Dermatologists have a wide scope of practice; given that they provide medical, surgical, and cosmetic services, it is important to consider what distinguishes medically necessary care from cosmetic treatments. This issue is particularly important as payers may be less likely to provide medical coverage for conditions that are viewed as cosmetic.

Current paradigms highlight a lack of consistency with regard to what constitutes a cosmetic treatment. In 2016, the 21st Century Cures Act¹ amended the Social Security Act paragraph 1903, section 21 to forbid payment of treatments for cosmetic purposes or hair growth—except where medically necessary. There is a trend for Centers for Medicare & Medicaid Services (CMS) and other payers to consider treatment of skin disease to be medically necessary when it is associated with a disturbance of sensation (eg, itch, pain) but not when the primary effects are psychosocial (eg, depression, stigma, social isolation).