Modern imaging techniques such as optical coherence tomography (OCT), lateral-confocal OCT, and confocal laser microscopy (KLM) are now well established in dermatology, enhancing diagnostic precision and therapeutic decisions. Currently, billing is handled via analogous codes in the German fee schedule (GOÄ), leading to legal and reimbursement challenges. Although the upcoming revised GOÄ will include specific codes, this may result in lower compensation. Public health insurance does not yet cover these services. Legal and reimbursement frameworks must be urgently adapted to ensure sustainable integration of these technologies into clinical practice.