GOÄ 26B III — Spezielle Beratungen und Untersuchungen450 points

GOÄ Number 26: the child screening examination, its points and its fee

Fee

60,33 €450 points × 5,82873 Cent × 2,3

The point count stands as written in the Gebührenverzeichnis; the point value stands in § 5 Abs. 1 Satz 3 GOÄ. The amounts are computed from these and rounded to the cent, as § 5 Abs. 1 Satz 4 requires. Which multiplier is appropriate in an individual case is set by § 5 Abs. 2 according to difficulty, time taken and the circumstances of performance — the practice decides that, not this table.

Service text

„Untersuchung zur Früherkennung von Krankheiten bei einem Kind bis zum vollendeten 14. Lebensjahr (Erhebung der Anamnese, Feststellung der Körpermaße, Untersuchung von Nervensystem, Sinnesorganen, Skelettsystem, Haut, Brust-, Bauch- und Geschlechtsorganen) - gegebenenfalls einschließlich Beratung der Bezugsperson(en) -“

Not alongside — per the Gebührenverzeichnis (10)

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 26 is the examination for the early detection of illness in a child up to the completed 14th year of life, valued at 450 points. That gives 26,23 € at the single rate and 60,33 € at the 2.3-fold rate, the usual span for this number. From the completed 2nd year of life onward it may be billed at most once per calendar year, and alongside it, Numbers 1, 3, 4, 5, 6, 7 and 8 are not billable.

The service text of Number 26

The service text lists the examination steps as one connected examination for children up to the completed 14th year of life, not a series of separately billable individual steps.

Counselling of the reference person(s) is included only "where applicable" — it belongs to Number 26 when it takes place, but does not create a separate claim when it does not. That distinguishes Number 26 from Number 4, whose service text separately describes taking a third-party history about a patient and/or instructing and guiding the reference person(s); the provision under Number 26 rules out billing both alongside each other.

Number 26 differs from Number 29 by its target group: Number 26 applies to children up to the completed 14th year of life, Number 29 to adults. The two service texts describe substantively different examinations — the body measurements and the named organ systems of a child here, whole-body status and risk profile there.

The sentences below stand exactly like this in the Gebührenverzeichnis — as Allgemeine Bestimmungen and directly under Number 26. 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.

„Die Leistung nach Nummer 26 ist ab dem vollendeten 2. Lebensjahr je Kalenderjahr höchstens einmal berechnungsfähig.“ — The service under Number 26 may be billed at most once per calendar year from the completed 2nd year of life onward.
„Neben der Leistung nach Nummer 26 sind die Leistungen nach den Nummern 1, 3, 4, 5, 6, 7 und/oder 8 nicht berechnungsfähig.“ — Alongside the service under Number 26, the services under Numbers 1, 3, 4, 5, 6, 7 and/or 8 are not billable.
„Als Behandlungsfall gilt für die Behandlung derselben Erkrankung der Zeitraum eines Monats nach der jeweils ersten Inanspruchnahme des Arztes.“ — A case of treatment, for the treatment of the same illness, is the period of one month after each first consultation of the physician.
„Terminvereinbarungen sind nicht berechnungsfähig.“ — Arranging appointments is not billable.
„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 26

Number 26 stands in the ordinary fee range: from the single rate up to the 3.5-fold rate, with the 2.3-fold rate as the span within which, under § 5 Abs. 2 Satz 4 GOÄ, a fee is as a rule assessed.

Decisive under § 5 Abs. 2 Satz 1 are the difficulty and the time taken for the particular service and the circumstances of how it was performed; under Satz 2, the difficulty of the case may also be taken into account. Criteria already built into the service text are left out under Satz 3.

Above the 2.3-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 an age-based screening examination with fixed, clearly outlined steps, such a justification can only come from the particular circumstances of performance in the individual case.

What the record has to carry for Number 26

The treatment record is independent of the fee schedule — § 630f BGB requires it in immediate temporal connection with the treatment, regardless of how it is billed. For Number 26, that includes which of the examination steps named in the service text were carried out and whether counselling of the reference person(s) took place.

The limit of one billing per calendar year from the completed 2nd year of life onward can only be verified from the record if disputed — which calendar year and which age applied at the time of the examination has to be stated there, not only recalled.

Above the 2.3-fold rate, the justification under § 12 Abs. 3 relates to the particular service; for an examination with such an extensive but fixed list of steps, it only holds up if the special circumstances of performance were already recorded elsewhere.

Frequently asked questions

How often is Number 26 billable?

At most once per calendar year from the completed 2nd year of life onward; the provision makes no statement of its own about the time before that.

Is counselling of the reference person(s) separately billable under Number 4?

No. The provision for Number 26 excludes Numbers 1, 3, 4, 5, 6, 7 and 8 alongside it — among them Number 4, whose service text describes taking a third-party history about a patient and/or instructing and guiding the reference person(s).

What does Number 26 cost at the 2.3-fold rate?

450 points times the point value of 5,82873 Cent give 26,23 € at the single rate; 2.3 times that is 60,33 €, and 3.5 times is 91,80 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.