GOÄ 651F — Innere Medizin, Kinderheilkunde, Dermatologie253 points

GOÄ Number 651: the resting ECG and its fee frame

Fee

26,54 €253 points × 5,82873 Cent × 1,8

The point count stands as written in the Gebührenverzeichnis; the point value stands in § 5 Abs. 1 Satz 3 GOÄ. Because Number 651 is one of the services named in Abschnitt A, § 5 Abs. 3 GOÄ replaces the ordinary 1.0-to-3.5-fold frame with a 1.0-to-2.5-fold frame and the 1.8-fold rate as the usual maximum; the difficulty of the case itself is not a criterion here, § 5 Abs. 2 Satz 2 GOÄ. Which multiplier is appropriate in an individual case is otherwise set by § 5 Abs. 2 according to difficulty, time taken and the circumstances of performance — the practice decides that, not this table.

Service text

„Elektrokardiographische Untersuchung in Ruhe - auch gegebenenfalls nach Belastung - mit Extremitäten- und Brustwandableitungen (mindestens neun Ableitungen)“

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 651 is the electrocardiographic examination at rest, valued at 253 points. That gives 14,75 € at the single rate and 26,54 € at the 1.8-fold rate. Number 651 stands in Abschnitt F, but it is one of the services listed separately in Abschnitt A of the Gebührenverzeichnis: there, the frame reaches only to the 2.5-fold rate, with the 1.8-fold rate as the usual maximum in place of the ordinary 2.3-fold rate.

The service text of Number 651

The examination covers the resting state and, where indicated, the state after exertion, in each case using leads on the limbs and on the chest wall. How many leads have to be present at a minimum is fixed by the service text itself; the provisions are not concerned with that count but with the relationship to neighbouring numbers.

That relationship is regulated extensively: Number 651 appears in its own exclusion sentences alongside no fewer than six other numbers — the cardiac catheterisation services of Numbers 626 to 632, whose service text already includes continuous ECG monitoring. Billing Number 651 means knowing these boundaries, not only the service text itself.

The narrower family of ECG numbers applies as well: Numbers 650 to 653 do not stand alongside each other. Which of these numbers applies in a given case depends on what was actually recorded and evaluated, not on whichever label seems the most obvious first.

The sentences below stand exactly like this in the Gebührenverzeichnis, as provisions to Abschnitt F and to § 5 GOÄ. They are quoted here in German, word for word rather than summarized, because the German wording is what is legally binding — a paraphrase of the sentence that sets the 2.5-fold ceiling, or of the sentences that exclude Number 651 from each neighbouring number, would be a claim of its own. 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 listed below, fees under § 5 may be assessed only up to the two-and-a-half-fold 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.
„Die Leistungen nach den Nummern 650 bis 653 sind nicht nebeneinander berechnungsfähig.“ — Services under Numbers 650 to 653 may not be billed alongside each other.
„Neben der Leistung nach Nummer 626 sind die Leistungen nach den Nummern 355, 356, 360, 361, 602, 648, 650, 651, 3710 und 5295 nicht berechnungsfähig.“ — Alongside the service under Number 626, services under Numbers 355, 356, 360, 361, 602, 648, 650, 651, 3710 and 5295 are not billable.
„Neben der Leistung nach Nummer 627 sind die Leistungen nach den Nummern 355, 356, 360, 361, 602, 648, 650, 651, 3710 und 5295 nicht berechnungsfähig.“ — Alongside the service under Number 627, services under Numbers 355, 356, 360, 361, 602, 648, 650, 651, 3710 and 5295 are not billable.
„Neben der Leistung nach Nummer 628 sind die Leistungen nach den Nummern 602, 648, 650, 651, 3710 und 5295 nicht berechnungsfähig.“ — Alongside the service under Number 628, services under Numbers 602, 648, 650, 651, 3710 and 5295 are not billable.
„Neben der Leistung nach Nummer 629 sind die Leistungen nach den Nummern 355, 356, 602, 648, 650, 651, 3710 und 5295 nicht berechnungsfähig.“ — Alongside the service under Number 629, services under Numbers 355, 356, 602, 648, 650, 651, 3710 and 5295 are not billable.
„Neben der Leistung nach Nummer 630 sind die Leistungen nach den Nummern 355, 356, 360, 361, 602, 648, 650, 651, 3710 und 5295 nicht berechnungsfähig.“ — Alongside the service under Number 630, services under Numbers 355, 356, 360, 361, 602, 648, 650, 651, 3710 and 5295 are not billable.
„Neben der Leistung nach Nummer 632 sind die Leistungen nach den Nummern 355, 356, 360, 361, 602, 648, 650, 651, 3710 und 5295 nicht berechnungsfähig.“ — Alongside the service under Number 632, services under Numbers 355, 356, 360, 361, 602, 648, 650, 651, 3710 and 5295 are 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, services under Sections 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 for the duration of inpatient intensive-care monitoring and treatment. These services may also not be billed in place of the service under Number 435.

The multiplier for Number 651

Number 651 is one of the services listed separately in Abschnitt A of the Gebührenverzeichnis. Under § 5 Abs. 3 GOÄ, a narrow frame applies to them: fees may be assessed only up to the 2.5-fold rate, and the 1.8-fold rate takes the place of the otherwise usual 2.3-fold rate as the usual maximum.

Within this frame, § 5 Abs. 2 applies only in part: under § 5 Abs. 2 Satz 2 GOÄ, the difficulty of the case itself is expressly not a criterion for Abschnitt A services. What remains decisive 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 Number 651, that justification can only draw on what was actually present in the specific tracing and its evaluation.

What the record has to carry for Number 651

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 651, this concerns a service that has to be clearly distinguishable from several neighbouring numbers.

The provisions exclude Number 651 alongside several other numbers and do not allow Numbers 650 to 653 alongside each other. Whether a resting ECG under Number 651 was actually performed in a given case, rather than one of the excluded services, can only be answered afterwards from the record, not from memory.

The same applies to a justification above the usual rate: its content can only come from the record of the examination itself. A record created while the appointment is happening is exactly the basis from which such a justification can be traced.

Frequently asked questions

Why does Number 651 have a frame only up to the 2.5-fold rate?

Number 651 is one of the services listed separately in Abschnitt A of the Gebührenverzeichnis. For these, § 5 Abs. 3 GOÄ assesses the fee only up to the two-and-a-half-fold rate, with the 1.8-fold rate as the usual maximum instead of the otherwise usual 2.3-fold rate.

May Numbers 650 to 653 be billed alongside each other?

No. The provisions state expressly that services under Numbers 650 to 653 may not be billed alongside each other.

What does Number 651 cost at the 1.8-fold rate?

253 points times the point value of 5,82873 Cent give 14,75 € at the single rate; 1.8 times that is 26,54 €, and 2.5 times is 36,87 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.