In Germany, doctors and dentists apply a severity factor (Steigerungsfaktor) to reflect how complex or time-consuming a treatment is. This multiplier is part of the official fee schedules—GOZ for dentists and GOÄ for doctors. Most insurers, including Feather, reimburse costs up to a factor of 3.5. Anything beyond that needs special justification and may not be fully reimbursed. This article breaks down how it works, why it’s used, and how it affects your bill.
What is the severity factor on my dental bill?
The Steigerungsfaktor (severity factor) is a multiplier used by doctors and dentists to reflect the complexity of a treatment. The more difficult, time-intensive, or specialized a procedure is, the higher the factor might be.
This factor is applied to a base rate, which is defined by the official fee schedules in Germany:
GOZ (Gebührenordnung für Zahnärzte) for dental treatments
GOÄ (Gebührenordnung für Ärzte) for general medical treatments
These fee schedules standardize prices across Germany—but the severity factor allows providers to adjust the cost when a treatment goes beyond what’s considered average.
How is the severity factor calculated?
The total cost of a treatment is usually calculated as:
Base Rate (x) Severity Factor (x) Teeth being Cleaned = Total Cost
The base rate and treatment units (such as number of teeth) are fixed in the GOZ/GOÄ. The severity factor varies depending on:
Time required
Difficulty of the procedure
Patient-specific factors
Most treatments are billed at a factor between 1.0 and 3.5. In some cases, dentists may charge above 3.5, but in these cases, you’re usually asked to sign a Mehrkostenvereinbarung (agreement to cover additional costs) before treatment begins.
How does the severity factor affect insurance reimbursement?
Feather reimburses costs up to a severity factor of 3.5. That means:
If your bill lists a factor of 3.5 or less, we reimburse the full amount (within your policy limits).
If your bill lists a factor above 3.5, we reimburse up to the 3.5 limit—and the rest is considered your out-of-pocket expense.
Can you provide examples of reimbursement amounts at different severity factors?
For example, the current base rate for dentists in Germany is €1.57 per tooth for professional dental cleanings. This is multiplied by the severity factor to get your total cost.
Let’s use an example of someone getting 28 teeth cleaned and how much it would cost and how much they would be reimbursed depending on the severity.
Severity factor | Total cost of a professional cleaning | Reimbursement |
1.0 | €43.96 | €43.96 |
2.0 | €87.92 | €87.92 |
3.0 | €131.88 | €131.88 |
3.5 | €153.86 | €153.86 (max reimbursement) |
4.0 | €175.84 | €153.86 |
What happens if the severity factor on my dental bill is higher than 3.5?
If the severity factor is higher than 3.5, reimbursement will be limited to the maximum amount for a factor of 3.5. It is uncommon for dentists to apply a factor above this limit. When they do, they must provide an explanation before starting treatment.
How do examples of different severity factors look on actual dental bills?
Below, you can see a dental cleaning bill for a severity factor of 1.4. This was fully reimbursed. Note that the number of teeth that were covered is under “Anz.” or Anzahl, which means that 30 teeth were cleaned for a 1.4 severity factor which costs €66 or €2.2 per tooth.
Below, you can see a bill for a severity factor of 3. While more expensive, this person had 28 teeth cleaned for €4.8 per tooth. This was fully covered because it's still below the max of 3.5.
Below, you can see a bill for a severity factor of 5. This person paid €120.30 to have 15 teeth cleaned, which cost them €8.02 per tooth. Since we only reimburse up to a severity factor of 3.5, they were covered up to €5.51 per tooth for a total reimbursement of €82.65.
