One of the advantages of telemedicine is its capacity to overcome the physical distance between a patient and a physician. Telemedical ICT technology, such as live-video interaction, may enhance patients’ access to a wide variety of healthcare services, especially in areas that suffer from the shortage of physicians. With the help of technology, doctors could remotely treat patients situated in rural areas, other states or countries. However, in many jurisdictions, the availability of direct-to-consumer telemedicine is subject to legal constraints, such as prohibitions or limitations on offering long-distance medical treatment. The legal norms that limit the use of telemedicine have the most straightforward impact on its adoption. These norms may take the form of a straightforward prohibition on long-distance treatment or on its important elements, such as diagnosis. The limitations may also be more subtle; for example, they may focus on setting qualifications for consultations or examinations of the patient or criteria for medicine prescriptions. Although present in many jurisdictions, we found no systematic review on these legal rules or their background. In order to gain an understanding of the interests at stake and justifications behind the limitations of the provision of telemedicine, we will review the historical background and recent legislative developments in the telemedicine legislation in the US and Germany. Both of the countries have federal political systems and limit the provision of telemedicine. However, in the US, the limitations were enacted as a reaction to the digitalisation of medical care, whereas in Germany, the prohibition of long-distance treatment has historical origins dating back to the nineteenth century.