Service text
„Gesundheitsuntersuchung zur Früherkennung von Krankheiten bei einem Erwachsenen - einschließlich Untersuchung zur Erhebung des vollständigen Status (Ganzkörperstatus), Erörterung des individuellen Risikoprofils und verhaltensmedizinischer orientierter 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 29 is the health examination for the early detection of illness in an adult, valued at 440 points. That gives 25,65 € at the single rate and 58,99 € at the 2.3-fold rate, the usual span for this number. The service text covers the complete status (whole-body status), the discussion of the individual risk profile and behavioural-medicine oriented counselling — which is why Number 8 may not be billed separately alongside it.
The service text of Number 29
The three elements belong together to Number 29, not to separately billable individual steps.
Because the whole-body status is already part of Number 29, the provision excludes Number 8 (examination to establish the whole-body status, where applicable including documentation) alongside Number 29 — otherwise the same examination would be paid for twice.
Number 29 differs from Number 26 by its target group: Number 26 applies to children up to the completed 14th year of life with child-specific examination steps, Number 29 to adults with whole-body status, risk profile and behavioural-medicine oriented counselling. Unlike Number 26, the provision for Number 29 states no age limit and no restriction to once per calendar year.
The sentences below stand exactly like this in the Gebührenverzeichnis — as Allgemeine Bestimmungen and directly under Number 29. 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.
- „Neben der Leistung nach Nummer 29 sind die Leistungen nach den Nummern 1, 3, 5, 6, 7 und/oder 8 nicht berechnungsfähig.“ — Alongside the service under Number 29, the services under Numbers 1, 3, 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 29
Number 29 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 a service that bundles three named elements into one examination, such a justification can only come from the particular circumstances of performance in the individual case.
What the record has to carry for Number 29
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 29, that includes that the whole-body status was established, the individual risk profile discussed, and the behavioural-medicine oriented counselling carried out.
Because Number 8 is not billable alongside Number 29, the record has to show that the whole-body status was established as part of Number 29 and not as a separate service under Number 8.
Above the 2.3-fold rate, the justification under § 12 Abs. 3 relates to the particular service; for an examination composed of three elements, it only holds up if the special circumstances of performance were already recorded elsewhere.
Frequently asked questions
What does Number 29 cover?
The examination to establish the complete status (whole-body status), the discussion of the individual risk profile, and behavioural-medicine oriented counselling — as one service, not as separately billable individual steps.
Is Number 8 billable alongside Number 29?
No. The whole-body status under Number 8 is already part of Number 29; the provision expressly excludes Number 8 alongside Number 29.
What does Number 29 cost at the 2.3-fold rate?
440 points times the point value of 5,82873 Cent give 25,65 € at the single rate; 2.3 times that is 58,99 €, and 3.5 times is 89,76 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.