Definition
The Gebührenordnung für Ärzte, GOÄ for short, regulates the fees charged for medical services that do not fall within the scope of medical care provided by SHI-accredited physicians. This means that the GOÄ does not apply to the billing of medical services for patients who are members of the statutory health insurance (SHI patients). For patients with statutory health insurance, the so-called uniform assessment standard (EBM) applies.
The GOÄ, however, regulates the fees for privately insured patients. In addition, medical services for patients with statutory health insurance that are not covered by the health insurance company, so-called individual health services, IGEL for short, are invoiced via the GOÄ. Physicians working in Germany are not allowed to charge individual fees for the medical services they provide to privately insured patients, but are very precisely bound by the GOÄ to certain billing figures.
How are the numbers calculated?
Which amount can be charged for which medical service is determined by several variables. First, the service to be billed is defined by means of a number. This digit corresponds to a fixed value in Euro, the so-called basic fee.
In addition to this figure, the fee rate also plays a role. Depending on how (time-consuming) the medical service provided is, a simple to 3.5-fold fee rate can be calculated. This means that the Euro amount defined by the respective figure can be multiplied by a number between 1 and 3.5.
The average fee rate is 2.3. If it is a medical service with below-average effort, the fee rate is reduced, if the service requires above-average effort, the fee rate is increased up to 3.5. If the fee rate exceeds the average of 2.3, the invoice issued by the doctor must show the reason for the above-average fee rate.
In addition to the number and the fee rate, there is a third variable in the GOÄ, the letter. Letters stand for surcharges. For example, the letter C stands for surcharges for services rendered between 10 p.m. and 6 a.m. Surcharges may only be invoiced at the simple rate, i.e. they are not revalued on the basis of the work done. The fee to be paid for a medical service rendered is thus made up of the number, the fee rate and the surcharge.
