Why Your Invoice Looks the Way It Does
As a private patient in Germany you receive itemised invoices directly from your doctor — and every line on them follows a legally prescribed fee schedule: the Gebührenordnung für Ärzte (GOÄ) for physicians, and the parallel GOZ for dentists. Understanding a few basics lets you check bills in seconds and predict what your insurer will reimburse.
The core mechanism: each medical service has a code and a base fee. The doctor multiplies the base fee by a factor — usually up to 2.3, in justified cases up to 3.5, and beyond that only with your prior written agreement.
The Multiplier System
| Factor | Meaning |
|---|---|
| 1.0 | Base fee — simple, quick services |
| Up to 2.3 | Standard rate for personal medical services; no justification needed |
| 2.3 to 3.5 | Requires written justification on the invoice (difficulty, time, circumstances) |
| Above 3.5 | Only with an individual written agreement (Honorarvereinbarung) signed before treatment |
Technical services (lab work, imaging) have lower maximum factors — typically 1.8 or 2.5 with justification for equipment-heavy services, and 1.15/1.3 for laboratory work.
What Your PKV Reimburses
Most good PKV tariffs reimburse GOÄ invoices up to the maximum rates (Höchstsätze, factor 3.5) in full. Some budget tariffs cap reimbursement at the standard rate of 2.3 — a detail worth checking before you sign, because specialists in large cities frequently bill above 2.3. If you sign a fee agreement above 3.5 (common with sought-after surgeons), the amount beyond 3.5 is usually your cost unless your tariff explicitly covers it.
Checking Your Invoice
- Codes and descriptions should match the treatment you actually received
- Factors above 2.3 must carry an individual written justification, not a generic phrase
- Payment deadline: you normally have several weeks — submit the invoice to your insurer immediately and, with reimbursement in hand, pay the doctor on time
- Queries: your insurer's claims department checks GOÄ conformity and will contest incorrectly billed items on your behalf
A Note on Reform
The GOÄ has been essentially unchanged since 1996, and a comprehensive reform has been under discussion between the medical profession and the PKV industry for years. Whenever a new GOÄ arrives, fee levels and codes will shift — but the reimbursement promise of your tariff (e.g. "up to the maximum rates") carries over.
The Bottom Line
The GOÄ makes private medicine transparent: every service, every factor, every euro is itemised. Learn to spot the multiplier column, make sure your tariff covers the maximum rates, and never sign a fee agreement above 3.5 without understanding that the excess may be yours to pay.
Frequently Asked Questions
Compare PKV Tariffs for Your Situation
Our independent advisors help expats and professionals find the right private health insurance — personalised to your age, health, and budget.
Get My Free Quote