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How does teleradiology work?

Most hospitals in the US rely on teleradiologists to read medical images — and help doctors treat their patients faster.

Around 77% of healthcare facilities around the country use teleradiology, according to the American College of Radiology (ACR). Also known as remote radiology, it allows radiologists to offer expert diagnoses 24/7 — even if they’re not physically present.

As a patient, your medical images might be sent to a teleradiologist for a first or second opinion, and your doctor may explain the results via a virtual platform.

What is teleradiology?

Teleradiology is a branch of telemedicine that involves sending radiological patient images from one location to another. It’s a way to share images for offsite radiologists to interpret and analyze. The report is then transmitted to the original facility to help physicians determine the best way to treat the patient.

These images may include:

  • CTs
  • MRIs
  • PET scans
  • Ultrasounds
  • X-rays

From the patient perspective, the term also applies to doctors who explain radiological results via virtual consults.

Who can provide teleradiology?

Qualified radiologists can offer teleradiology services through hospitals, mobile imaging companies, urgent care facilities and private practices. They’re trained in using medical images to diagnose and treat injuries and diseases.

Some have subspecialties, such as:

  • Body imaging
  • Neuroradiology
  • Mammography
  • Musculoskeletal radiology
  • Pediatric neuroradiology
  • Thoracic imaging

Doctors can also interpret images, but the ACR says they must be licensed in both the state where the image was generated as well as the state where it’s received.

How does teleradiology work?

Together, radiologists and doctors use the internet, phone lines and cloud-based software to read and communicate the results of radiological images.

At its core, teleradiology is about sending and receiving images, so store-and-forward is the most relevant modality.

ModalityHow it’s usedExample of this modality in action
Live videoTo conduct a real-time, two-way conversation between a physician and their patientA doctor schedules a video consultation to discuss the results of their patient’s MRI.
Remote patient monitoring (RPM)To track the patient’s progress virtually.A doctor sends an email to the patient to see how they’re doing following a diagnosis.
Store-and-forwardTo collect and transfer medical data using a secure electronic platform.A hospital sends an x-ray to an experienced radiologist, who then replies with their diagnosis. A doctor then updates the patient notes, which are stored on the hospital’s portal.
Mobile healthTo access health information and programs via a smartphone, tablet or laptop.A radiologist calls a physician to explain their patient’s MRI, or a patient logs into their online portal to access their treatment plan after a diagnosis.

What services can teleradiologists offer?

Teleradiologists can provide two services:

  • Preliminary Reads. For emergency and critical cases, teleradiologists put together an initial report with the most important findings. These reports typically have a 30-minute turnaround, and they’re designed to help doctors determine the next step.
  • Final Reads. These reports are filed in the official patient record. They’re more comprehensive and include all findings as well as all the relevant patient information for a complete diagnosis.

Doctors also use teleradiology to collaborate and consult with other doctors in different locations. They may ask for a second opinion, or a first opinion if their facility doesn’t have a radiologist or subspecialist on staff — which is common in rural areas.

What’s changed during COVID-19?

The demand for teleradiologists has increased due to the COVID-19 pandemic, according to Signify Research. There are two reasons for this: hospital resources are strained, and the nature of the coronavirus means more patients require respiratory exams, such as chest x-rays and CTs.

Hospitals and urgent care clinics rely on teleradiologists to relieve the pressure on on-site radiologists and reduce wait times for patients.

Health insurance and COVID-19

Does health insurance cover teleradiology?

In most cases, you’ll have to pay an out-of-pocket sum if you need medical imaging, such as an x-ray or MRI. But private health insurance companies, Medicare and Medicaid treat radiology differently, so it’s important to look at each individually.

This table breaks down the cost of radiological images for the patient.

Type of insuranceHow it treats radiology
Private health insuranceMedical imaging is expensive, and insurers try to limit the number of unnecessary tests. Because of this, cost-sharing has increased in recent years — and you’ll most likely have to pay for most radiological services out of pocket.

Around 48% of private plans charge coinsurance for advanced imaging, according to a study in the Journal of the American College of Radiology. Nearly 10% of plans have copays for radiology, while 8% require both types of out-of-pocket payments.

MedicareMedicare Part B (Medical Insurance) covers medically necessary diagnostic x-rays ordered by your doctor, according to Medicare.gov.

You’ll pay the Part B deductible, as well as 20% of the Medicare-approved appointment. And if you get an x-ray in a hospital outpatient setting, you’ll also be charged a copay.

MedicaidAll states cover x-ray services under Medicaid, according to the Kaiser Family Foundation.

Some states charge a copay, including Alaska, Colorado, Florida, Georgia, Kentucky, Maine, Minnesota, Missouri, Montana, Oklahoma and Wisconsin. The fee typically ranges from $1 to $4, though a handful of states charge a copay based on your income.

A few states limit Medicaid patients to medically necessary x-rays, while others require prior authorization.

How much does teleradiology cost?

These are the out-of-pocket costs you can expect to pay if you have private health insurance, according to the ACR study:

  • Deductible. This varies between plans.
  • Copay. You’ll pay an average copay of $319 at in-network facilities and $630 at out-of-network facilities.
  • Coinsurance. Fees average 28% in network and 48% out of network.

For a telemedicine consult with your doctor to discuss the results of medical imaging, the average cost is $79, according to a Health Affairs study.

7 benefits of teleradiology

Many hospitals, clinics and healthcare facilities have limited access to radiologists. Teleradiology has made it possible to offer round-the-clock diagnoses, which means doctors can treat patients sooner.

These are the key benefits of teleradiology:

  1. Offers a quick turnaround time, especially for Preliminary Reads
  2. Expands access to radiologists after hours
  3. Improves the level of care at rural facilities or those who don’t have radiologists on staff
  4. Allows patients to get an accurate diagnosis from an experienced radiologist, even if they’re offsite
  5. Allows doctors and radiologists to get a second opinion from subspecialists — like neuroradiology experts — without having to transfer patients to other facilities
  6. Helps doctors to consult each other and figure out the next steps
  7. Allows for faster diagnosis

The drawbacks of teleradiology

For patients, teleradiology is overwhelmingly positive. The practice speeds up diagnoses and opens up access to radiologists and valuable second opinions.

The medical community has a couple of concerns about teleradiology, according to an ACR survey in early 2019. They say the main challenge is inconsistent access to health records (63.5%), followed by the radiologic technologist working alone (48.2%). In other words, the teleradiologist can’t instruct the person who preps the patients and actually takes the images.

Ask an expert: Which services can radiologists perform virtually?


Radiologists can perform most of their medical practice remotely. They are experts in image interpretation, so they can review ultrasounds, CTs, MRIs, radiographs all remotely utilizing their picture archiving and communication systems (PACS). Radiologists can also review those images with patients and referring providers remotely to help expedite care across regions in real time.

How to find a teleradiologist

If you need medical imaging, your physician will refer you to a reputable facility. This may be a hospital, clinic or imaging center.

To cut costs, try to choose a facility within your insurer’s network.

Are teleradiologists regulated?

Yes. Teleradiologists must meet compliance standards under the Health Insurance Portability and Accountability Act (HIPAA). This means they have to protect patients’ privacy and confidentiality, use secure internet connections and communicate via encrypted platforms.

While teleradiologists can work internationally in some cases, they must be on US soil to reimburse Final Reads for Medicare and Medicaid patients.

If you have a virtual consultation with a doctor to go over your radiology results, they must use HIPAA-approved software.

These are the most popular HIPAA-approved platforms:

  • Doxy.me
  • Google Meet
  • SimplePractice
  • Thera-Link
  • TheraNest
  • VSee
  • VocoVision
  • WeCounsel
  • Zoom Healthcare

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Bottom line

Since the 1990s, healthcare facilities have relied on teleradiologists to analyze medical images around-the-clock. The practice means patients can access expert opinions, and it’s in high demand at the moment due to the coronavirus’ respiratory symptoms.

But under most health insurance plans, you’ll pay an out-of-pocket cost for radiological images.

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