The GOÄ and GOZ are Germany's official fee schedules for doctors and dentists, listing a code and a base rate for each treatment at a severity factor of 1.0. Providers may apply a higher severity factor for more difficult treatments, which raises the cost. Reimbursement depends on your plan: our Private health insurance (PKV) Premium plan has no fixed severity-factor limit, our other private (PKV) plans cover up to 3.5 times the base rate, and our Expat health insurance reimburses personal medical services up to 2.3 times the base rate.
What are the GOÄ and GOZ schedules of fees?
The GOÄ (Gebührenordnung für Ärzte) and GOZ (Gebührenordnung für Zahnärzte) are Germany's official fee schedules for doctors and dentists. Each schedule lists a code (Ziffer) and a base rate for every treatment or service, and the base rate sets the standard price at a severity factor of 1.0. For example, treating a large wound with stitches is billed under GOÄ code 2004, and its base rate at factor 1.0 is €13.99. Understanding these schedules is useful if you hold Private health insurance (PKV), Expat health insurance, or supplementary dental insurance, because the schedules determine how German doctors and dentists calculate their charges and how much your plan reimburses.
Can doctors and dentists charge more than the base rate?
Yes. If a doctor or dentist considers a treatment more difficult than usual, they can apply a severity factor (Steigerungsfaktor) that raises the cost above the base rate. Severity factors typically fall between 1.0 and 3.5, though a provider can apply a factor outside that range. For example, if a treatment has a base rate of €10 at factor 1.0 and the provider applies a factor of 2.0, the treatment costs €20.
What should a doctor's or dentist's invoice include?
After an appointment, a doctor or dentist in Germany must give you an official final invoice. The invoice must include:
An itemized list of every treatment or service provided during the appointment.
The code (Ziffer) that matches each treatment or service.
The severity factor (Steigerungsfaktor) applied to each treatment or service.
The total cost of each treatment or service.
How does the severity factor affect my reimbursement?
Your plan reimburses a treatment up to its severity-factor limit, and you pay any amount charged above that limit. As an example, take a plan that reimburses up to 2.3 times the base rate, applied to a treatment with a base rate of €10 at a severity factor of 1.0:
At a severity factor of 1.0, the treatment costs €10 and is reimbursed in full at €10.
At a severity factor of 2.0, the treatment costs €20 and is reimbursed in full at €20.
At a severity factor of 2.3, the treatment costs €23 and is reimbursed at €23, the maximum reimbursement for this plan.
At a severity factor of 3.5, the treatment costs €35 but is reimbursed at €23, so you pay the remaining €12.
At a severity factor of 5.0, the treatment costs €50 but is reimbursed at €23, so you pay the remaining €27.
Once the severity factor passes your plan's limit, the reimbursement stops increasing, so a higher factor means a higher out-of-pocket cost. Always review your policy limits to see how much your specific plan covers.
Can I find out in advance whether a higher severity factor will be charged?
It is not always possible for a doctor or dentist to know how difficult a service will be before providing it. You can, however, ask for a cost estimate (Kostenvoranschlag), and in many cases the provider can give you an estimate of the services and expected costs. In addition, when a severity factor exceeds certain limits, your doctor is legally required to give you a written explanation and obtain your signed consent before treatment. This requirement applies to:
Personal medical services (persönliche Leistungen) above a 3.5 severity factor.
Medical-technical services (medizinisch-technische Leistungen) above a 2.5 severity factor.
Laboratory services (Laborleistungen) above a 1.3 severity factor.
You can contact our support team for more assistance or additional resources.