Anyone who wants to start psychotherapy quickly runs into the question of whether a referral is needed. The answer depends on whether you have statutory or private health insurance and at which stage of treatment you are. This guide explains the difference between a referral and a consultation report, and what the decision of the Federal Joint Committee of 15 October 2026 changes.
Short answer: Before a guideline-based psychotherapy starts, statutory health insurance provides for a physical clarification by a consultant. If a referral from a contracted doctor exists, the consultation report is not needed for this step, according to the Kassenärztliche Bundesvereinigung (KBV). The Federal Joint Committee (G-BA) adopted new rules on 15 October 2026. They take effect after publication in the Federal Gazette, which had not yet happened in early November 2026. Last updated: November 2026.
The most important points
- A referral is a medical recommendation to a specialist service. A consultation report is the statement of a consulting doctor after a personal examination.
- If a referral exists, the KBV reports that the consultation report is no longer required.
- Under the G-BA decision of 15 October 2026, the consultation report is provided for before therapy begins, after the probatory sessions.
- The decision has been adopted but is not yet in force. It takes effect the day after publication in the Federal Gazette.
- Private health insurance follows its own terms, which you should check in your policy documents.
What is the difference between a referral and a consultation report?
Both terms appear in connection with psychotherapy, but they are not the same thing. The table classifies them:
| Term | What it is | Who issues it |
|---|---|---|
| Referral | Medical recommendation to a specialist service or treatment | Contracted doctor |
| Consultation report | Statement after a personal examination that clarifies physical and, if needed, psychiatric causes | Consulting doctor |
| Psychotherapy consultation hour | First contact with a psychotherapist | Psychotherapy practice |
The consultation hour is a separate route with its own rules, described in the guide Psychotherapeutische Sprechstunde. The consultation report concerns the step after that, namely the start of the treatment itself.
When is the consultation report provided for?
According to the decision text of the G-BA, the consultation report is provided for before a guideline-based psychotherapy begins. For this purpose the psychotherapist refers the person to a consulting doctor after the probatory sessions. The consulting doctor examines the person in person and sends the report as soon as possible, and at the latest three weeks after the examination. The meaning of probatory sessions is explained in the guide Probatorische Sitzungen.
The KBV also reports that no consultation report is needed for a referral or after a hospital recommendation. This is a status taken from a press release. Whether and from when it applies to you is best confirmed by your practice or your health insurer.
What changes with the decision of 15 October 2026?
The Federal Joint Committee revised the guideline on 15 October 2026. The most important points named in the decision are:
- The consulting doctor now transmits the report only to the psychotherapist.
- The report concentrates on information relevant to indication and treatment. According to the KBV, it covers six areas of information.
- Existing contraindications are explained.
- If the consulting doctor considers psychotherapy contraindicated and an application is still filed, the health insurer arranges an assessment by the Medizinischer Dienst.
- The change only takes effect after review by the Federal Ministry of Health and publication in the Federal Gazette.
According to the KBV, the decision does not name an exact date for taking effect. If you are planning the process now, ask your practice which version it works with.
What applies to the consultation hour and referrals?
The psychotherapy consultation hour, appointment placement through the 116117 service and acute treatment each follow their own procedures. If you need a place quickly, the entry points are described in the guide Psychotherapy through the 116117 service and in the guide on acute treatment Psychotherapy as acute treatment.
What applies with private health insurance?
Private insurers do not work under the statutory guideline. The documents they require and the psychotherapy they reimburse are set out in your policy terms. An overview of cost questions is in the guide PKV and psychotherapy (in German). If you pay without insurance coverage, the guide Psychotherapy as a self-payer (in German) gives background.
Frequently asked questions
Do I need a new referral for every session?
The rules on the consultation report concern the start of a guideline-based psychotherapy, not every single session. Whether further documents are needed for your treatment is clarified by the practice before it starts.
Can I contact a psychotherapist without a referral?
A request for an appointment is generally possible. The question of the consultation report arises before treatment begins and does not decide the first enquiry. When you make contact, ask which steps are required before treatment starts.
What happens if the consulting doctor advises against psychotherapy?
Under the decision text, the health insurer arranges an assessment by the Medizinischer Dienst if an application is still filed. You can discuss the assessment with your doctor.
Does this also apply at a university outpatient clinic?
University outpatient clinics have their own access routes and procedures. What applies there is described in the guide Hochschulambulanz Psychotherapie. If in doubt, ask the clinic directly.
Questions you can ask the practice
A short phone call or message to the practice clears up many open points. These questions help you prepare:
- Which form of consultation hour does the practice offer, and how long is the waiting time for a first contact?
- Is a consultation report provided for after the probatory sessions, and who issues it?
- Does the practice submit the report itself, or do you have to present it to your health insurer?
- Which documents does your statutory or private insurer require for the application?
- Is there a deadline by which the report must be available?
Note the answers with the date. If the rules change after they take effect, you have a record of which version you asked about.
Why the rules seem confusing
The question of referrals is answered in several places: in the law, in the psychotherapy guideline of the G-BA, in agreements between insurers and doctors, and in the practice itself. The law sets the framework and the guideline specifies it. Until the new version takes effect, it does not yet apply, so information from older articles and forums can go out of date quickly. Ask for important information to be confirmed in writing where possible.
What to do now
- Ask your statutory or private insurer in writing which documents it requires for a guideline-based psychotherapy.
- Clarify with the practice whether a consultation report is needed and who issues it.
- Book the examination with the consulting doctor before therapy starts.
- Follow the publication of the decision in the Federal Gazette to know from when the new version applies.
Related guides
- Psychische Gesundheit im Studium
- Psychotherapeut finden
- Psychotherapeutische Sprechstunde
- Online-Psychotherapie per Video
- PKV und Psychotherapie (in German)
Sources: KBV practice news, “Konsiliarverfahren wird vereinfacht” (15 October 2026, status: October 2026). Federal Joint Committee (G-BA), decision on the review of the consultation procedure in the psychotherapy guideline (15 October 2026, German original).
Last updated: November 2026. This guide is general information, not individual advice.
