Tennessee Ambulance Service Association • TennCare Guidance
TN-T2 Model: Frequently Asked Questions & Billing Guidance
A practical EMS reference for TennCare's Triage, Navigate, Treat and Transport (TN-T2) payment model, including Treatment in Place (TIP), Transport to an Alternate Destination (TAD), billing modifiers, and provider scenarios.
Revised July 30, 2026What is TN-T2?
TN-T2 is a TennCare payment model designed to give EMS care teams greater flexibility following a 9-1-1 call. The model supports person-centered care, EMS system efficiency, and appropriate utilization by allowing reimbursement for certain Treatment in Place (TIP) services and Transport to Alternate Destination (TAD) services.
View / Download the Full TN-T2 FAQ & Guidance
Below is a quick reference/summary of the TNT2 FAQ's & Guidance
Participation is Optional
EMS services are not required to offer TN-T2 interventions and may provide TAD, TIP, or both.
No 24/7 Requirement
TAD and TIP services do not have to be available 24 hours per day.
Medical Director Protocols
Providers should coordinate with their medical director to establish clinical protocols for TAD and TIP.
Key Participation & Partner Requirements
Important: A Qualified Healthcare Partner (QHP) or alternate destination must be contracted with the member's TennCare MCO, as required by TennCare's MCO contract, for reimbursement.
- EMS providers may establish partnerships with QHPs for TIP.
- Before transporting to alternate destinations, EMS providers may establish agreements with eligible destinations such as Community Mental Health Centers, Federally Qualified Health Centers, and Urgent Care providers.
- Transport to a primary care provider is disallowed under the guidance.
- A QHP may provide covered services in person on scene or by remote access, depending on the intervention.
- Paramedics and EMTs who are not otherwise licensed as a physician or non-physician practitioner do not meet the individual-practitioner standard for a QHP under the model.
TN-T2 Billing Modifiers
| Service | Modifier / Billing Guidance |
|---|---|
| TAD – Community Mental Health Center | C |
| TAD – Federally Qualified Health Center | F |
| TAD – Urgent Care | U |
| TIP via QHP | W – treatment by QHP in person or via remote access. |
| TIP by EMS without QHP | File the claim using the same modifier for both the incident location and destination location (for example, RR for a residence or SS for the scene of an accident/acute event). |
Mileage: Mileage charges are not applicable to TIP or other non-transport claims. TAD transport claims may include mileage as applicable. Claims remain subject to medical necessity determinations and applicable geographic factors/add-ons and multiple-patient rules.
Origin / Destination Modifiers for EMS TIP Without QHP Consultation
| Modifier | Description |
|---|---|
| D | Diagnostic or therapeutic site other than P or H when those are used as origin codes |
| E | Residential, domiciliary, custodial facility (other than 1819 facility) |
| G | Hospital-based ESRD facility |
| H | Hospital |
| I | Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transport |
| J | Freestanding ESRD facility |
| N | Skilled nursing facility |
| P | Physician's office |
| R | Residence |
| S | Scene of accident or acute event |
| X | Intermediate stop at physician's office on way to hospital (destination code only) |
EMS Provider Scenarios at a Glance
| Scenario | What Happens | EMS Billing Guidance | Dual-Eligible Guidance |
|---|---|---|---|
| 1 – No Transport TIP without QHP |
EMS assesses and provides treatment/supplies/equipment on scene without a QHP and does not transport. | Paid per appropriate HCPCS code. Use the same modifier for incident and destination. No mileage. | Bill TennCare MCO directly; this is not a Medicare-covered service. |
| 2 – No Transport TIP with remote QHP |
EMS arrives and facilitates remote-access treatment with a QHP. | EMS and QHP are paid separately. EMS uses modifier W. No mileage. | Bill TennCare MCO directly; this is not a Medicare-covered service. |
| 3 – Transport TIP followed by transport |
Scenario 1 or 2 occurs, but the member still must be transported. | EMS is paid only for the last service furnished (the transport). Use H for hospital or the applicable TAD modifier (C, F, U). Mileage is payable. | Hospital ED: bill Medicare first. Alternate destination: bill TennCare MCO directly. QHP bills TennCare MCO separately. |
| 4 – No Transport TIP with QHP on scene |
EMS and QHP are on scene; QHP performs TIP. | EMS and QHP are paid separately. EMS uses modifier W. No mileage. | Bill TennCare MCO directly; this is not a Medicare-covered service. |
| 5 – Transport TAD without QHP |
EMS provides treatment and transports the member to an alternate destination. | Use the appropriate HCPCS code and C, F, or U. Mileage is payable. | Bill TennCare MCO directly; this is not a Medicare-covered service. |
| 6 – Transport Normal transport to ER |
EMS provides treatment and transports the member to the Emergency Department. | Traditional HCPCS code with modifier H. Mileage is payable. | Bill Medicare first; QHP bills TennCare MCO separately when applicable. |
| 7 – No Transport Patient refusal with necessary assessment |
EMS performs a medically necessary assessment, but the member refuses treatment and ED transport. | Paid per appropriate BLS/ALS HCPCS code. Use the same modifier for incident and destination. No mileage. | Bill TennCare MCO directly; this is not a Medicare-covered service. |
| 8 – No Transport Patient refusal without assessment |
Member refuses assessment, treatment, and transport. | No EMS payment; no modifiers; no mileage. | Guidance states TennCare MCO direct billing for dual-eligible members, while EMS receives no payment for the refused service. |
Frequently Asked Questions
1. What is the TN-T2 Model?
Triage, Navigate, Treat and Transport (TN-T2) is a payment model that gives EMS care teams greater flexibility to address emergency health care needs of TennCare beneficiaries after a 9-1-1 call. It enables TennCare reimbursement for Treatment in Place (TIP) and Transport to an Alternate Destination (TAD), when requirements are met.
2. What are the goals of the TN-T2 Model?
- Provide person-centered care so individuals receive care safely at the right time and place.
- Increase EMS system efficiency and increase opportunities to respond to high-acuity cases.
- Encourage appropriate use of emergency medical services.
3. Must an EMS service provide both TAD and TIP?
No. EMS providers may provide TAD, TIP, or both.
4. Is an EMS service required to provide either service?
No. EMS services are not required to provide TN-T2 services.
5. Must TN-T2 interventions be available 24 hours per day?
No. TAD and TIP do not have to be available 24 hours per day.
6. What are the requirements to participate?
There are no regulatory requirements identified in the FAQ for providing these services. Providers should coordinate with their medical director on protocols, may establish QHP partnerships for TIP, and should establish arrangements with alternate destinations before offering TAD. The QHP or alternate destination must be contracted with the member's TennCare MCO for reimbursement.
7. Who is considered a Qualified Healthcare Partner (QHP)?
Examples include a TennCare-enrolled group practice, physician or non-physician practitioner, or an entity that contracts with or employs a TennCare-enrolled practitioner to furnish TIP services. Individual practitioners must meet applicable laws, regulatory requirements, accreditation standards, and licensing rules. Paramedics and EMTs who are not also licensed as eligible practitioners do not meet the individual-practitioner QHP standard.
8. How are TN-T2 claims filed?
Claims are submitted to the TennCare MCO through normal procedures. TAD/TIP modifiers are generally placed in the destination position, with special same-origin/destination modifier rules for EMS-delivered TIP without a QHP. TIP/non-transport claims do not include mileage.
9. Does a QHP have to be onsite to furnish TIP?
It depends on the intervention. A QHP must be on scene for in-person TIP. For remote-access TIP, the qualified practitioner is located at a distant site.
10. Must a QHP ride in the ambulance to provide in-person TIP?
No. A QHP may arrive after the EMS service makes a triage decision for TIP as a second-tier onsite response, or may connect by remote access.
11. Who pays for remote-access services?
TennCare MCOs reimburse QHPs for medically necessary covered remote-access TIP services. The EMS service is reimbursed for the base ambulance charge at the ALS or BLS rate depending on the assessment/procedure performed.
12. May EMS consult a physician or non-physician practitioner when making a triage decision?
Yes. The intervention offered is driven by predetermined clinical protocols approved by the EMS medical director, and those protocols may include consultation with a physician or non-physician practitioner. MCOs may request protocols for audit purposes.
13. Can a QHP be paid for TIP when the patient is later transported?
Yes. The EMS agency may receive payment for only one available intervention per incident—generally the intervention furnished last in time. Other providers may separately bill for covered services they furnish to the beneficiary.
14. Must an ambulance be on scene for a TIP intervention?
No. The response vehicle is determined by local system design and the EMS service's approved clinical protocols/standard operating procedures. A triage decision under those protocols must occur before offering a TN-T2 intervention.
15. How should EMS bill for dual-eligible members?
The FAQ provides scenario-specific guidance. Most TN-T2 scenarios are billed directly to TennCare MCOs because they are not Medicare-covered services. Scenario 3 and Scenario 6 have additional Medicare-first guidance when the transport is a Medicare-covered service.
16. How should EMS bill on-scene services without transport (Scenarios 1 and 7)?
Use the same modifier for both the incident location and destination location. Examples in the guidance include RR for a residence and SS for the scene of an accident or acute event.
Source: TennCare TN-T2 Model Frequently Asked Questions, revised July 30, 2026. This web page is a condensed presentation of the attached guidance. EMS providers should consult the full TennCare document for complete billing and operational details.