Teledermatology Expands Patient Access, Reimbursement Opportunities

This content was developed independently and is not endorsed by the American Academy of Dermatology.

Through video visits, portal messaging, and electronic consultations (e-consults), teledermatology can improve efficiency, expand patient access, and offer billable alternatives to traditional in-person care, experts explained during a Friday afternoon session at the 2026 American Academy of Dermatology (AAD) Annual Meeting.¹

Working Smarter With Teledermatology

Elizabeth Jones, MD, FAAD, associate professor of dermatology and director of teledermatology at Thomas Jefferson University Hospitals, kicked off the session, “Leveraging Teledermatology to Improve Patient Access to Dermatologist-Level Care,” with a primer on synchronous teledermatology.

She explained that dermatologists are facing declining reimbursement, particularly due to the Medicare Physician Fee Schedule efficiency adjustment, which reduces payments for non–time-based services by approximately 2.5% and is expected to recur every 3 years, disproportionately affecting procedural care.² Given the uncertainty of policy reversal, Jones emphasized that dermatology cannot rely solely on advocacy to address these challenges.¹

Instead, she encouraged dermatologists to “work smarter, not harder” by leveraging teledermatology to protect revenue, improve efficiency, and help solo and small MD-led practices survive narrow margins.

Teledermatology adoption has remained steady since the COVID-19 pandemic, with about 63% of dermatologists reporting use in 2022 and about 6 in 10 continuing to provide some virtual care in 2025, primarily through live interactive video. Although only about 1% to 10% of visits are conducted virtually, and most dermatologists plan to maintain this level in 2026, Jones advocated for expanding use.

She explained that video visits offer several advantages, including improved convenience and flexible scheduling for patients, as well as the ability for practices to maintain clinic volume during staffing shortages. Teledermatology also enables clinicians to see appropriate patients the same day via video rather than overbooking in-person visits. Additionally, it can help reduce bottlenecks, allow providers to alternate between in-person and virtual care, and create more predictable schedules that improve staff satisfaction.

Jones also addressed concerns about visit length and reimbursement. With proper triage, she noted that video visits are efficient, typically lasting about 15 minutes for established patients and 20 minutes for new patients. Reimbursement, she added, is generally comparable to in-person evaluation and management services, particularly as telehealth policy support continues.

Jones also positioned teledermatology as a practical solution to the growing inbox burden in dermatology. She explained that providers often spend about 30 minutes per day reviewing patient messages and images, many of which could be converted into billable video visits.

Jones recommended a hybrid care model that combines in-person and virtual visits. Video visits are well-suited for acne, common rashes, chronic inflammatory disease follow-up, medication monitoring, and prescription refills. In contrast, suspicious lesions, full skin examinations, and sensitive areas where imaging may be inadequate should be evaluated in person.

Lastly, she highlighted the emerging role of artificial intelligence (AI) scribes. Although adoption remains limited, Jones noted that 80% to 90% of video visits could potentially benefit from scribe support. Early data suggest these tools can improve efficiency, saving approximately 90 seconds per note and cutting documentation time roughly in half when comparing in-person visits without a scribe to video visits with one.

“Ultimately, what we're trying to show here is that we can finally have a system that works for us if we apply AI and are using modern technology for things like triage, inbox management, image quality control, billing, scribing, and scheduling,” Jones concluded. “To recap, for video visits, the type of model I recommend is hybrid.”

Addressing Inbox Overload Through E-Visit Billing

Lia Gracey Maniar, MD, PhD, FAAD, director of teledermatology and digital health strategy at Ascension, next outlined how teledermatology can help dermatologists manage inbox demands while creating opportunities for reimbursement.

Building on Jones’ discussion, she explained that dermatology practices are facing a sharp rise in patient portal messaging. This trend accelerated following the passage of the Health Information Technology for Economic and Clinical Health Act of 2009 and further expanded during the COVID-19 pandemic. Dermatologists now receive nearly 50 messages per day on average, many involving photos and clinical decision-making, creating a “second, unpaid clinic” that strains workflow and contributes to burnout.

In response, Gracey Maniar noted that CMS allows clinicians to bill certain portal interactions as e-visits using Current Procedural Terminology (CPT) codes 99421 through 99423. To qualify, services must involve established patients, be patient-initiated, require at least 5 minutes of medical decision-making, and not be related to recent or imminent in-person visits.

At least 25 major institutions have implemented billing for portal messages, including UCSF Health. Early data from the institution show only a modest impact, with message volume decreasing by 2% to 3% after billing was introduced. However, there were no significant changes in scheduled visits or shifts to telephone calls to avoid the new billing protocol.

Despite the potential clinician benefits, she emphasized that patient equity and cost concerns remain key barriers. Some studies show reduced portal use among certain populations, including Latinx and Asian individuals, following billing implementation. Additional research suggests that messages from non-White patients are less likely to receive responses from attending physicians and more often handled by other care team members, raising concerns about widening disparities.

Patient out-of-pocket costs also remain inconsistent, complicating transparency. Gracey Maniar explained that some institutions report costs of $14 to $52 for Medicare beneficiaries with minimal costs for privately insured patients, and others report no cost for Medicare beneficiaries but potential charges of $30 to $75 for private plans. This variability, she said, can make it challenging for patients to make informed consent.

Overall, Gracey Maniar emphasized that broader adoption of portal message billing will require careful attention to workflow integration, equity, and patient communication.

“In theory, it could potentially reduce the patient portal message load, but it might be a little more modest based on some early data that we're seeing from these institutions…” she said. “On the flip side, there is risk for patient abrasion when trying to bill for things they were used to getting for free, and…the billing policies are a little bit unclear, so it can be hard for patients to give informed consent when they're not really sure how much this is going to cost them.”

Replacing Curbsides With Structured, Reimbursable e-Consults

Sara Harcharik Perkins, MD, FAAD, associate professor of dermatology at Yale School of Medicine, then discussed how teledermatology can reduce informal “curbside” consultations. She noted that curbsides remain a common but problematic part of dermatology practice, with clinicians frequently fielding questions via texts, electronic medical record messages, or hallway conversations.

Many dermatologists handle multiple curbsides each week, often spending at least 5 minutes on each case, yet nearly all receive no compensation or work relative value unit (wRVU) credit. These exchanges are typically undocumented, raising concerns about liability, consistency, and equity. While valued for their speed and collegiality, Harcharik Perkins noted that experts increasingly view curbsides as an unsustainable model for delivering specialty input.

e-Consults, by contrast, offer a structured, billable alternative. Under CPT code 99451, dermatologists can provide remote consultative input to primary care clinicians for new or established patients. Like portal messaging billing, qualifying interactions must meet specific criteria, including at least 5 minutes of medical decision-making and no recent or imminent in-person visit.

The workflow uses standardized templates, with referring clinicians submitting clinical history and images and specialists providing recommendations, rationale, and follow-up guidance.

Evidence suggests e-consults are both effective and well-received. Harcharik Perkins highlighted high satisfaction among primary care clinicians, with 70% to 85% of cases managed without requiring an in-person visit. When in-person care is needed, e-consults improve triage, enabling faster access for urgent cases and more appropriate scheduling overall without reducing traditional referral volumes.

She emphasized that successful implementation requires institutional support, clinician champions, and robust IT infrastructure to streamline workflows and track outcomes. Compensation models vary, ranging from per-consult incentives to fully integrated wRVU credit or dedicated teledermatology roles.

Overall, Harcharik Perkins noted that e-consults represent a scalable solution to replace curbside care, helping to improve access, documentation, and equity while ensuring dermatologists are appropriately compensated.

“Hopefully, I have left you with the sense that curbsides are a problem, e-consults are a promising solution, evidence does support their utility, and you can start doing them,” she concluded.

References

1. Jones E, Gracey Maniar L, Harcharik Perkins S, Vanchinathan V, Zhang M, Georgesen CJ. Leveraging teledermatology to improve patient access to dermatologist-level care. Presented at: 2026 AAD Annual Meeting; March 27-31, 2026; Denver, CO.
2. Calendar year (CY) 2026 Medicare Physician Fee Schedule final rule (CMS-1832-F). News release. FDA. October 31, 2025. Accessed March 28, 2026. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f