Barriers to Patch Testing: Assessing Reimbursement Challenges and Practice Patterns Among Members of the American Contact Dermatitis Society.

Background

Allergic contact dermatitis (ACD) affects 15-20% of the population, with patch testing as the best diagnostic tool. However, inappropriate reimbursement models and the absence of a physician work relative value unit create financial disincentives that limit access to patch testing services.

Objective

This study assessed patch test utilization among American Contact Dermatitis Society (ACDS) members to identify updated reimbursement models and to explore barriers affecting the availability of patch testing.

Methods

A 20-question survey was electronically distributed to ACDS members between December 2024 and January 2025, with questions pertaining to practice type, patch testing patterns, current reimbursement structures, and financial barriers to patch testing administration.

Results

Among 76 respondents, 83% were dermatologists, with a median of 14 years in practice. Compensation varied: 41% received no payment beyond evaluation and management codes, and 38% were reimbursed via collections. 42% of respondents never conduct extended patch testing. Additionally, 42% of respondents did not accept Medicaid. Frequently cited barriers included lack of standardized billing and high no-show rates.

Conclusions

Administrative and financial challenges continue to hinder patch testing accessibility. Standardized reimbursement models, expanded insurance coverage, and policy reforms may help improve equitable access to this critical diagnostic service, though additional barriers such as provider expertise and geographic distribution might also play important roles.