How Billing Works Under BEMA
Statutory insured patients are billed according to the Standard Assessment Scale for Dental Services (BEMA). BEMA defines which services are covered by statutory health insurers.
BEMA covers exclusively those services that statutory health insurers partially or fully reimburse. For dental practices, it forms the basis of insurance billing.
How BEMA is structured
BEMA is divided into several service categories. For orthodontists, Part 3 is particularly relevant:
- Part 1: Conservative and surgical services and X-ray services
- Part 2: Treatment of facial skeleton injuries
- Part 3: Orthodontic treatments
- Part 4: Systematic treatment of periodontopathies
- Part 5: Provision of dentures and dental crowns
Individual services and fee codes can be viewed online via the BEMA search tool.
Cost calculation under BEMA
Each BEMA service has its own fee number, service description, and point value.
Example: The "Comprehensive examination to identify dental, oral, and jaw diseases including consultation" in Part 1 of BEMA carries the number 01 and a point value of 18.
To calculate the fee, the point value is multiplied by the applicable point rate of the health insurer. Point rates vary by federal state and insurer. An exception is Part 5 for dentures and crowns, whose point rate is set nationally.
Example: With a point rate of 1.1479, the calculation for the comprehensive examination is as follows:18 × 1.1479 = €20.66
Private services and treatments for self-paying patients are billed under GOZ.
How Billing Works Under GOZ
Services for privately insured patients and self-payers are billed according to the Fee Schedule for Dentists (GOZ). It governs the remuneration of private dental and orthodontic services.
How GOZ is structured
GOZ is divided into 11 service categories:
- General dental services
- Prophylactic services
- Conservative services
- Surgical services
- Services for diseases of the oral mucosa and periodontium
- Prosthetic services
- Orthodontic services
- Fitting of occlusal splints and bite guards
- Functional analysis and functional therapy services
- Implantological services
- Surcharges for certain dental-surgical services
Important: For certain GOZ items, parts of the material and laboratory costs are already included in the fee. Additional costs can only be charged under specific conditions.
GOZ can be viewed online via the German Dental Association (Bundeszahnärztekammer).
Cost calculation under GOZ
Each service in GOZ also has its own fee number and point value. The point rate is uniform nationwide and amounts to €0.0562421.
Example: The "Comprehensive examination to identify dental, oral, and jaw diseases including recording of the periodontal findings" carries the number 0010 in GOZ and a point value of 100.
At the basic fee rate, the calculation is:100 × 0.0562421 = €5.62
Unlike BEMA, GOZ allows for an additional scaling factor to be applied. This affects the fee amount and is based on the effort and difficulty of the treatment.
The following scaling rates are possible:
The 2.3x rate is commonly used in practice as the standard scaling rate for average effort. Higher factors such as 3.5x must be substantiated with clear justification.
Example: If the comprehensive examination is billed at the 2.3x rate, the calculation is:100 × 0.0562421 × 2.3 = €12.94
The 1.0x and 2.3x rates generally require no additional justification. For factors above 2.3x, a comprehensible written justification is typically required.
Avoiding double billing under GOZ
Some GOZ services may not be combined with each other or billed twice. Which combinations are excluded follows from the respective fee items.
One example is the combined billing of items 0040 (preparation of a treatment and cost plan for orthodontics) and 0030 (preparation of a treatment and cost plan).
Due to the numerous special regulations, many practices face the question of whether GOZ billing should be managed in-house or outsourced.
Common Mistakes in GOZ and BEMA Billing
Errors in GOZ or BEMA billing can quickly lead to queries, fee reductions, or additional administrative effort. Problems most commonly arise from incorrect fee codes, incomplete documentation, or incorrectly applied scaling factors.
1. Incorrectly justified scaling factors
Errors involving the choice of scaling factor are particularly common in GOZ billing. Higher factors must be documented in a comprehensible manner. Missing or overly vague justifications can result in invoices being challenged.
2. Double billing and impermissible combinations
Certain GOZ items are mutually exclusive or can only be combined to a limited extent. If fee items are incorrectly combined or billed twice, this can lead to issues with payers or private insurers. Especially for more complex treatments, a careful review of permissible fee combinations is worthwhile.
3. Incomplete documentation of additional services
Additional services, material costs, or private agreements must be documented correctly. If written agreements or comprehensible treatment details are missing, reimbursement by insurers may be made more difficult.
4. Failing to distinguish between GOZ and BEMA
A common mistake is accidentally billing services under the wrong fee schedule. Particularly for self-pay services, additional services, or orthodontic treatments, it is important to verify whether billing should be done under GOZ or BEMA.
Special Considerations for Orthodontist Billing
Orthodontic treatments are subject to partially different billing rules than standard dental services. Particularly relevant are the differences between insurance-covered services, private additional services, and the correct documentation of treatment and cost plans.
Which orthodontic services do health insurers cover?
Statutory health insurers generally cover orthodontic treatments only when medically necessary. The basis for this is the so-called orthodontic indication groups (KIG). Depending on the severity of the misalignment, certain services are covered fully or partially.
When orthodontic services are billed privately
Many modern or aesthetic orthodontic services are considered additional services and must be billed privately under GOZ. These include, for example, invisible aligners, certain retainers, or special materials and treatment methods that go beyond standard care.
Correctly documenting treatment and cost plans
A treatment and cost plan is required for many orthodontic treatments. All planned services as well as potential additional costs should be documented completely and comprehensibly. Errors or incomplete information can complicate subsequent billing or lead to queries from insurers.
Your Options: In-House or Outsourced GOZ Billing
Billing private and orthodontic services creates a high administrative burden in many practices. This is why many dentists and orthodontists face the question of whether GOZ billing should be managed in-house or outsourced to external service providers.
Outsourced GOZ billing through service providers
Many practices outsource their GOZ billing partially or fully to external billing service providers. Depending on the provider, these services may include invoicing, dunning, or factoring.
Some providers also take on the risk of payment defaults ("true factoring"), while others only handle the organizational processing.
Before selecting a provider, practices should carefully compare services, costs, and contract terms.
In-house GOZ billing in the practice
GOZ billing can also be fully managed in-house by the practice team. However, this requires sufficient time, clear processes, and up-to-date billing knowledge.
Digital solutions like Nelly help automate administrative workflows and significantly reduce the workload for the practice. This leaves more time for patients and day-to-day operations.
Digitizing GOZ Billing with Nelly
With Nelly, GOZ, self-pay, and orthodontic billing can be managed far more efficiently. Practices can process payment workflows digitally, reduce administrative overhead, and automate recurring manual tasks.
Patients select their preferred payment method digitally, while invoicing and payment processing run automatically in the background. This saves the practice team time and reduces the effort involved in billing and dunning.
An additional advantage: using Nelly requires no extensive training or additional billing software. The solution can be integrated into existing practice workflows with ease.
We are happy to advise you without obligation on how to digitize your GOZ and orthodontic billing.
Frequently Asked Questions
What is the difference between GOZ and BEMA?
GOZ (Fee Schedule for Dentists) applies to private services and self-pay services. BEMA (Standard Assessment Scale for Dental Services), on the other hand, governs the billing of statutory insurance services with health insurers. While GOZ allows flexible scaling factors, the remuneration rates in BEMA are fixed.
Which services may dentists bill privately?
Dentists may bill privately for services that are not or only partially covered by statutory health insurers. These include, for example, aesthetic treatments, certain materials, additional services for dentures, or modern orthodontic procedures such as aligners.
When may the 3.5x GOZ rate be used?
The 3.5x GOZ rate may be used when a treatment is particularly complex, difficult, or time-intensive. The higher billing must be justified in a comprehensible manner and documented in writing. This may be the case, for example, with complex surgical procedures, significant anatomical anomalies, or an exceptionally high treatment workload.
What is true factoring in dental billing?
With true factoring, an external service provider takes on not only the invoicing process but also the risk of potential payment defaults. The practice typically receives its fee directly and thereby improves its liquidity.
Which services may not be billed twice?
Certain GOZ items are mutually exclusive and may therefore not be billed together. Which combinations are impermissible follows from the respective fee schedules and service descriptions. One example is the combination of GOZ items 0040 and 0030 for treatment and cost plans, which may not be billed together.
Can orthodontic services be billed privately?
Yes, many orthodontic services can be billed privately under GOZ. This applies in particular to additional services or treatments that go beyond the medically necessary standard care. These include, for example, invisible aligners, special retainers, or aesthetic add-on services that are not fully covered by statutory health insurers.
How does billing work for self-paying patients?
For self-paying patients, the practice issues a private invoice based on GOZ. Before treatment begins, patients should be transparently informed about the expected costs. Additional services or material costs often need to be agreed upon separately.
Is outsourced GOZ billing worthwhile for small practices?
This depends on the administrative workload and the internal resources of the practice. External billing service providers can save time and relieve the practice team. At the same time, additional costs are incurred, which is why comparing different providers is advisable.
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