GOÄ explained: How to read a private medical bill

To understand the GOÄ, the German fee schedule for physicians (Gebührenordnung für Ärzte), you first need to know when it applies. It governs how doctors bill their services when they bill privately rather than through a statutory insurer. This mainly affects patients with private health insurance or Beihilfe (state-aid for civil servants).

The invoice determines what your insurer can check and reimburse. This guide explains the fee multiplier, the mandatory details and a checking routine, so you can follow a private bill before you submit it.

The most important points at a glance

• The GOÄ is a federal regulation. It sets the fees doctors may charge for medical services (last updated: October 2026).
• The fee multiplier ranges from the single rate (1.0) to 3.5 times the base fee (section 5(1) GOÄ).
• Up to 2.3 times the base fee is the standard. Above that, only specific circumstances justify the amount (section 5(2) GOÄ).
• An invoice must show the date of service, the service number, the description, the amount and the multiplier (section 12(2) GOÄ).
• A multiplier above 2.3 must be justified in writing (section 12(3) GOÄ).
• A reform of the GOÄ is in preparation. Whether and when a new version applies is open.

What does the GOÄ actually regulate?

The GOÄ is a federal regulation (Rechtsverordnung). It contains a fee schedule in which every medical service has a number. The base fee of a service results from a points value multiplied by a monetary unit (section 5 GOÄ). The physician then chooses a multiplier within a range.

If you are privately insured, the doctor usually bills you directly. You then submit the invoice to your insurer. The guide Leistungsabrechnung in der PKV explains how to read the reimbursement (in German).

How does the fee multiplier work?

The multiplier shows how far the fee goes beyond the single rate. The calculation is simple: base fee times multiplier gives the amount for the service. The table below shows this with a hypothetical base fee.

Assumption: The base fee of a service is 50 euros. These figures are worked examples, not prices of any specific doctor.

At 2.3 times, a 50 euro base fee gives 115 euros; at 3.0 times it would give 150 euros. The difference of 35 euros per service lies above the standard maximum, and exactly that part needs a justification.

Statutory health insurance patients are not billed under the GOÄ but under the rules of the statutory system. The GOÄ governs private billing, that is, cases where you settle the bill yourself and submit it to your insurer.

The standard range runs up to 2.3 (section 5(2) GOÄ). If the multiplier is higher, check the written justification. This is the first thing to look at on any private bill.

What must a medical invoice contain?

Under section 12(2) GOÄ, the invoice must state at least the following for each service you are billed for:

• the date on which the service was provided,
• the number and description of each service, if necessary with a minimum duration,
• the amount of each individual service,
• the multiplier applied.

For out-of-pocket expenses under section 10 GOÄ, the amount and type must be stated. For inpatient or partly inpatient private services, the reduction amount under section 6a GOÄ may also apply.

Checking an invoice in five steps

1. Check the date. Does the service date match the period of your treatment? A date that does not fit your appointment is a clear reason to ask.
2. Match the service. Compare the description and number with the medical report or treatment record.
3. Classify the multiplier. Is it 2.3 or lower? If not, look for the written justification.
4. Check the mandatory details. If something from section 12(2) GOÄ is missing, ask the practice for a corrected invoice.
5. Re-add the total. Add up the individual items and compare the sum with the total amount.

When may a doctor go above 2.3?

The fee depends on the difficulty and time required for the service and on the circumstances of its performance, applied at reasonable discretion (section 5(2) GOÄ). Going above 2.3 times the base fee is only permitted where particular circumstances justify it. The doctor must give the justification in writing (section 12(3) GOÄ).

Whether a justification holds up in your case cannot be decided on the basis of the statute alone. If you have doubts, raise them with the practice and ask your insurer how it assesses the multiplier.

What does this mean for reimbursement in your private plan?

The GOÄ sets what the doctor may charge. What your insurer actually reimburses is set out in your policy conditions. There you will find the maximum multiplier that is reimbursed, any exclusions and any caps. Read the conditions before you submit your first invoice. The invoice is only one part of the check; the policy is the other.

What about the planned GOÄ reform?

A reform of the GOÄ is in preparation. A draft legal section dated 9 July 2026 can be found on the website of the German Medical Association (Bundesärztekammer), status July 2026. Whether and when a new version takes effect has not been decided. When you receive new invoices, check which version applies before you compare amounts. This guide describes the text published on gesetze-im-internet.de (status: October 2026).

Frequently asked questions

Do I have to pay a private invoice immediately?

Under section 12(1) GOÄ, the fee becomes due once a correct invoice has been issued. You therefore receive an invoice with the mandatory details before you pay. The GOÄ does not set a deadline for issuing the invoice in this section.

May a doctor always charge the maximum?

No. 3.5 times the base fee is the upper limit of the range, not the usual case. Going above 2.3 times requires special circumstances in the individual case and a written justification.

Does the GOÄ also apply to dentists?

No. Dental services are billed under the German dental fee schedule (Gebührenordnung für Zahnärzte, GOZ). It is a separate regulation with its own fee numbers.

What do I do if a mandatory detail is missing?

Ask the practice for a corrected invoice before you submit it. How your insurer handles an incomplete invoice is set out in your policy conditions. A short call to the insurer often clears things up faster than writing back and forth.

How do I spot an above-standard multiplier on the invoice?

The multiplier is shown for each individual service. If it is above 2.3, a justification should be included. If it is missing, you can ask the practice for it.

How to proceed now

1. Check each invoice against the five steps in this guide.
2. For multipliers above 2.3, ask for the written justification.
3. Read your policy conditions to see up to which multiplier reimbursement applies.
4. Submit the invoice only once every detail is correct. The step-by-step guide is PKV-Rechnungen einreichen: So geht es richtig und schnell (in German).

Related reading

• Leistungsabrechnung in der PKV: So liest du Rechnung und Erstattung (in German)
• PKV-Rechnung einreichen: Original, Kopie, App und Fristen (in German)
• Kostenerstattung in der PKV: So funktioniert das Prinzip (in German)
• Private Health Insurance for Working Students in Germany
• Health insurance for students: glossary from A to Z

Sources: Gebührenordnung für Ärzte (GOÄ), gesetze-im-internet.de, status October 2026; section 5 GOÄ, status October 2026; section 12 GOÄ, status October 2026; German Medical Association, GOÄ reform, status July 2026.

If you are unsure whether an invoice fits your policy, you can arrange personal advice: How we work.

Last updated: October 2026. This guide is general information, not individual advice.