Gebührenordnung für Ärzte (GOÄ)

What is the GOÄ?

The Gebührenordnung für Ärzte (GOÄ) is Germany's federal fee schedule for private medical services. Every time a doctor treats a privately insured patient (PKV, Beihilfe, or self-payer), the invoice is built from GOÄ items. The last major overhaul was in 1996, and the system is widely considered out of date.

Inside the public health system (GKV), doctors bill under a completely separate schedule, the EBM (Einheitlicher Bewertungsmaßstab), and they bill the Krankenkasse (statutory health-insurance fund) directly, not the patient. As a PKV member you see the GOÄ bill first and get reimbursed later (see Kostenerstattungsprinzip).

How the factor system works

Each GOÄ item has a base rate (Einfachsatz) in cents. The doctor applies a multiplier (Faktor) that reflects the complexity, time, or difficulty of the specific case:

• 1.0×-2.3×, default range (Regelspanne). Used for most routine work.

• Above 2.3×, allowed, but the doctor must provide a written justification on the invoice (§ 5 Abs. 2 GOÄ) explaining the increased effort.

• Up to 3.5×, normal maximum for personal medical services.

• Up to 2.5×, for technical services and radiology.

• Up to 1.3×, for laboratory services.

Higher factors can be agreed in advance by written contract (Honorarvereinbarung, § 2 GOÄ), but this is unusual outside specialist cosmetic or premium-clinic settings.

Why you see big swings between invoices

Two physicians treating the same condition can produce significantly different bills. A straightforward consultation billed at 2.3× will cost roughly a third less than the same service at 3.5× with a justification. PKV reimbursement follows the tariff's rules: most tariffs reimburse up to the Regelhöchstsatz without question, above that they may push back or partly reduce the claim.

Disputes over "overbilling" are common. If your invoice sits well above the usual range and the justification looks thin, raise it with your insurer before paying. Some PKV tariffs include direct-billing (Direktabrechnung) for hospital stays, which sidesteps this for larger cases.

Psychotherapy and the GOÄ

Psychotherapy is billed under the GOÄ's section G.IV, items 861 (Tiefenpsychologisch fundierte Therapie, per session) and 863 (Analytische Psychotherapie) are the most common. These rules apply even when the therapist is a Psychologischer Psychotherapeut, not a doctor, provided they hold an Approbation (the German medical licence). See the Psychotherapie entry for coverage mechanics.

The reform: status as of April 2026

A long-planned GOÄ reform has been drafted jointly by the Bundesärztekammer, the PKV-Verband, and the Beihilfeträger. The industry estimates cost increases of up to +13.2 % over the first three years after it comes into force.

Where it stands:

• 30 May 2025: the Deutscher Ärztetag passed the consensus draft and handed it to the regulator

• Mid-2026: the federal Health Ministry (BMG) is preparing the official Referentenentwurf (ministerial draft bill)

• H2 2026: cabinet vote, followed by Bundesrat consultation, the bottleneck where the Länder may push back over Beihilfe costs

• 2027, realistically 2028: earliest expected Inkrafttreten (entry into force)

So the reform is firmly in motion but not yet law. Any article claiming "the new GOÄ is in force" is premature. When it does arrive, it will affect premium calculations for new tariffs first, and eventually flow through as Beitragsanpassungen (premium adjustment) for existing ones.