tariff for doctors

Basic data
Title:	tariff for doctors
Abbreviation:	GOÄ
Type:	Federal Ordinance
Scope:	Federal Republic of Germany
Legal matter:	Professional law of the medical professions , special administrative law
References :	2122-4
Original version from:	March 18, 1965 ; ( Federal Law Gazette I p. 89 )
Entry into force on:	April 1, 1965
New announcement from:	February 9, 1996 ; ( BGBl. I p. 210 )
Last revision from:	November 12, 1982 ; ( BGBl. I p. 1522 )
Entry into force of the ; new version on:	January 1, 1983
Last change by:	Art. 1 Regulation of 21 October 2019 ; ( Federal Law Gazette I, p. 1470 )
Effective date of the ; last change:	January 1, 2020 ; (Art. 2 of October 21, 2019)
	Please note the note on the applicable legal version.

The fee schedule for doctors ( GOÄ ) regulates the billing of medical services outside of contract medical care in Germany. A private liquidation created in accordance with the provisions of the GOÄ is granted to both private patients , i.e. H. Patients who are insured or uninsured with a private health insurance and pay for their treatment themselves as well as those with statutory health insurance in the case of so-called individual health services or when choosing the reimbursement method .

On the other hand, the remuneration of contract medical services is regulated by the fifth social code by the uniform assessment standard ( Section 87 (2) SGB V). Billing is not made to the insured person here, but via the Association of Statutory Health Insurance Physicians.

Doctors with a license to practice medicine are not allowed to charge self-calculated fees for medical services in Germany, but are bound to the GOÄ according to the medical professional law , as specified in the case law of the Federal Constitutional Court . Your right to set prices, which is covered by the freedom to exercise your profession, is, however, subject to fewer restrictions than in the system of statutory health insurance, which largely eliminates market mechanisms with regard to the need for social protection of the insured and the safeguarding of their care. Restrictions on the right to claim payment are only justified where the fee schedule serves the public interest of balancing the legitimate interests of the service provider and the patient. The GOÄ is similar to the fee schedules of other liberal professions, e.g. B. by lawyers and architects .

history

The immediate predecessor of the GOÄ was the Prussian fee schedule for licensed doctors and dentists (Preugo). The Preugo of 1896 (revised 1924) was the state fee schedule for medical services in the German Reich and was incorporated into federal law in 1952. The Hartmannbund ("Association of Doctors in Germany") published its own fee schedule in 1928, the General German Fee Schedule for Doctors (Adgo). In some cases it contained rates twice as high as the Preugo and was used if the doctor and patient agreed this under private law. Preugo and Adgo enumerated the individual medical services and set minimum and maximum rates for them, a so-called tax .

On April 1, 1965, the Preugo was replaced in the Federal Republic by the first GOÄ and the "Federal Standard Fee Regulations for Dentists" (BUGO-Z). During the transition from Preugo to GOÄ, the general legal fee provisions of Preugo were combined with the service specifications of the “ Ersatzkassen -Adgo” (“E-Adgo”), including their accounting provisions . The Adgo remained in use as a "private Adgo" until 1982 when the current GOÄ came into force. In 1987 the fee schedule for dentists (GOZ) was also issued.

The current fee schedule for doctors (GOÄ) dates from November 12, 1982 and has been changed several times since then.

Further development

In view of the experience with the GOÄ from 1965, a warning was issued even before the new GOÄ came into force: "In the future, the state should think about the ongoing development of the official fee schedule, because the years of doing nothing since 1965 has in no way proven itself." As with the previous fee schedules, however, there was no further development. The German Medical Association therefore called for a reform in 2005: “The current GOÄ still dates largely from 1982, the last comprehensive reform; The then revised schedule of fees is based on the replacement fund fee schedule - E-Adgo - from 1978. This means that of the total of 37 sections of the list of services in the current GOÄ since 1982 and 1978, 26 chapters have not been fundamentally updated. The remaining 11 chapters of the list were redrafted with the Fourth Amendment Ordinance of December 18, 1995: They are now more than 10 years old. The progress in medicine over the past three decades has therefore not been systematically included in the GOÄ. "

The German Medical Association is currently negotiating a new version of the GOÄ (as of 2015) with the Association of Private Health Insurance . Medical Association President Montgomery said at the German Medical Congress in May 2015 : “In an admittedly arduous process, we negotiated a new GOÄ with the PKV Association ... We are now so far that we have been able to make a jointly agreed proposal to the ministry, the 400 Includes total services and 160 additional services, which cover around 80 percent of the volume of the GOÄ ”.

construction

The GOÄ regulates the remuneration for the professional services of doctors, including compensation and reimbursement of expenses, which are necessary according to the rules of medical art for medically necessary medical care. Services that go beyond the extent of medically necessary medical care may only be charged if they have been provided at the request of the payer ( § 1 GOÄ).

Within a fee range between one and three and a half times the fee rate, the fees are to be determined at reasonable discretion, taking into account the difficulty and the time required for the individual service as well as the circumstances during the execution ( § 5 GOÄ). The 2.3 times the fee rate represents the average performance in terms of difficulty and time required. Exceeding this fee rate is only permissible if special features justify this and must be justified in the invoice to the payer in an understandable and comprehensible manner. Services with a below-average level of difficulty or expenditure of time are to be charged at a lower rate. On the basis of a written agreement with the patient, the 3.5-fold fee rate can also be exceeded ( § 2 GOÄ).

The billable services can be found in the schedule of fees as an annex to the GOÄ.

The schedule of fees is divided into 16 subject-specific sections. In these sections, possible services of the doctor are defined by numbers, e.g. B.
Section 1: Consultation (simple fee rate 4.66 euros, 2.3 times the fee rate 10.72 euros)
Section 5: Symptom-related examination (simple fee rate 4.66 euros)

Besides the numbers there are letters; they stand for the surcharges. So z. B.
Surcharge B "Surcharge for services provided between 10 p.m. and 6 a.m.".

The GOÄ also regulates which number the doctor may not bill together with other numbers.

Analog services

In accordance with Section 6 (2) GOÄ, the doctor can charge independent medical services that are not included in the list of fees according to a service of the list of fees that is equivalent in terms of type, cost and time expenditure. The selected analog service must therefore be equivalent to the service not shown in the GOÄ, not the same, i.e. not similar in content. The analog performance must reflect the corresponding reasonable monetary value of the performance not included.

To avoid billing problems, a common evaluation committee of private health insurance and who was German Medical Association created the new medical procedures analyzed and published its analogue billing recommendations German doctors Journal. Since this analogous calculation has no binding effect on all parties involved, including private health insurances and aid agencies, reimbursement problems with private health insurers often arise even when the billing recommendations are used as a basis.

Currency information

In the course of the changeover to the euro as the sole legal tender in Section 5 (1) sentence 3 GOÄ on January 2, 2002, the statement “11.4 German Pfennigs” was replaced by “5.82873 Cent”, Section 5 (1) sentence 3 GOÄ However, 1 sentence 4 GOÄ remains unchanged: When assessing fees, the resulting fractions of a penny below 0.5 are rounded down and fractions of 0.5 and more are rounded up. Travel allowance and travel expenses are also given in German marks and pennies in Sections 8 and 9 : “ If you are absent for more than 8 hours, 200 German marks per day” ( Section 9, Paragraph 2, No. 2).

The DM amounts listed in the GOÄ apply within the framework of the automatic legal mechanism established by the relevant EU regulations for the introduction of the euro as of January 1, 2002 using the official exchange rate as converted to the cent.

Individual evidence

↑ BVerfG decision of March 20, 2001 - 1 BvR 491/96 = BVerfGE 103, 172

↑ BVerfG decision of October 25, 2004 - 1 BvR 1437/02

↑ BVerfGE 68, 319 para. 28 ff. On the history of medical fee schedules

↑ ^a ^b Official justification of the Federal Government on GOÄ 1982, Bundesrats-Drucksache 295/82 of 19 July 1982.

↑ Federal Law Gazette (BGBl) 1982 Part I, p. 1522.

^ Friedrich Nienhaus: New GOÄ - end of private Adgo. In: Deutsches Ärzteblatt. Edition B, Volume 79, Issue 49, December 10, 1982, p. 61.

↑ Press release of the German Medical Association for the German Medical Congress 2005.

↑ Falk Osterloh: 118th German Medical Congress In: Deutsches Ärzteblatt. Issue C, Volume 112, Issue 20, May 15, 2015, p. 727.

↑ Federal Court of Justice judgment of November 8, 2007 - III ZR 54/07