Service text
„Blutentnahme mittels Spritze, Kanüle oder Katheter aus der Vene“Not alongside — per the Gebührenverzeichnis (1)
Numbers the fee schedule names together with this one in an exclusion sentence. Open a chip for the wording, in German, and where it stands; about a particular case the sentence says only what it says.
Number 250 is the blood draw from a vein by syringe, cannula or catheter, valued at 40 points. That gives 2,33 € at the single rate and 4,20 € at the 1.8-fold rate, the usual maximum for this number. Number 250 is listed in Abschnitt A of the Gebührenverzeichnis, and for the services named there § 5 Abs. 3 GOÄ narrows the frame to the single up to the 2.5-fold rate and sets 1.8-fold, not 2.3-fold, as the usual span — the difficulty of the case does not count as a criterion here. The other boundary that matters is against Numbers 270 to 287: a vessel puncture needed for one of those is settled with their fee, not with this one.
The service text of Number 250
Three technical routes stand side by side because the result is the same: blood is drawn from a vein, and whether that is done with a syringe, a cannula or a catheter makes no difference to the number. The service is measured by the access to the vein, not by the instrument used.
Not named is a blood draw from an artery or from capillary blood — for Number 250, only the vein counts. Also not part of this number is a vessel puncture that becomes necessary in connection with an infusion, transfusion or similar service under Numbers 270 to 287; that is settled with their fee and is not billed again under Number 250.
What happens to the sample afterward is not part of Number 250 either; it covers only the act of drawing. A wound dressing under Number 200 applied afterward in connection with the puncture, by contrast, counts as part of this service and is not billed separately.
The sentences below stand exactly like this in the Gebührenverzeichnis — as Allgemeine Bestimmungen and directly under Number 250. They are quoted here in German, word for word rather than summarized, because the German wording is what is legally binding. The English text after each dash is a working translation, not a substitute for the statutory wording.
- „Für die nachfolgend genannten Leistungen dürfen Gebühren nach Maßgabe des § 5 nur bis zum Zweieinhalbfachen des Vergütungssatzes bemessen werden: Nummern 2 und 56 in Abschnitt B, Nummern 250, 250a, 402 und 403 in Abschnitt C, Nummern 602, 605 bis 617, 620 bis 624, 635 bis 647, 650, 651, 653, 654, 657 bis 661, 665 bis 666, 725, 726, 759 bis 761 in Abschnitt F, Nummern 855 bis 857 in Abschnitt G, Nummern 1001 und 1002 in Abschnitt H, Nummern 1255 bis 1257, 1259, 1260, 1262, 1263, 1268 bis 1270 in Abschnitt I, Nummern 1401, 1403 bis 1406, 1558 bis 1560 in Abschnitt J, Nummern 4850 bis 4873 in Abschnitt N.“ — For the services named below, fees under § 5 may be assessed only up to two-and-a-half times the standard rate: Numbers 2 and 56 in Abschnitt B, Numbers 250, 250a, 402 and 403 in Abschnitt C, Numbers 602, 605 to 617, 620 to 624, 635 to 647, 650, 651, 653, 654, 657 to 661, 665 to 666, 725, 726, 759 to 761 in Abschnitt F, Numbers 855 to 857 in Abschnitt G, Numbers 1001 and 1002 in Abschnitt H, Numbers 1255 to 1257, 1259, 1260, 1262, 1263, 1268 to 1270 in Abschnitt I, Numbers 1401, 1403 to 1406, 1558 to 1560 in Abschnitt J, Numbers 4850 to 4873 in Abschnitt N.
- „Gegebenenfalls erforderliche Gefäßpunktionen sind Bestandteil der Leistungen nach den Nummern 270 bis 287 und mit den Gebühren abgegolten.“ — Vessel punctures required where applicable are part of the services under Numbers 270 to 287 and are settled with their fees.
- „Wundverbände nach Nummer 200, die im Zusammenhang mit einer operativen Leistung (auch Ätzung, Fremdkörperentfernung), Punktion, Infusion, Transfusion oder Injektion durchgeführt werden, sind Bestandteil dieser Leistung.“ — Wound dressings under Number 200 performed in connection with a surgical service (including cauterization, removal of a foreign body), puncture, infusion, transfusion or injection are part of that service.
- „Neben der Leistung nach Nummer 435 sind für die Dauer der stationären intensivmedizinischen Überwachung und Behandlung Leistungen nach den Abschnitten C III und M sowie die Leistungen nach den Nummern 1 bis 56, 61 bis 96, 200 bis 211, 247, 250 bis 268, 270 bis 286a, 288 bis 298, 401 bis 424, 427 bis 433, 483 bis 485, 488 bis 490, 500, 501, 505, 600 bis 609, 634 bis 648, 650 bis 657, 659 bis 661, 665 bis 672, 1529 bis 1532, 1728 bis 1733 und 3055 nicht berechnungsfähig. Diese Leistungen dürfen auch nicht anstelle der Leistung nach Nummer 435 berechnet werden.“ — Alongside the service under Number 435, for the duration of inpatient intensive-care monitoring and treatment, services under Abschnitte C III and M and under Numbers 1 to 56, 61 to 96, 200 to 211, 247, 250 to 268, 270 to 286a, 288 to 298, 401 to 424, 427 to 433, 483 to 485, 488 to 490, 500, 501, 505, 600 to 609, 634 to 648, 650 to 657, 659 to 661, 665 to 672, 1529 to 1532, 1728 to 1733 and 3055 are not billable. Nor may these services be billed instead of the service under Number 435.
The multiplier for Number 250
Number 250 is named in Abschnitt A of the Gebührenverzeichnis („Gebühren in besonderen Fällen“), and for the services of that Abschnitt § 5 Abs. 3 GOÄ applies: not the ordinary frame up to the 3.5-fold rate, but a frame from the single rate up to the 2.5-fold rate, with the 1.8-fold rate as the usual span in place of the otherwise usual 2.3-fold rate.
§ 5 Abs. 2 Satz 2 GOÄ also expressly excepts the services named in Absatz 3: for Number 250, the difficulty of the case cannot establish the difficulty of the service. What remains decisive under § 5 Abs. 2 Satz 1 is only the difficulty and the time taken for the particular service, and the circumstances of how it was performed.
Above the 1.8-fold rate, § 12 Abs. 3 GOÄ requires a written justification tied to the particular service, comprehensible and traceable for the person liable to pay. For a service text this short, that justification can only come from the circumstances of performance, which have to be recorded somewhere else.
What the record has to carry for Number 250
The treatment record is independent of the fee schedule — § 630f BGB requires it in immediate temporal connection with the treatment, whether billed privately or through statutory insurance. For Number 250, that means when and for what reason the vein was punctured belongs in the record, not first in the invoice.
Because Number 250 is one of the services covered by § 5 Abs. 3 GOÄ, for which the difficulty of the case is excluded as a criterion, a justification above the 1.8-fold rate can only come from the circumstances of performance. Without a corresponding note in the record, there is nothing for a justification under § 12 Abs. 3 to draw on.
The boundary against Numbers 270 to 287 can likewise only be traced from the record: whether a vessel puncture was part of an infusion or transfusion, or a stand-alone blood draw under Number 250, has to be evident from how each service was documented.
Frequently asked questions
Is a blood draw from an artery also Number 250?
No. The service text names the vein expressly. A blood draw by syringe or cannula from an artery is Number 251, at 60 points; a capillary blood draw in children up to the completed eighth year of life is Number 250a, at 40 points.
Is a vessel puncture for an infusion billed additionally under Number 250?
No. A vessel puncture required for that purpose is part of the services under Numbers 270 to 287 and settled with their fee; Number 250 is not added alongside it.
What does Number 250 cost at the 1.8-fold rate?
40 points times the point value of 5,82873 Cent give 2,33 € at the single rate; 1.8 times that is 4,20 €, and 2.5 times is 5,83 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.