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May a German doctor bill private patients more than 2.3 times the fee rate?

In short

May a German doctor bill private patients more than 2.3 times the fee rate? Yes, but only with a reason. The fee schedule for doctors (GOÄ) allows up to 3.5 times if difficulty, time or circumstances of the specific service were unusual, and the bill must explain this clearly. Above 3.5 times requires a written fee agreement signed before treatment.

May a German doctor bill private patients more than 2.3 times the fee rate?

What it costs

Examples from the GOÄ fee schedule.

ExampleTypical range
No. 3, detailed consultation, 150 points, 2.3 timesEUR 20.11
No. 3, detailed consultation, 3.5 timesEUR 30.60
No. 5, symptom based examination, 80 points, 2.3 timesEUR 10.72
No. 5, symptom based examination, 3.5 timesEUR 16.32

As of October 2026, calculated with the point value of 5.82873 cents.

A new GOÄ has been drafted but applies only once enacted.

Worked example

Consultation and examination at the GP

Items 3 and 5 at the standard rate and at the maximum.

Items 3 and 5 at 2.3 timesEUR 30.83
Items 3 and 5 at 3.5 timesEUR 46.92

The maximum costs about 52 percent more and needs a reason for each service.

When a doctor may bill more than 2.3 times

Normally a fee may be between 1 and 2.3 times the base rate. Above that is allowed only if difficulty, time or circumstances of the individual service justify it (§ 5 (2) GOÄ). A practice may not apply higher rates across the whole bill.

Service typeStandard rateMaximum without agreement
Personal medical services2.3 times3.5 times
Technical services (sections A, E, O)1.8 times2.5 times
Lab (section M)1.15 times1.3 times

What the reason must say

If a fee exceeds 2.3 times, the bill must give a written, understandable reason for that specific service, and the doctor must explain further on request (§ 12 (3) GOÄ). Generic phrases with no link to your case are not enough.

Fee agreements above 3.5 times

Above the maximum, a doctor needs a fee agreement made before treatment, after a personal discussion, in writing, naming the item, service, multiplier and amount, plus a warning that your insurer may not reimburse everything (§ 2 GOÄ). Emergency and acute pain treatment may not depend on it.

What your insurer pays

Your tariff decides. Many tariffs reimburse up to the GOÄ maximum; above it you often pay the difference yourself. Check before signing any agreement.

Step by step

  1. Check the bill for multipliers above 2.3, 1.8 or 1.15.
  2. Read the reason for each item.
  3. Ask in writing for an explanation if unclear.
  4. Check what your tariff reimburses.

Checklist

  • Multiplier shown for each item
  • Specific reason where the standard rate is exceeded
  • Any fee agreement in writing before treatment
  • Tariff reimburses up to the maximum

Common mistakes

  • Accepting generic reasons
  • Signing a fee agreement in the waiting room
  • Paying without knowing your reimbursement

Questions and answers

Frequently asked

Do I have to pay a bill above 2.3 times?

If the reason justifies it, yes.

Without a sound reason that part of the bill can be challenged.

Can the receptionist sign a fee agreement with me?

No, the GOÄ requires a personal discussion with the doctor.

Is a new GOÄ coming?

Doctors and the PKV association submitted a joint draft in 2025.

Until a new regulation takes effect, the current GOÄ applies.

Does this apply to dentists?

Dentists use their own schedule (GOZ) with similar rules.

Sources

NAMMERT insurance broker

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Related questions

Your broker: Norman Nammert, trading as NAMMERT.

Insurance broker licensed under section 34d(1) of the German Trade Regulation Act.

Broker register no. D-C08Q-TOSD4-37.

NAMMERT Assekuradeur GmbH is a separate company.

It does not arrange your contract.

Statutory disclosure (German) · Updated

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