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Meaning and areas of application of the German Medical Fee Schedule (Gebührenordnung für Ärzte) briefly explained

The German Medical Fee Schedule (Gebührenordnung für Ärzte, or GOÄ for short) regulates the billing of services provided by private physicians. These include all services outside the statutory health insurance.

Listed by means of a catalog, the evaluations of medical services are found there - namely their tariff, thematic and point-based evaluation. Accordingly, the GOÄ serves as a service catalog for physicians who wish to bill their services to private physicians.

Which service areas are regulated by the GOÄ?

In addition to actual examination services and consultation services, the GOÄ primarily covers treatment-related services and non-area-related special services, which include the application of pressure bandages and blood sampling.

Furthermore, area-related services are also listed in the GOÄ catalog - these refer to surgical treatments and laboratory tests.

The history of today's GOÄ

Issued as a legal ordinance by the German government, the GOÄ has existed in its original version since March 18, 1965. Since the original version in 1965, there have also been various new versions and amendments. Accordingly, the latest amendment was passed by the Bundesrat on October 21, 2019 - this came into full effect on January 1, 2020.

As the successor to its historical predecessor, the Prussian Fee Ordinance for Licensed Physicians, today's GOÄ thus serves as a pricing specification document on the basis of which only the uniformly specified prices for private medical treatments can be passed on.

Admissibility of self-calculated fees by physicians in Germany

According to the GOÄ, licensed physicians in the Federal Republic of Germany are not permitted to charge patients or third parties self-calculated fees for private medical services. The medical professional law specifies the binding nature of the Federal Constitutional Court's GOÄ.

Restrictions on the determination of prices by physicians are only given insofar as a balance of justified interests of the service providers can be achieved in this way. Beside the GOÄ there are still further fee regulations for further, free occupations as for example architects or attorneys.

What the target service principle is all about

This is a term from the GOÄ, which has the purpose of avoiding fees to be charged twice. The services contained in the GOÄ catalog are all recorded as individual items. A private medical treatment invoice usually consists of several of these individual items and thus treatment services.

Difficulties only arise when individual treatment items overlap with each other - a licensed physician billing for surgical services, for example, may not bill for stopping bleeding at the same time. In these cases, only the superficial service can be billed according to GOÄ. The same applies if the scope of services of a previously billed service also corresponds to that of another service - or to a large extent.

Even then, the summation of various individual services is restricted by the target service principle.

Always on the right side with the practical GOÄ calculator

To bill for services performed according to the current GOÄ fee catalog, we recommend using the practical online GOÄ calculator tool for private physician billing. With this free tool, you can call up the individual treatment services by category and find out how they are structured in terms of tariffs and points according to GOÄ. This basically saves a lot of time and potential sources of error when billing private physician services.

The tool classifies the individual treatment services on the basis of a code number as well as a thematic numbering. Furthermore, a detailed description is also stored for each treatment item, as well as brief information on compatibility with the target service principle.

How to use the advantageous GOÄ calculator for your private medical billing

First, use the GOÄ calculator to search for the corresponding service in the GOÄ database. To do this, enter the respective treatment service in the "Service" field, which you will find in the "Search GOÄ database for rate data and costs" section (for example, "Home visit").

Then click on "Search" to filter the corresponding service from the GOÄ database. In the "Result" area, you will then find a detailed listing for the filtered treatment service. For the topic, you will find the stored code number according to GOÄ as well as a thematic description. The treatment description also lists the service content of the retrieved treatment service.

Furthermore, you will find the number of points associated with the treatment, which can be used to calculate the fee rate you are looking for. The online calculator then presents you with a standard rate and an increased rate for the respective treatment service and also provides you with useful information on billability according to the target service principle in the info area.



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