Reimbursement for teledermatology has generally mirrored reimbursement for other forms of telemedicine. However, some states, including California, have carved out teledermatology for special reimbursement arrangements. This special treatment may be a consequence of the large body of evidence supporting the quality (e.g., interobserver diagnostic concordance) of teledermatology for the care of patients with cutaneous disease as well as the lack of access to expert dermatological care in many parts of the country (see Chapter 4). This chapter discusses the current status of reimbursement for telemedicine, including teledermatology, in the United States. Although some restrictions still apply depending on the type of payer, reimbursement for telemedicine services, including teledermatology, is increasingly common.

The early days

There was a major expansion in the use of telemedicine in the United States in the early 1990s subsidized by federal grant dollars (competitive grants and earmarks) from the U.S. Departments of Health and Human Services, Commerce, and Agriculture. The bulk of these programs were developed where a clear mission base of service and outreach exists, such as in academic health centers, or where patients are distant or otherwise expensive to transport, such as in correctional healthcare systems. Federal agencies with direct patient care responsibilities also provided substantial early investment in telemedicine. Teledermatology was a leading clinical service in the Veterans Affairs (VA) healthcare system as telemedicine was introduced to this population, and teledermatology has long been a leading clinical telemedicine service in the Department of Defense.