Self-employed physiotherapist in Germany: approval, practice and first patients

Professional licence and legal form

Anyone who calls themselves “Physiotherapeutin” or “Physiotherapeut” needs the licence under § 1 MPhG. You receive it from the competent state authority after passing the state examination. The certificate is the most important document for your start-up: without it, no statutory insurance approval.

• Liberal profession: Physiotherapy (still called “Krankengymnasten” in the statute) counts as a liberal profession under § 18(1) No. 1 EStG (Income Tax Act). You pay no trade tax and need no trade registration.
• Solo or shared practice: Most start on their own. A partnership with colleagues is possible; every practice needs a professional lead who is registered with the ARGE.
• Law under reform: On 26 October 2026, the Federal Ministry of Health presented the draft bill for a Physiotherapy Professions Reform Act (PhyThBRefG). It mainly concerns training and does not provide for direct access for now. For your start-up, the MPhG still applies.

Statutory insurance approval under § 124 SGB V

Around nine in ten people in Germany have statutory health insurance. To treat them at the expense of their insurance fund, you need approval under § 124 SGB V (Fifth Book of the Social Code). In every federal state, an Arbeitsgemeinschaft (ARGE) – a joint body of the state associations of the health insurance funds and the substitute funds – decides on approval for all funds. You will find the approval offices at zulassung-heilmittel.de. The law sets three requirements:

1. the training and licence to use the professional title,
2. practice equipment that ensures appropriate and economical care,
3. acceptance of the contracts under § 125 SGB V.

What “practice equipment” means in detail is set out in Annex 5 (approval requirements) to the contract under § 125 SGB V. Since August 2021, the requirements are found there and no longer in the former approval recommendations.

Mandatory equipment includes two height-adjustable treatment tables with positioning aids, equipment for exercise therapy, timers, an emergency call system, and options for cold and heat therapy (at least one radiant heat device, such as infrared). Services such as KGG, electrotherapy or baths require additional equipment. Check the floor plan against Annex 5 before you sign the lease.

IK number and liability insurance

For billing you need an Institutionskennzeichen (IK) – an institution code under § 293 SGB V – for each location and therapy area. You apply for it free of charge at the SVI, the collection and distribution office of the Arbeitsgemeinschaft Institutionskennzeichen. The ARGE asks for the IK during the approval procedure, so apply early.

Neither the MPhG nor the framework contract prescribes professional liability insurance with a fixed sum insured. Still, don’t carry out a single treatment without it: a treatment error could otherwise ruin you personally. Ask your ARGE which proof it wants to see in the application.

Contract under § 125 SGB V: prices and duties

With your approval, you accept the nationwide contract under § 125(1) SGB V, concluded by the GKV-Spitzenverband (National Association of Statutory Health Insurance Funds) and the physiotherapy associations. It governs services, billing, continuing education and prices. There is nothing to negotiate: every practice receives the same rates.

• Co-payment: Adult patients pay 10% of the costs plus €10 per prescription. You collect this amount and it is offset against your claim to the insurance fund.
• Continuing education: 60 points in four years, ideally 15 per year (Annex 4). One point equals 45 minutes. Courses on marketing, billing or wellness don’t count.
• Certificate services: For MT, KG-ZNS, lymphatic drainage or KGG you need the corresponding further training and must report it to the ARGE before billing.

Prescription, Blankoverordnung and direct access

You provide insured services on a doctor’s prescription under the Heilmittel-Richtlinie (therapeutic products directive) of the G-BA (Federal Joint Committee). Treatment must begin within 28 calendar days of issue, or within 14 days if treatment is urgent (§ 15 HeilM-RL). Check every prescription before the first session – formal errors are otherwise at your expense.

• Blankoverordnung (§ 125a SGB V): Since 1 November 2024, doctors can issue an open prescription for certain shoulder diagnoses in diagnosis group EX. You then decide on the therapy, amount and frequency yourself – and bear responsibility for cost-effectiveness. Whether further indications will be added is still open in November 2026.
• No direct access: Without a prescription the insurance fund doesn’t pay. The 2026 reform draft does not provide for direct access for now either.
• Sektoraler Heilpraktiker Physiotherapie: With this licence under the Heilpraktikergesetz (Alternative Practitioners Act), limited to physiotherapy, you may treat self-paying patients without a prescription. You apply at the public health office; the procedure (assessment based on records or an oral exam) varies by federal state.

Private patients and self-payers

Privately insured patients, people entitled to Beihilfe (state allowance for civil servants) and self-payers receive an invoice from you. There is no official fee schedule for physiotherapy; you set your prices yourself. But point out that insurers and Beihilfe only reimburse up to their maximum amounts – federal Beihilfe, for example, under Annex 9 of the Bundesbeihilfeverordnung. Transparent prices on your website save you many questions.

Registrations: tax office, public health office, BGW, pension

Premises, home visits and working models

Annex 5 describes approval for a practice with minimum floor space; for home visits you take the necessary equipment with you. The contract does not provide for a pure home-visit practice without premises – clarify special cases with your ARGE in advance. How to find and finance premises is shown in the guide to opening a practice in Germany.

How patients find you

Prescription in hand, many patients search on their phone for “physiotherapy near me” – and choose the practice with the earliest free appointment. Add to that recommendations from orthopaedists, GPs and surgeons.

• Website with areas of focus: one page per service, such as “manual therapy”, “lymphatic drainage” or “physiotherapy after knee surgery”. What is allowed is covered in our post on advertising physiotherapy in Germany.
• Mandatory information: a legal notice (Impressum) with your statutory professional title, the country where it was awarded and the professional regulations – see mandatory information for physiotherapy websites and the imprint generator.
• Google profile: opening hours, photos, home-visit area and genuine reviews – more in our posts on the Google Business Profile and local SEO.
• Inform doctors: A short visit with a flyer and your free capacity often works better than advertising. Money or benefits for referrals are off limits.

Roadmap: eight steps to your own practice