Opening a psychotherapy practice in Germany: Approbation, Kassensitz, private practice

Three routes to your own psychotherapy practice

In Germany, psychotherapy is Heilkunde (the practice of healing). With the Approbation you may treat patients, but how you bill depends on your further qualifications and on the planning area. This results in three routes:

Your professional title is protected (§ 1(1) PsychThG): under the new law “Psychotherapeutin” or “Psychotherapeut”, under the old law “Psychologische Psychotherapeut:in” or “Kinder- und Jugendlichenpsychotherapeut:in” (child and adolescent psychotherapist). Once you complete your further training, you add the title “Fachpsychotherapeut:in” for your field, for example for adults or for children and adolescents.

Approbation and further training after the reform

• New law since 1 September 2020: a bachelor’s and master’s degree with a focus on psychotherapy, the state psychotherapy examination, then the Approbation as a “Psychotherapeut:in”. With it, you may already treat patients privately.
• Further training: at least five years, of which at least two years in outpatient and two years in inpatient care, in one of the fields adults, children and adolescents or neuropsychological psychotherapy. It ends with recognition as a Fachpsychotherapeut:in by your state chamber.
• For a Kassensitz, you need an entry in the Arztregister: Approbation plus completed further training in a method recognised by the Gemeinsamer Bundesausschuss (G-BA, Federal Joint Committee) (§ 95c(1) SGB V).
• Old law: If you started the training or a suitable degree before 1 September 2020, you can complete the training as a Psychologische Psychotherapeut:in or Kinder- und Jugendlichenpsychotherapeut:in by 1 September 2032, in cases of hardship by 31 August 2035 (§ 27 PsychThG). For the Arztregister, the Fachkunde then counts (§ 95c(2) SGB V).

Chamber, professional code and Versorgungswerk

With the Approbation, you become a compulsory member of the Landespsychotherapeutenkammer of your federal state. Its professional code is binding; on most points it follows the model professional code of the Bundespsychotherapeutenkammer (BPtK, Federal Chamber of Psychotherapists), the MBO-PP. The most important duties for your practice:

• Professional liability insurance: With a Kassensitz, the law requires at least €3 million per insured event and €6 million per year, for practices with employees or Berufsausübungsgemeinschaften (joint practices) €5 million and €15 million (§ 95e SGB V).
• Versorgungswerk: In almost all federal states, chamber members are automatically also members of a psychotherapists’ Versorgungswerk. It replaces the statutory pension insurance; employees apply for an exemption for this (§ 6 SGB VI). Ask your chamber which Versorgungswerk is responsible.
• Taxes: Psychotherapy is a freier Beruf (liberal profession); you don’t need to register a trade. Medical treatment is exempt from VAT (§ 4 No. 14 UStG), supervision or coaching for companies usually is not. Register with the Finanzamt (tax office) using the Fragebogen zur steuerlichen Erfassung (tax registration questionnaire).

Kassensitz: needs-based planning, succession, partial licence

In needs-based planning, psychotherapists and doctors working psychotherapeutically form their own group (§ 101(4) SGB V). If a planning area is oversupplied, the Landesausschuss (state committee) closes it to new licences (§ 103(1) SGB V) – this affects many regions. There are still several routes:

• Vacant licences: If an area is fully or partially reopened, the Kassenärztliche Vereinigung advertises the licences. Get on the waiting list and follow the decisions of the Landesausschuss.
• Practice succession: If someone gives up their licence, they apply for the Nachbesetzungsverfahren (succession procedure). The KV advertises the licence, and the Zulassungsausschuss (licensing committee) chooses among the applicants, for example by suitability, time since Approbation and length of professional activity (§ 103(3a) and (4) SGB V). The purchase price only counts up to the market value of the practice.
• Half care mandate: Licences are often split. With a half licence, consultation hours and duties are halved (§ 19a(2) Ärzte-ZV) – a popular way in alongside employment.
• Job sharing: You work in an existing practice, as a partner or employee, with a cap on the combined volume of services (§ 101(1) sentence 1 Nos. 4 and 5 SGB V).
• Employment: with a contracted psychotherapist or in a Medizinisches Versorgungszentrum (MVZ, medical care centre) that takes over a licence (§ 103(4b) and (4c) SGB V).
• Special need: In exceptional cases, an additional licence if a local or specialist care need is proven (§ 101(1) sentence 1 No. 3 SGB V and the Bedarfsplanungs-Richtlinie, needs-based planning guideline).

With a full licence, you offer at least 25 hours per week of consultation hours for patients with statutory insurance (§ 19a(1) Ärzte-ZV). Under the G-BA’s Psychotherapie-Richtlinie (psychotherapy guideline), this usually includes 100 minutes of psychotherapeutic consultation and 200 minutes of telephone availability per week, free appointments for the Terminservicestelle (appointment service) and connection to the Telematikinfrastruktur (telematics infrastructure).

Private practice: PKV, Beihilfe, self-payers

• Fee schedule: Licensed psychotherapists bill under the Gebührenordnung für Psychotherapeuten (GOP, fee schedule for psychotherapists). It refers to the GOÄ (fee schedule for doctors), specifically to its sections B and G (§ 1 GOP). A new GOÄ is in the works but not yet in force (as of November 2026).
• Private health insurance (PKV): What is reimbursed depends on the plan – often with session quotas and an application before therapy starts.
• Beihilfe: Civil servants need recognition by the Beihilfe office before treatment, usually with an expert review procedure.
• Self-payers: If you know that an insurer will not pay, inform patients in text form about the expected costs in advance (§ 630c(3) BGB).

Cost reimbursement under § 13(3) SGB V: how it works in practice

If a health insurance fund cannot provide necessary treatment in time, it must reimburse the costs of a private practice. This is an exceptional route, not a business model – many funds initially refuse. The usual process:

1. The patient attends a psychotherapeutic consultation at a statutory health insurance practice and receives the “Individuelle Patienteninformation” (individual patient information, PTV 11) recommending treatment.
2. They look for a therapy place, note every enquiry with date and waiting time and contact the KV’s Terminservicestelle.
3. If no place is found within a reasonable time, they apply for cost reimbursement before treatment starts – with the search log, the PTV 11 and your confirmation that you can start soon.
4. The fund must usually decide within three weeks, or within five weeks if an expert opinion is obtained (§ 13(3a) SGB V). An appeal against a rejection is possible.
5. Only treatment by psychotherapists who meet the requirements for the Arztregister is reimbursed – that is, Approbation plus Fachkunde or further training (§ 13(3) in conjunction with § 95c SGB V). Agree the hourly rate and billing with the patient in advance.

Premises, confidentiality and data protection

The professional code requires premises that ensure confidential and undisturbed conversations and are separate from your private life. Breaching confidentiality is a criminal offence (§ 203 StGB), and health data is specially protected under Art. 9 GDPR. This means:

Online sessions: rules for video consultations

• Professional law: Psychotherapy by video is allowed if personal contact is not required, initial diagnostics and indication are not carried out exclusively by video, and the same psychotherapist who is also available in person provides the treatment (§ 5a MBO-PP). Outside the practice premises, video may not predominate (§ 20(3) MBO-PP).
• Statutory health insurance practice: You use a certified video service provider and notify your KV. Since 2025, consultations and probatory sessions are also possible by video; the first consultation and the first probatory session should take place in the practice where possible.
• Upper limit: Since 1 April 2025, at most 50% of a practice’s cases per quarter may be treated exclusively by video. Video groups have a maximum of eight participants.
• Private practice: Professional law applies here too. A tool with end-to-end encryption and servers in the EU is mandatory for every practice.

How patients find you

Statutory health insurance practices receive many enquiries via the Terminservicestelle (116117) and the KV’s doctor search. Private practices have to become visible on their own: through recommendations from GPs and psychiatrists, the chamber’s therapist search, directories and above all their own website. The professional code only allows directory entries if the directory is open to everyone with a free basic entry (§ 23(5) MBO-PP).

Which details belong in your legal notice (Impressum) is covered in the post on mandatory information for psychotherapy websites, which advertising is allowed in the post on advertising rules for psychotherapists. How to be found on Google is shown in the post on the Google Business Profile.

Checklist: your psychotherapy practice in seven steps

How to plan location, financing and the steps of starting a practice in general is described in the guide to opening a practice in Germany.