GOÄ 27B III — Spezielle Beratungen und Untersuchungen320 points

GOÄ Number 27: the cancer-screening examination of a woman, its points and its fee

Fee

42,90 €320 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 einer Frau zur Früherkennung von Krebserkrankungen der Brust, des Genitales, des Rektums und der Haut - einschließlich Erhebung der Anamnese, Abstrichentnahme zur zytologischen Untersuchung, Untersuchung auf Blut im Stuhl und Urinuntersuchung auf Eiweiß, Zucker und Erythrozyten, einschließlich Beratung -“

Not alongside — per the Gebührenverzeichnis (7)

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 27 is the examination of a woman for the early detection of cancer of the breast, the genitals, the rectum and the skin, valued at 320 points. That gives 18,65 € at the single rate and 42,90 € at the 2.3-fold rate, the usual span for this number. Part of that is that the smear collection for cytological examination (Number 297) and the tests for blood in the stool and in the urine (Numbers 3500, 3511, 3650, 3652) may not be billed separately alongside it, because they are already part of the service under Number 27.

The service text of Number 27

Four areas stand side by side: the breast, the genitals, the rectum and the skin. What the number covers is a woman's cancer-screening examination in these four areas — not a general physical examination, and not the screening examination of a child or of an adult regardless of sex.

The service text lists the individual components: taking the history, collecting a smear for cytological examination, testing for blood in the stool, testing the urine for protein, sugar and erythrocytes, and counselling. All five are settled with the 320 points of Number 27.

Not named is a man's examination — that is Number 28, at 280 points, covering the rectum, the prostate, the external genitals and the skin, but without a smear collection. Nor is this the general health check-up for an adult under Number 29, which takes a complete whole-body status regardless of sex and without the smear collection typical of Number 27.

The sentences below stand exactly like this in the Gebührenverzeichnis — as Allgemeine Bestimmungen and directly under Number 27. 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.

„Mit der Gebühr sind die Kosten für Untersuchungsmaterialien abgegolten.“ — The fee settles the costs of examination materials.
„Neben der Leistung nach Nummer 27 sind die Leistungen nach den Nummern 1, 3, 5, 6, 7, 8 297, 3500, 3511, 3650 und/oder 3652 nicht berechnungsfähig.“ — Alongside the service under Number 27, the services under Numbers 1, 3, 5, 6, 7, 8, 297, 3500, 3511, 3650 and/or 3652 are not billable.
„Als Behandlungsfall gilt für die Behandlung derselben Erkrankung der Zeitraum eines Monats nach der jeweils ersten Inanspruchnahme des Arztes.“ — A treatment case, for the treatment of the same illness, is the period of one month following the first time the doctor is consulted.
„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 27

Number 27 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. What the service text of Number 27 already names itself — taking the history, the smear collection, the stool and urine tests, counselling — is 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.

What the record has to carry for Number 27

The treatment record is independent of the fee schedule — § 630f BGB requires it in immediate temporal connection with the treatment. For Number 27, that includes which of the four named areas were examined and which of the included components were actually carried out.

Because the smear collection under Number 297 and the stool and urine tests under Numbers 3500, 3511, 3650 and 3652 are settled with the fee under Number 27, which of these components actually took place in a given case can only be clarified from the record if disputed, not from memory.

Above the 2.3-fold rate, the justification under § 12 Abs. 3 GOÄ relates to the particular service; for a service description this comprehensive, it only holds up if the special circumstances of performance were already recorded elsewhere.

Frequently asked questions

Is the smear collection for cytological examination billable separately alongside Number 27?

No. Number 297 (collection and preparation of smear material for cytological examination) is expressly excluded alongside Number 27, because the smear collection is already part of the service text of Number 27.

What does Number 27 cost at the 2.3-fold rate?

320 points times the point value of 5,82873 Cent give 18,65 € at the single rate; 2.3 times that is 42,90 €, and 3.5 times is 65,28 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.

How does Number 27 differ from Number 28?

Number 27 is a woman's examination — the breast, the genitals, the rectum and the skin, with a smear collection. Number 28 is a man's examination — the rectum, the prostate, the external genitals and the skin, without a smear collection; alongside it, Number 11, the digital examination of the rectum and/or the prostate, is additionally excluded.