diverge slightly on categorization, cross-referencing both catches discrepancies a single source would miss. Layered on top of that, billing teams need a recurring calendar check against state legislative sessions and CMS rulemaking cycles, since both payment parity mandates and Medicare's own flexibility extensions have historically landed with hard, non-negotiable effective dates rather than gradual rollouts. Treating parity status as a fixed fact rather than a live variable can lead a practice to discover, on a denied remittance, that the ground shifted months earlier without anyone noticing.