It is common for telehealth visits to occur via scheduled video but synchronous video is more slow and more costly for many types of medical interactions. In cases like dermatology follow ups, behavioral health check ins, post procedure photo reviews and medication titration, store-and-forward telehealth is an alternative. By using asynchronous telehealth, providers can provide clinical quality that is equal to or higher than video visits. There is also less difficulty for both patients and clinicians – this text provides a framework to determine when asynchronous methods are appropriate, what technical features are necessary, how billing works and how this affects the time economics of providers.
Clinical patterns where asynchronous methods are effective
As clinicians choose between methods, four patterns favor asynchronous communication over scheduled video:
- Visual diagnosis with limited interaction. In visual diagnosis where interaction is minimal, like dermatology follow ups or wound checks, real time conversation is rarely helpful. The diagnostic information is present in the images and the written history.
- Medication titration and refills. For medication titration and refills, the tasks are brief – when a clinician adjusts a dose or reviews blood pressure logs, a 20-minute video appointment is an inefficient use of time.
- Behavioral health check ins between sessions. In behavioral health check ins between formal sessions, patients can send structured messages about sleep or mood – those are manageable without a new appointment.
- Chronic care monitoring. During chronic care monitoring for conditions like diabetes or weight management, there are many small points of contact. If those are forced into video blocks, the process is slower for everyone.
And in each case the encounter is short and relies on evidence. To use live video for the tasks adds scheduling difficulty and a risk that patients will not attend.
Technical requirements for asynchronous telehealth
By definition asynchronous telehealth is more complex than simple messaging. To support those workflows, a white label telehealth platform requires four specific features:
- Structured intake forms. With structured intake forms, patients provide history, photos and vitals at the start.
- Attachment handling. For attachment handling, the system must support images, files and video clips that are high in quality.
- Threaded, audit-logged messaging. Through threaded and logged messaging, there is a record of time and content for billing and clinical documentation.
- Time tracking on the provider side. By using time tracking, a review that lasts 7 minutes is recorded accurately for documentation and metrics.
As generic messaging tools lack the features, they are not sufficient. Due to the fact that healthcare data is increasing by approximately 36% each year according to MedCity News, the audit trails and storage systems are more important than in previous years. On single tenant platforms, the compliance process is more straightforward than on shared systems.
Billing codes for asynchronous services
If a provider wants to know if asynchronous methods are viable, they must look at reimbursement. In 2026 the relevant codes are:
- 99421, 99422 and 99423. For 99421, 99422 and 99423, clinicians bill for digital evaluation based on cumulative time over 7 days.
- G2010. With G2010, providers evaluate images or video that patients submit.
- G2012. By using G2012, professionals perform a brief virtual check in.
- 98970, 98971 and 98972. For 98970, 98971 and 98972, non physician clinicians perform digital evaluations.
But there are limitations to those codes – as the codes usually require a previous relationship with the patient, encounters with new patients are often not billable. Because payer policies are different in each state, it is necessary to confirm coverage with specific insurance providers.
The economics of provider time
On the subject of provider utilization, asynchronous methods provide a significant benefit. If a clinic has gaps between scheduled video blocks, asynchronous tasks fill those gaps.
There are multiple patterns for this:
- Batch review windows. In batch review windows, a clinician handles many encounters in a short time.
- No-show recovery. When a video appointment is a no show, the clinician uses the time for the asynchronous queue.
- Specialist throughput. For specialists in dermatology or behavioral health, this method allows for more patients.
And small practices are often able to implement the workflows more quickly than large systems.
Factors that prevent patient adoption
When asynchronous systems fail, it is often for predictable reasons:
- Unclear response-time expectations. Expectation for response time is often not clear – patients feel that the clinic is ignoring them when they anticipate an answer in sixty minutes but receive it in one day. To fix this set specific Service Level Agreements on every digital intake form.
- Bad intake forms. Intake forms are sometimes of low quality – if a patient is required to send multiple messages to provide necessary data, the patient is likely to use a telephone call instead.
- No fallback path. In many systems, there is no alternative path – every asynchronous process is required to have a clear method for escalation – this is ideally a single action to change to a video or in person appointment if the condition of the patient changes.
- Poor mobile UX. Mobile user experiences are often not sufficient – many patients send messages using a cellular phone. If a form is functional on a computer but is difficult to use on a phone, the patient is unlikely to use the service.
By focusing on those patterns, an organization makes a decision about the platform rather than a clinical decision.
A short decision tree: sync, async, or hybrid
| Visit type | Default mode | Notes |
|---|---|---|
| New patient evaluation | Sync (video or in-person) | Asynchronous visits are generally not eligible for payment and the relationship between the provider and patient is important. |
| Stable medication refill | Async | Codes are 99421-99423 or 98970-98972. |
| Dermatology follow up | Async with photos | Code is G2010 with a structured intake form. |
| Behavioral health check in between sessions | Async | Code series is 98970 for a patient who is already established. |
| Acute symptoms (fever, chest pain, severe new symptoms) | Sync or in person | Asynchronous communication is not fast enough for care that is sensitive to time. |
| Chronic care monitoring (BP, glucose) | Async + periodic sync | This is a hybrid schedule. |
| Pre procedure consent or counseling | Sync | Documentation is required to have confirmation in real time. |
And this framework is not permanent – revisit the plan every few months as the rules for payers, the choices of patients and the abilities of the platform change. ATI Advisory notes that the direction of policy is in favor of digital tools that are efficient through 2026 – this suggests that the payment coverage for asynchronous care is likely to grow.
Choosing a platform that handles both
For many owners of a medical practice, the question is not “sync or async” but “can my platform do both well.” Many organizations are looking at white label telehealth platforms with HIPAA compliance – those tools support structured intake, the management of photos and documents, the tracking of time that is eligible for billing and a transition between asynchronous and synchronous visits within one process.
With the Healee platform, both modes are supported natively – it is used by more than 200 clinics, 1 million patients and for 5 million appointments. If you are looking at how asynchronous care fits into your service, request a demo. We are available to review the workflow with the specific types of visits in your clinic.
Frequently asked questions
Is async telehealth reimbursable by Medicare?
For patients who are already established with the clinic. The codes 99421-99423 for physician E/M & G2010 for the review of images are covered – this is true when the total time over one week reaches the required amount. Asynchronous meetings for new patients are generally not eligible for payment.
How is async telehealth different from secure messaging?
Asynchronous telehealth is a clinical meeting that is structured. It includes a record of the intake, the tracking of time and a CPT code that is billable. In generic secure messaging, the structure, the time tracking and the records for an audit are not present.
What clinical use cases work best for async?
The four uses with the most utility are follow ups for dermatology, the adjustment and refill of medications, check ins for behavioral health between sessions and the monitoring of chronic conditions.
How long does it take to deploy an async telehealth workflow?
For a clinic that uses a modern telehealth platform with structured intake, a new asynchronous process is ready in multiple days. On a white label platform, a new deployment is typically finished in one to four weeks.
Does async telehealth require HIPAA-specific infrastructure?
Yes. Asynchronous processes involve health information that is protected – this requires the encryption of data that is stored and data that is being sent. It also requires an audit trail and infrastructure that is covered by a Business Associate Agreement. Due to the isolation of data for each client, a single tenant architecture is a way to make compliance simple.
Sources:
- Trends in Health IT: What Should Organizations Prioritize in 2026 – MedCity News, 2025
- 2025 Industry Trends and What to Watch in 2026 – ATI Advisory, 2025