Psychotherapie

How PKV psychotherapy is billed

PKV reimbursement for psychotherapy follows the GOÄ, the same fee schedule as for physicians, even when the therapist is a Psychologischer Psychotherapeut with an Approbation (licence). The relevant GOÄ codes (section G.IV):

• 860, verbal intervention (heilkundlich)

• 861, psychodynamic therapy (TP), individual, minimum 50 minutes

• 862, TP, group (per participant), minimum 100 minutes

• 863, analytic therapy (AP), individual, minimum 50 minutes

• 870, behavioural therapy (VT), individual, minimum 50 minutes

• 871, VT, group

Most PKV claims run through codes 861, 863, or 870. The session length and the therapist's licence determine which code applies.

Newer methods

The industry-wide recommendation from BÄK / BPtK / PKV-Verband (January 2025, updated October 2025) clarifies that newer methods are billed analogue to GOÄ 870:

• Systemische Therapie (systemic therapy)

• EMDR (eye movement desensitisation and reprocessing)

• Neuropsychologische Therapie

This means that what the GKV has recently recognised as covered standard methods are also billable in the PKV under a structured recommendation.

Tariff-level variation

Three independent dimensions drive how much a PKV member actually gets reimbursed:

• Session cap per calendar year: unlimited, or 30 / 50 / 80 / 100 sessions

• Reimbursement rate: typically 100 % or 80 % of GOÄ

• Approval requirement: many tariffs need a formal approval after a set number of initial sessions (often 5, sometimes 8)

Common tariff levels:

• Premium tariffs: unlimited sessions after approval, 100 % reimbursement

• Middle-market tariffs: 50-80 sessions per year, usually 100 %

• Entry-level tariffs: 30 sessions per year, often at 80 %

• Worst combination: 30 sessions × 80 %, produces substantial out-of-pocket costs for anyone in active treatment

Approval process

PKV has no unified approval system like the GKV does. The typical AVB (Allgemeine Versicherungsbedingungen, the general policy terms) pattern:

1. Probatorische Sitzungen, the first 5 (sometimes 8) sessions can be billed without pre-approval 2. Application for cost coverage before continuing into full therapy, diagnosis (ICD-10), treatment plan, session count 3. Insurer approval, sometimes involves their own reviewer

Gaining approval for a longer treatment plan (e.g. 80 sessions over two years) is usually straightforward if the ICD-10 diagnosis and treatment rationale are clearly documented.

The 8-month waiting period

Psychotherapy falls under the besondere Wartezeit, a special waiting period of 8 months after the policy start, defined in § 3 Abs. 3 MB/KK. During those first 8 months, PKV does not reimburse planned psychotherapy treatment that starts inside the window.

Exceptions:

• Seamless transitions from GKV or from another substitutive PKV waive the waiting period entirely, prior cover counts (§ 3 Abs. 4 MB/KK; see the Wartezeit entry)

• A PKV-internal Tarifwechsel (tariff switch within the same insurer, § 204 VVG) carries the served waiting period over; for an Anbieterwechsel (switch to a different PKV insurer), the waiting time is typically credited for comparable coverage

• Acute emergency treatment is usually still covered under the general provisions

If you are actively in therapy when switching to PKV, the timing matters, a poorly sequenced switch can produce an uncovered gap.

The disclosure trap: 5-10 year lookback

Psychotherapy history is one of the most frequently under-disclosed items on PKV applications. Most Gesundheitsfragebögen ask about mental-health treatments in the previous 5-10 years. The lookback is long, the questions are broad (any diagnosed condition, any session count, any medication), and the Anzeigepflicht consequences are severe.

Even a short course of therapy from six years ago may need to be disclosed if the question frame covers it. The insurer's medical review will cross-check with medical records if a claim is later submitted.

Two practical consequences:

• Always include past therapy in a Risikovoranfrage. Insurers differ sharply in how they treat resolved historic therapy vs. ongoing treatment, a Voranfrage reveals which insurer offers the cleanest path. A practical warning: ongoing psychotherapy combined with current psychiatric medication is treated by most insurers as effectively ablehnungsrelevant, the application is unlikely to clear cleanly until treatment is concluded.

• Never omit a diagnosis "because it was resolved". § 19 VVG treats this as a disclosure failure. A diagnosis with a note "fully resolved 2020, no treatment since" is accepted cleanly by most insurers and creates no contract risk.

Why early disclosure matters

Past psychotherapy is one application area where preparation matters. Insurers vary widely in how they assess the same therapy history, and several have moved towards a more case-by-case approach in recent years. What does cause real problems later is omitting it from the application. Under § 19 and § 22 VVG, the insurer keeps rescission rights for years afterwards if undisclosed history surfaces. If past therapy sits in your medical record, flag it early in a consultation so the broker can position the application across the right insurers.

Heilpraktiker (non-medical alternative practitioner) and inpatient

• Heilpraktiker-Psychotherapie is reimbursed only in tariffs with an explicit Heilpraktiker clause, typically capped at €500-1,500 per year

• Inpatient psychotherapy is covered under the standard inpatient benefits, with optional premium add-ons (chief-physician treatment) if tariff-contracted