Advertising for physiotherapists in Germany: HWG, UWG and insurance rules

Which rules apply: HWG, UWG and the insurer contract

Doctors have the professional code of their state medical chamber; physiotherapists do not. There is neither a chamber nor a professional code with an advertising clause. Instead, general laws apply – and they are stricter than many think. The HWG (Heilmittelwerbegesetz, the act on advertising for medicines and treatments) does not only cover medicines: under § 1 para. 1 no. 2 HWG it also covers “procedures, treatments” where the advertising refers to detecting, curing or relieving illnesses and complaints. That is exactly what physiotherapy does.

In practice, breaches of the HWG and UWG are usually challenged by competitors or competition associations with a cease-and-desist letter (Abmahnung). Breaches of the insurer contract are sanctioned by the health insurers themselves – from a warning to a contractual penalty (§ 20 of the contract).

Professional title, practice name and Heilpraktiker licence

Only those with a licence under § 1 of the Masseur- und Physiotherapeutengesetz (MPhG, Masseurs and Physiotherapists Act) may call themselves “Physiotherapeutin” or “Physiotherapeut”. The practice name “Praxis für Physiotherapie” is therefore unproblematic as long as physiotherapists work there. The professional licence does not, however, entitle you to treat without a medical prescription – the Federal Administrative Court made this clear in 2009 (BVerwG 3 C 19.08).

• Without a Heilpraktiker licence: only advertise medical treatment with a prescription. For self-paying patients without a prescription, you are left with prevention, training and wellness – without reference to illnesses.
• With a sectoral Heilpraktiker licence (a licence to practise as a non-medical practitioner limited to physiotherapy): you may treat without a prescription and say so. State the licence exactly as granted, e.g. “Heilpraktikerin, beschränkt auf das Gebiet der Physiotherapie” – a plain “Heilpraktikerin” would suggest an unrestricted licence.
• Osteopathy and other methods: according to case law, offering osteopathy requires a Heilpraktiker licence; the Higher Regional Court of Düsseldorf prohibited advertising it without a licence as anti-competitive (I-20 U 236/13).
• Further training: certificates such as manual therapy, manual lymphatic drainage or KG-ZNS (neurological physiotherapy) are factual information. Self-invented titles like “back specialist” are risky because they suggest a special qualification nobody has checked (misleading under § 5 UWG).

Patients with statutory insurance: co-payment, insurer benefits, referrals

For therapeutic services (Heilmittel), insured persons aged 18 and over pay 10% of the costs plus €10 per prescription (§ 32 para. 2 in conjunction with § 61 SGB V). As an approved practice you must collect this co-payment (§ 43c SGB V). The nationwide contract under § 125 SGB V sets out the details in § 8: due on the first day of treatment, receipt, written reminder with a 14-day deadline; only then does the insurer collect it.

• Do not advertise with insurer benefits: § 9 para. 3 of the contract expressly prohibits this. “Approved for all statutory insurers” is information; “Massage at your health insurer’s expense!” is advertising with the obligation to pay.
• Private additional services only by written agreement and never as a condition for treatment covered by the insurer (§ 8 para. 6).
• No benefits for referrals: cooperation with doctors that influences patients’ free choice is not allowed (§ 9 para. 4, § 128 para. 5b SGB V). Offering doctors benefits for referrals can be a criminal offence under § 299b StGB. The doctors’ side is covered in the article on advertising for doctors in Germany.

Self-paying patients: prices, discounts and vouchers

For private patients and self-payers you set your prices yourself. State them as final prices – the Price Indication Ordinance (Preisangabenverordnung) requires this towards consumers anyway. For discounts and vouchers, § 7 HWG decides as soon as the advertising relates to treatments:

“Free” may only describe what really costs nothing – otherwise it is always unfair under no. 20 of the UWG annex. And a discount for statutory patients on insurer-covered treatment is ruled out: apart from the co-payment there is no price you could reduce.

Reviews, testimonials and social media

The HWG is more liberal about patient voices than often assumed. Under § 11 para. 1 no. 11 HWG, third-party statements such as thank-you letters or reviews are only prohibited if they are abusive, repulsive or misleading. The same limit applies to case histories (no. 3) and images of physical changes (no. 5). The UWG adds: fake or bought reviews are always unfair (Annex no. 23c), and anyone showing reviews must say whether and how they check they are genuine (§ 5b para. 3 UWG).

• Collect reviews fairly: ask satisfied patients directly, for example with a QR code for Google reviews. No discounts for stars.
• Answer criticism, keep confidentiality: as a physiotherapist you are bound by § 203 StGB (professional secrecy). Do not confirm in replies that someone was a patient.
• Photos and videos: recognisable patients only with explicit written consent (Art. 9 GDPR, § 22 Kunsturhebergesetz on the right to one’s own image) – with a note on the right to withdraw.
• Label collaborations: paid posts with brands or influencers must be recognisable as advertising (Annex no. 11 UWG).

Google Ads and service pages

The same laws apply to ads. Good ads name the service, location and practice: “Physiotherapy in Leipzig-Plagwitz – evening appointments too”. Be careful with diseases listed in the annex to § 12 HWG: “Physiotherapy for cancer” as an ad is not allowed. Describe lymphatic drainage or oncology experience on your website factually, without advertising relief of the cancer itself. You can check page titles and descriptions with the Google preview.

Advertising prevention courses under § 20 SGB V

Back courses, Pilates or fall prevention are a second pillar for many practices. For statutory insurers to subsidise a course under § 20 SGB V, it must be certified by the Zentrale Prüfstelle Prävention (ZPP, central testing body for prevention) according to the GKV-Spitzenverband’s prevention guideline (Leitfaden Prävention). Certification is usually valid for three years. The guideline brings its own rules for advertising:

• Same fee for everyone: the participation fee stated during certification applies to all participants. Individual discounts on certified courses do not fit with this.
• No tie-in to memberships and no sale of accompanying products such as supplements or sports equipment.
• Describe the subsidy honestly: each insurer decides the amount and frequency itself. Write “your health insurer may reimburse part of the course fee”, not “free with your insurer”.
• No misleading promotion: the guideline lists misleading advertising of the service as a serious breach that can lead to exclusion from the certification process.

Quick check: do’s and don’ts

If you are just setting up your practice, also read the guide to opening a physiotherapy practice in Germany.