Evaluation standard of dental services

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The evaluation standard for dental services ( BEMA 2004 ) forms the basis for billing contract dental services within the statutory health insurance in Germany . The set of rules is agreed in the evaluation committee for contract dental services between representatives of the central association of the statutory health insurance funds and the National Association of Statutory Health Insurance Dentists . The current version came into force on January 1, 2004 and was expanded to include visits to care for people in need of care on April 1, 2013 and April 1, 2014, respectively.

The other cost units also settle on the basis of BEMA 2004. The other health insurances include the following cost carriers: social welfare providers , pension offices , state police , armed forces , federal police , community service .

The billing of services for private patients is based on the fee schedule for dentists (GOZ).

Point values ​​for the primary funds and the substitute funds

The point values for the KZV Westfalen-Lippe at the primary health insurers (e.g. AOK, BKK etc.) and the substitute health insurers (e.g. TK, Barmer etc.) were as of the 4th quarter of 2012:

Point values ​​Westfalen-Lippe Conservative / surgical services
jaw fracture
periodontology
IP / FU services Orthodontic services dentures
Primary funds Ortskrankenkassen
Betriebskrankenkassen
guild funds
health insurance Agricultural.
Miners
€ 0.8904 € 0.9032 € 0.7252 € 0.7771
Replacement funds BARMER GEK € 0.9625 € 1.0000 € 0.7860 € 0.7771
TK € 0.9588 € 0.9700 € 0.7827 € 0.7771
DAK health € 0.9598 € 0.9851 € 0.7809 € 0.7771
KKH alliance € 0.9654 € 1.0000 € 0.7884 € 0.7771
HEK € 0.9652 € 1.0000 € 0.7884 € 0.7771
hkk € 0.9655 € 1.0000 € 0.7884 € 0.7771
Other payers Welfare recipients € 0.8904 € 0.9032 € 0.7252 € 0.7771
armed forces € 0.9914 € 0.9914 € 0.8512 € 0.8512
Federal Police € 0.9914 € 0.9914 € 0.8512 € 0.8512

The point value for Part 5 (dentures) is uniform throughout the Federal Republic. This uniform point value was enacted by law on January 1, 2005. The point value at that time was € 0.7235. From January 1, 2007 to December 31, 2007 it was € 0.7269, and from January 1, 2008 to March 31, 2009 it was € 0.7316. Since April 1, 2009, the point value has been € 0.7454. On January 1, 2010, the point value for ZE was raised nationwide to € 0.7533 and has been € 0.7620 since January 1, 2011. The point value was also increased on January 1, 2012 and amounts to € 0.7771. From April 1, 2014 until the end of the year, a clearing point value of EUR 0.8490 applies. This includes additional remuneration for the previous five quarters in which the contractual partners could not agree on an increase in the point value. The starting value for the contract negotiations for 2015 is € 0.8152.

Content of the BEMA 2004

General provisions

The content of BEMA 2004 begins with general provisions.

Part 1 - Conservative and Surgical Services and X-ray Services

Ä1 BEMA no. Ä1 9 points Advice and symptom-related examination
01 BEMA no. 01 18 points Detailed check up
01k BEMA no. 01k 28 points Orthodontic Exam
Without BEMA no. 02 20 points Assistance in the event of fainting or collapse
To BEMA no. 03 15 points Night surcharge, Sunday or public holiday surcharge
04 BEMA no. 04 10 points Collect PSI code
05 BEMA no. 05 20 points Extraction of cell material
Inc1 BEMA no. Ä161 15 points Opening of a superficial abscess
Rö2 BEMA no. Ä925a 12 points X-ray diagnosis of the teeth
up to 2 images
Rö5 BEMA no. Ä925b 19 points X-ray diagnosis of the teeth
up to 5 images
Rö8 BEMA no. Ä925c 27 points X-ray diagnosis of the teeth
up to 8 images
Stat BEMA no. Ä925d 34 points X-ray status for more than 8 exposures
Ä928 BEMA number Ä928 30 points X-ray of the hand
Ä934a BEMA no. Ä934a 19 points an x-ray of the
skull ( cephalometric x-ray )
Ä934b BEMA no. Ä934b 30 points two x-rays of the
skull (cephalometric x- rays )
Ä934c BEMA no. Ä934c 36 points more than two x-rays of
the skull (cephalometric x- rays )
Ä935a BEMA no. Ä935a 21 points a partial image
(panoramic image ) of the skull
Ä935b BEMA no. Ä935b 25 points two partial shots
(panoramic view) of the skull
Ä935c BEMA no. Ä935c 31 points more than two partial exposures
(panoramic exposures ) of the skull
OPG BEMA no. Ä935d 36 points Orthopantomography
ViPr BEMA no. 8th 6 points Teeth vitality test
üZ BEMA no. 10 6 points Treatment of hypersensitive
teeth, per session
pV BEMA no. 11 19 points Temporary closure of
a cavity
bMF BEMA no. 12 10 points Special measures when
preparing or filling
F1 BEMA no. 13a 32 points Filling - one surface
F2 BEMA no. 13b 39 points Filling - two-sided
F3 BEMA no. 13c 49 points Filling - three-sided
F4 BEMA no. 13d 58 points Filling - more than three areas
or corner build-up in the anterior region
13e BEMA no. 13e 52 points Posterior composite filling - single surface
13f BEMA no. 13f 64 points Posterior composite filling - two-sided
13g BEMA no. 13g 84 points Posterior composite filling - three-sided
14th BEMA no. 14th 50 points Ready-made crown (for children)
St. BEMA no. 16 20 points Post anchorage of a filling,
per tooth, including material
Ekr BEMA no. 23 17 points Removal of a crown, bridge anchor
or root post
Cp BEMA no. 25th 6 points indirect
pulp capping ; per cavity ( C aries p rofunda)
P BEMA no. 26th 6 points direct pulp capping; per tooth ( p ulpa)
Pulp BEMA no. 27 29 points Pulpotomy (vital amputation)
VitE BEMA no. 28 18 points Extirpation of the vital pulp; per channel
Dev BEMA no. 29 11 points Devitalizing a pulp; per tooth
Trep1 BEMA number 31 11 points Trepanation of a pulp-dead tooth
WK BEMA no. 32 29 points Root canal preparation; per channel
Med BEMA no. 34 15 points Medicinal insert
WF BEMA no. 35 17 points Root filling; per channel
Nbl1 BEMA no. 36 15 points Stopping excessive
bleeding (secondary bleeding)
Nbl2 BEMA no. 37 29 points Stopping excessive
bleeding by tying
or piercing (secondary bleeding)
N BEMA no. 38 10 points Follow-up treatment after surgery
I. BEMA no. 40 8 points Infiltration anesthesia
L1 BEMA no. 41a 12 points Intraoral conduction anesthesia
L2 BEMA no. 41b 16 points extraoral conduction anesthesia
X1 BEMA no. 43 10 points Removal of a single root tooth
X2 BEMA no. 44 15 points Removal of a multi-rooted tooth
X3 BEMA no. 45 40 points Removal of a deeply fractured tooth
XN BEMA no. 46 21 points Surgical wound revision
East1 BEMA no. 47a 58 points Tooth removal by osteotomy
Hem BEMA no. 47b 72 points Hemisection u. Partial extraction of multi-rooted teeth
East2 BEMA no. 48 78 points Removal of a displaced
or retained tooth by
osteotomy, including wound care
Exc1 BEMA number 49 10 points Excision of the oral mucosa; per dental area
Exz2 BEMA number 50 37 points Excision of a mucosal growth
Pla1 BEMA no. 51a 80 points Plastic closure by gum plasty
Pla0 BEMA no. 51b 40 points Plastic closure in
connection with an osteotomy
Trep2 BEMA no. 52 24 points Trepanation of the jawbone
East3 BEMA no. 53 72 points Sequestrotomy for osteomyelitis
WR1 BEMA no. 54a 72 points Root tip resection (ESR) - anterior tooth
WR2 BEMA no. 54b 96 points WSR - posterior tooth; for
the first root tip
WR3 BEMA no. 54c 48 points WSR - each additional
root tip on the same posterior tooth
RI BEMA no. 55 72 points Reimplantation of a tooth
Zy1 BEMA no. 56a 120 points Cyst Surgery - Cystectomy
Zy2 BEMA no. 56b 72 points Cyst surgery - cystostomy
Zy3 BEMA no. 56c 48 points Cyst operation - cystectomy
with osteotomy or ESC
Zy4 BEMA no. 56d 48 points Cyst operation - cystostomy
with osteotomy or ESC
SMS BEMA no. 57 48 points Elimination of disruptive mucous membrane bands
KnR BEMA no. 58 48 points Bone resection
Pla2 BEMA no. 59 120 points Oral floor surgery or vestibuloplasty
Pla3 BEMA no. 60 80 points Tuberoplasty; one-sided
slide BEMA no. 61 72 points Lip frenulum correction ( diastema )
Alv BEMA no. 62 36 points Alveolotomy
Fl BEMA no. 63 80 points Exposure of a retained
and / or displaced tooth
for orthodontic adjustment
Gladly BEMA no. 64 72 points Germectomy
Mu BEMA no. 105 8 points local drug
treatment of the oral mucosa;
per session
sK BEMA no. 106 10 points Elimination of sharp tooth edges
or denture edges ; per session
Zst BEMA no. 107 16 points Removing hard plaque;
per session ( tartar )

Visits / outreach care

Bs1     BEMA no. 151   36 points Visiting an insured person, including advice and an in-
depth examination
Bs2 BEMA no. 152     34 points Visit for each additional insured person in the same household
or facility in direct temporal
connection with a benefit according to No. 151 -
including advice and detailed examination.
Bs3 BEMA no. 153  28 points Visit of an insured person in need of care in an inpatient
care facility at previously agreed times
and with regular activity in the care facility
including advice and detailed examination,
without the existence of a cooperation agreement
Bs4 BEMA no. 154  28 points Visit of an insured
person in need of care in an inpatient care facility within the framework of a cooperation agreement,
including advice and detailed examination
Bs5 BEMA no. 155  26 points Visit for every additional insured person in need of care in the same
inpatient care facility within the framework of a
cooperation contract in direct
temporal connection with a service according to No. 154
including advice and detailed examination
Surcharges for visits according to nos. 151 and 154
ZBs1a BEMA no. 161a  18 points Surcharge for urgently requested and immediately
carried out visits
ZBs1b BEMA no. 161b  29 points Surcharge for
visits made Monday to Friday between 8 p.m. and 10 p.m. or 6 a.m. to 8 a.m.
ZBs1c BEMA no. 161c  50 points Surcharge for
visits made Monday to Friday between 10 p.m. and 6 a.m.
ZBs1d BEMA no. 161d  38 points Surcharge for
visits made on Saturdays, Sundays or public holidays between 8 a.m. and 8 p.m.
ZBs1e BEMA no. 161e  67 points Surcharge for
visits on Saturdays, Sundays or public holidays between 8 p.m. and 10 p.m. or 6 a.m. to 8 a.m.
ZBs1f BEMA no. 161f  88 points   Surcharge for
visits made on Saturdays, Sundays or public holidays between 10 p.m. and 6 a.m.
Surcharges for visits under nos. 152 and 155
ZBs2a BEMA no. 162a    9 points  Surcharge for urgently requested and immediately
carried out visits
ZBs2b BEMA no. 162b  15 points Surcharge for
visits made Monday to Friday between 8 p.m. and 10 p.m. or 6 a.m. to 8 a.m.
ZBs2c BEMA no. 162c  25 points Surcharge for
visits made Monday to Friday between 10 p.m. and 6 a.m.
ZBs2d BEMA no. 162d  19 points Surcharge for
visits made on Saturdays, Sundays or public holidays between 8 a.m. and 8 p.m.
ZBs2e BEMA no. 162e  34 points Surcharge for
visits on Saturdays, Sundays or public holidays between 8 p.m. and 10 p.m. or 6 a.m. to 8 a.m.
ZBs2f BEMA no. 162f  44 points   Surcharge for
visits made on Saturdays, Sundays or public holidays between 10 p.m. and 6 a.m.
Surcharge for children
ZKi      BEMA no. 165    14 points   Surcharge to the benefits under nos. 151, 152, 153, 154
and 155 for children up to the age of four
Surcharges according to Section 87 (2i) SGB V
PBA1a BEMA no. 171a 35 points   Surcharge for visiting insured persons who are in need of care, have
a disability or have limited everyday skills
PBA1b BEMA no. 171b 30 points   Surcharge for visiting each additional insured person who is in need of care, has
a disability or limited everyday skills,
in the same household or facility
in direct temporal connection with a benefit according to No. 171a
Surcharges within the framework of a cooperation agreement according to Section 87 (2j) SGB V
SP1a   BEMA no. 172a 36 points   Surcharge for visiting an insured person in need of care in an
inpatient care facility
SP1b   BEMA no. 172b 31 points   Surcharge for visiting each additional insured person in need of care in the same inpatient
care facility in direct temporal connection with a service according to No. 172a
SP1c   BEMA no. 172c 16 points   Assessment of the dental treatment needs, the condition of the teeth, the
oral mucosa and the prostheses, introduction of insured-related
suggestions for measures to maintain and improve oral health,
including documentation using the form
in Appendix 2 to the framework agreement in accordance with Section 119b (2) SGB V
SP1d   BEMA no. 172d 20 points   Support and, if necessary, practical guidance of the nursing staff
in carrying out the tasks incumbent on them by means of insured-related
suggestions for measures to maintain and improve
oral health as well as information on special features of
dental care and the care and handling of dentures
Travel allowance for visits (Section 8 (2) GOZ)
up to two kilometers 4.30 euros, at night (between 8 p.m. and 8 a.m.) € 8.60.
more than two kilometers up to five kilometers 8.00 euros, at night 12.30 euros.
more than five kilometers up to ten kilometers 12.30 euros, at night 18.40 euros.
more than ten kilometers up to 25 kilometers 18.40 euros, at night 30.70 euros.
Travel compensation for visits (Section 8 (3) GOZ)
if the distance is more than 25 kilometers: 0.42 euros for each kilometer traveled if he
uses his own vehicle , if he uses other means of transport, the actual expenses,
if absent for up to eight hours 56 euros,
if you are absent for more than eight hours 112.50 euros per day,
Reimbursement of the costs for necessary overnight stays.
Consilia
KSIK    BEMA no. 181    14 points  Consultation with doctors and dentists
KSIK    BEMA no. 182    14 points  Consultative discussion with doctors and dentists
within the framework of a cooperation agreement in accordance with Section 119b (1) SGB V

Individual prophylaxis / early detection examination

IP1      BEMA no. IP1     20 points   Oral hygiene status
IP2     BEMA no. IP2     17 points   Oral health education
IP4     BEMA no. IP4     12 points   Local fluoridation of the teeth
IP5     BEMA no. IP5     16 points   Fissure sealing (6 and 7 only); per tooth       
FU      BEMA no. FU     25 points   Dental screening examination

Part 2 - Treatment of injuries to the facial skull (broken jaw), TMJ diseases (bite aids)

BEMA no. 2 20 points Treatment and cost plan for a broken jaw
BEMA no. 7a 19 points Models of the upper and lower jaw, three-dimensional (orthodontic)
BEMA no. 7b 19 points Upper and lower jaw models (dentures and broken jaws)
BEMA no. K1   Bite bite aid with adjusted surface -
in the specific version as listed below:
BEMA no. K1a 106 points - to interrupt the occlusion contacts
BEMA no. K1b 106 points - as an occlusal splint for PAR treatment
BEMA no. K1c 106 points - as a bite guide plate for dentures
BEMA no. K2 45 points Bite block without adjusted surface
BEMA no. K3 61 points Modification of existing prostheses for bite implants
BEMA no. K4 11 points semi-permanent splinting; per interdental space
BEMA no. K6 30 points Restoration and / or relining of a bite aid
BEMA no. K7 6 points Control treatment, if necessary with a simple correction
BEMA no. K8 12 points Control treatment with grinding in the bite aid
BEMA no. K9 35 points Control treatment with construction of a new adjusted surface

Part 3 - Orthodontic Treatment

BEMA no. 5 95 points Orthodontic treatment planning
BEMA no. 7a 19 points Impression taking, bite taking in habitual occlusion for the
creation of three-dimensionally oriented models (orthodontic)
BEMA no. 116 15 points Photography, per shot
BEMA no. 117 35 points Model analysis, no. 7a each
BEMA no. 118 25 points Cephalometric evaluation
BEMA no. 119   Measures for reshaping a jaw
  a 132 points easy 11 points per quarter
b 204 points moderate 17 points per quarter
c 276 points difficult 23 points per quarter
d 336 points particularly difficult 28 points per quarter
BEMA no. 120   Measures to adjust the lower jaw
  a 204 points easy 17 points per quarter
b 228 points moderate 19 points per quarter
c 276 points difficult 23 points per quarter
d 336 points particularly difficult 28 points per quarter
BEMA no. 121 17 points Elimination of habits, per session
BEMA no. 122   Orthodontic performance as sole service
BEMA no. 122a 21 points Control of the success of the treatment, per session
BEMA no. 122b 43 points Preparatory measure, per jaw
BEMA no. 122c 27 points Insertion of treatment agents
BEMA no. 123a 40 points Keeping gaps open for each jaw
BEMA no. 123b 14 points Control of a gap holder, per treatment quarter
BEMA no. 124 16 points Grinding in milk teeth, per session
BEMA no. 125 30 points Measures to restore treatment agents,
per session
BEMA no. 126a 18 points Integration of a bracket or attachment (including ML costs)
BEMA no. 126b 42 points Incorporation of a band (including ML costs)
BEMA no. 126c 30 points Reintegration of a band
BEMA no. 126d 6 points Removal of a band, bracket or attachment
BEMA no. 127a 25 points Integration of a partial questionnaire (including ML costs)
BEMA no. 127b 7 points Outsourcing of a sub-sheet
BEMA no. 128a 32 points Integration of a made-up full arch
BEMA no. 128b 40 points Incorporation of an individualized full arch
BEMA no. 128c 9 points Outsourcing of full arches, per arch
BEMA no. 129 24 points Reintegration of a full or partial arch
BEMA no. 130 72 points Integration of intra- / extraoral anchoring devices (including ML costs)
BEMA no. 131 50 points Incorporation and removal of a palatal expansion appliance
BEMA no. 132 50 points Autumn hinge
BEMA no. 133 50 points Face mask (plus ML costs)

Part 4 - Systematic treatment of periodontal disease

BEMA no. 4th 39 points Findings and treatment and cost plan PAR
BEMA no. P200 14 points Debridement - closed PAR treatment; each single-rooted tooth
BEMA no. P201 26 points Debridement - closed PAR treatment; the more rooted tooth
BEMA no. P202 22 points surgical therapy - open PAR treatment; each single-rooted tooth
BEMA no. P203 34 points surgical therapy - open PAR treatment; the more rooted tooth
BEMA no. P108 6 points Grinding in the natural dentition; per session
BEMA no. P111 10 points Aftercare; per session

Part 5 - Provision of dentures and dental crowns

BEMA no. 18a 50 points assembled structure; one time
BEMA no. 18b 80 points cast structure; two-stage
BEMA no. 19th 19 points temporary crown or pontic of a temporary bridge
BEMA no. 20a 148 points metallic full crown
BEMA no. 20b 158 points vestibular veneer crown
BEMA no. 20c 187 points metallic partial crown
BEMA no. 21st 28 points provisional crown with pin anchorage
BEMA no. 22nd   Partial performance in the event of incomplete performance
according to numbers 18 and 20
BEMA no. 24a 25 points Replace a crown or the like.
BEMA no. 24b 43 points Renewing or reinserting a facet,
a veneer or the like.
BEMA no. 24c 7 points Removal / replacement of a temporary crown
BEMA no. 89 16 points Elimination of articulation or occlusion disorders
BEMA no. 90 154 points
Root post cap with anchorage in the root canal with spherical stud anchor
BEMA no. 91a 118 points Metallic full crown as bridge anchor
BEMA no. 91b 128 points Full crown with vestibular veneer as bridge anchor
BEMA no. 91c 136 points Metallic partial crown as bridge anchor
BEMA no. 91d 190 points Telescopic crown
BEMA no. 91e 43 points Attachment with a split bridge
BEMA no. 92 62 points Bridge span (per span)
BEMA no. 93 335 points Adhesive bridge
BEMA no. 94a   Partial services for bridges according to numbers 90 to 92
BEMA no. 94b   Partial services for adhesive bridges according to number 93
BEMA no. 95a 34 points Reinstalling a bridge with two bridge anchors
BEMA no. 95b 50 points Reinstalling a bridge with more than two bridge anchors
BEMA no. 95c 36 points Renewal or replacement of a facet
BEMA no. 95d 18 points Removal / reinstallation of a temporary bridge
BEMA no. 96a 57 points Partial denture - to replace 1 to 4 missing teeth
BEMA no. 96b 83 points Partial denture - to replace 5 to 8 missing teeth
BEMA no. 96c 115 points Partial denture - to replace more than 8 missing teeth
BEMA no. 97a 250 points Full denture / cover denture prosthesis ; upper jaw
BEMA no. 97b 290 points Full denture / cover denture prosthesis ; Lower jaw
BEMA no. 98a 29 points Individual spoon (individualized spoon) per jaw
BEMA no. 98b 57 points Functional impression of the upper jaw
BEMA no. 98c 76 points Functional impression of the lower jaw
BEMA no. 98d 23 points Support pin registration ; intraoral
BEMA no. 98e 16 points Metal base (toothless jaw)
BEMA no. 98f 22 points double-armed holding device
BEMA no. 98g 44 points Metal base (partially edentulous jaw)
BEMA no. 98h / 1 29 points cast holding and supporting device (one)
BEMA no. 98h / 2 50 points cast holding and supporting device (at least two)
BEMA no. 99a 19 points Partial service for prostheses (anatomical impression)
BEMA no. 99b 1/2 fee Partial service for prostheses (measure; including determination of the bite position)
BEMA no. 99c 3/4 fee Partial service for prostheses (further measures)
BEMA no. 100   Restoration of prostheses - in the specific execution
as listed below:
BEMA no. 100a 30 points - Restoration of a prosthesis - smaller size ( without an impression)
BEMA no. 100b 50 points - restoration of a prosthesis - larger size ( with impression)
BEMA no. 100c 44 points - Partial relining
BEMA no. 100d 55 points - complete relining; indirectly
BEMA no. 100e 81 points - complete relining with edge design; upper jaw
BEMA no. 100f 81 points - complete relining with edge design; Lower jaw
BEMA no. 101a 80 points Soft tissue support with residual dentition
BEMA no. 101b 120 points Soft tissue support in the edentulous jaw
BEMA no. 102 240 points Obturator
BEMA no. 103a 160 points temporary defect prosthesis
BEMA no. 103b 80 points Supplementary measures to No. 103a
BEMA no. 103c 300 points permanent defect prosthesis
BEMA no. 104a 300 points Epithesis (small)
BEMA no. 104b 500 points Epithesis (large)

Reimbursement of expenses - laboratory and material costs

BEMA no. 601   Pen material
BEMA no. 602   Telephone costs, shipping costs, postage costs
BEMA no. 603   Laboratory cost dental laboratory
BEMA no. 604   Laboratory costs external laboratory

See also

Uniform evaluation standard (EBM) for doctors

Web links

Individual evidence

  1. a b GOZ (PDF) with reference to the uniform assessment standard for dental services in accordance with Section 87 Paragraphs 2 and 2 h1 in the version of SGB V, valid from April 1, 2014, General Provisions; 3a