Opening a private practice in Germany: how to become a private doctor (Privatarzt)

Private practice or statutory health insurance practice?

Around nine in ten people in Germany have statutory health insurance (GKV). To treat them at the expense of their Krankenkasse, you need a Zulassung (approval) as a Vertragsärzt:in (contract doctor). It is granted by the Zulassungsausschuss (admissions committee) – and in many regions the planning areas are closed. A Privatpraxis, on the other hand, can be opened anywhere: there are no admission restrictions for private practice. The general steps of setting up – premises, financing, tax – are covered in our guide to opening a practice in Germany.

Formally, the Approbation is enough – but in case of doubt, you owe care at specialist standard (§ 630a (2) BGB). If you use a specialist title, the state laws on the healing professions generally restrict your work to that specialty. Many therefore only start after their specialist recognition, often alongside a hospital job.

Requirements and registration

Billing according to the GOÄ

Freely set fees do not exist in a private practice either. All medical services are billed according to the Gebührenordnung für Ärzte (GOÄ), Germany’s official fee schedule for doctors – self-payers included. Each service has a number of points, and the point value is 5.82873 cents. You multiply the single rate by a multiplier (Steigerungsfaktor) that depends on difficulty, time required and circumstances (§ 5 GOÄ). You may not undercut the GOÄ rates in an unfair way (§ 12 (1) MBO-Ä).

An example: the detailed consultation under no. 3 GOÄ has 150 points – that is €8.74 at the single rate, €20.11 at 2.3 times and €30.60 at 3.5 times. Above the threshold, you must justify the increase on the invoice in an understandable and comprehensible way (§ 12 (3) GOÄ).

Fee agreements: what is allowed

• You can agree a higher multiplier with patients – but not a different number of points or a different point value (§ 2 (1) GOÄ).
• The agreement is made before treatment, personally and in writing. It states the number and name of the service, the multiplier and the amount, plus a note that reimbursement may not be guaranteed in full. It may contain no other statements; the patient receives a copy (§ 2 (2) GOÄ).
• For services in sections A, E, M and O, an agreement is not permitted (§ 2 (3) GOÄ). You may not make emergency or acute pain treatment conditional on an agreement.

Who are your patients?

• Privately insured (PKV): They receive the invoice and submit it to their insurer. What is reimbursed depends on the plan – some plans only reimburse up to the threshold.
• Beihilfe recipients: Civil servants get part of their costs from the Beihilfe (state healthcare allowance) and the rest from their PKV. At federal level, amounts from a fee agreement that exceed the GOÄ fees are not eligible for Beihilfe (§ 6 (5) BBhV); the states have their own, mostly similar rules.
• Self-payers: for example for second opinions, check-ups or services no insurer covers. If you know that nobody will cover the costs in full, inform patients in text form about the expected costs beforehand (§ 630c (3) BGB) – in writing, according to the professional code (§ 12 (5) MBO-Ä).
• Statutorily insured patients with reimbursement (§ 13 (2) SGB V): Insured people can opt for Kostenerstattung (reimbursement) and are bound by it for at least one calendar quarter. For doctors without a Zulassung, this only applies with the prior consent of the Krankenkasse, which requires medical or social reasons and equivalent care. The fund reimburses at most what it would have paid as a benefit in kind, minus up to 5 % administrative costs – usually only a fraction of the GOÄ invoice.
• Statutorily insured patients under § 13 (3) SGB V: If the fund could not provide an urgent service in time or wrongly refused a service, it reimburses the necessary costs. This is an exception, not a business model.

A statutory approval later on?

Many private practices are an intermediate step. You apply for the Zulassung to the Zulassungsausschuss in your region, made up of the Kassenärztliche Vereinigung (Association of Statutory Health Insurance Physicians) and the health insurance funds. The prerequisite is entry in the Arztregister (doctors’ register), which usually requires completed specialist training. Whether a seat is free is decided by needs-based planning (Bedarfsplanung): if the supply level in a planning area is 110 % or more, the state committee closes it to new approvals.

In closed areas, the route is usually a practice succession: when a contract doctor gives up their seat, the Kassenärztliche Vereinigung advertises it and the Zulassungsausschuss selects from the applicants (§ 103 (3a) and (4) SGB V). Half seats are also possible – a way to expand an existing private practice step by step. Register your interest early with the Kassenärztliche Vereinigung; many keep waiting lists and practice exchanges.

Out-of-hours duty, TI and ePA: what applies to private practices

• Out-of-hours duty: Doctors must take part in the emergency or on-call service as provided for by the states’ chamber and healing professions laws (§ 26 MBO-Ä). In many states this explicitly includes private doctors in their own practice: in Westphalia-Lippe, for example, they are scheduled like everyone else; in Hesse, they also contribute to the costs of the on-call service. How you are scheduled and whether an exemption is possible is set out in the out-of-hours rules of your chamber or Kassenärztliche Vereinigung – ask them.
• Telematics infrastructure (TI) and ePA: The duties to prove a TI connection and to fill the electronic patient record (ePA) apply to providers taking part in statutory outpatient care (§§ 341 (6), 347 SGB V). Without a Zulassung, connecting your private practice is voluntary. Some private health insurers now also offer their policyholders an ePA.
• Professional law applies in full: confidentiality, documentation, continuing education and advertising rules apply to private doctors just as they do to contract doctors.

How patients find your private practice

Private patients and self-payers search in a targeted way – by specialty, location, appointment availability and reviews. Without referrals from the statutory system, your online presence is your most important channel:

• A website that answers questions: services, areas of focus, costs, billing under the GOÄ, directions, step-free access and online booking. What it should include is in 12 things patients look for on your website; the mandatory information is in the guide to legal notice and privacy in Germany.
• A well-maintained Google Business Profile: with opening hours, photos and reviews. How to do it is shown in the post on the Google profile for practices; for searches like “private cardiology practice Munich”, local SEO helps.
• Doctor portals such as Jameda or Doctolib: a complete profile with online booking brings visibility, especially at the start. Make sure your details are consistent everywhere.

What advertising doctors are allowed in Germany is covered in detail in the post on advertising rules for doctors in Germany.

Checklist: before your first appointment