With tourism carbon dioxide emission efficiency (TCDEE) as an undesired output, this study establishes an index system based on the inputs and outputs of TCDEE and measures the provincial TCDEE of China in 2010–2018, using the epsilon-based measure (EBM). In addition, the impactors of TCDEE were tested by the Tobit model. The main results are as follows: China’s TCDEEs had obvious provincial differences. Only six provinces reached the efficient frontier of TCDEE, namely, Beijing, Tianjin, Inner Mongolia, Shanghai, Jiangsu, and Guangdong. The other provinces failed to reach this state, leaving a room for improvement. Most eastern provinces had relatively high TCDEEs, while the central and western provinces had relatively low TCDEEs. In the sample period, the TCDEEs in eastern, central, and western parts all changed in the shape of letter N. The TCDEEs of the eastern part were much higher than those of the central and western parts. According to the results of the Tobit model, TCDEE is clearly enhanced by the urbanization level, strongly inhibited by industrial structure, technical progress, opening-up, and environmental regulation, and not significantly affected by the tourism level.