Therapeutic services

Therapeutic services are non-medication-based treatments that are applied externally. In the German healthcare system, the term “therapeutic services” indicates certain treatments to which people with statutory health insurance are entitled: physiotherapy, occupational therapy, voice, speech, language and swallowing therapy (logopedics), podology (medical foot care and treatment) and nutritional therapy. They are provided by specially trained therapists.

Therapeutic services have the following objectives:

• To restore physical functions that have been impaired by an illness
• To recover lost abilities
• To develop suitable support options

What do the various therapeutic services involve? 

• Physiotherapy: this involves various methods of movement therapy. Where necessary, these can be complemented by physical procedures such as heat or electrotherapy.
• Occupational therapy: this aims to help people with health impairments to live more independently. As such, it often relates to everyday activities such as getting dressed, eating or writing. Occupational therapists use various exercises to this end. These train aspects such as fine motor skills, balance, concentration, coordination, strength or endurance.
• Voice, speech, language and swallowing therapy is used to treat language, speech, voice and swallowing disorders. The therapies are provided by speech therapists among other professionals. They are used, for example, to treat children with pronunciation problems or problems learning to speak, people who stutter or people who need to learn to speak again as a result of illness.
• Podology: podologists treat pathological changes to the feet, such as to the nails or the skin. The treatments can alleviate conditions and prevent them from getting worse, for example in the case of diabetic foot or certain rheumatic disorders.
• Nutritional therapy: this is available as a therapeutic service for people with rare congenital metabolic disorders. Patients receive advice on the selection and preparation of natural foods as well as on nutritional strategies tailored to specific illnesses. 

A distinction must be made between therapeutic services and medical aids: the latter are products intended to help people who are ill, disabled or in need of care cope better with everyday life, for example a wheeled walker or walking aid.

For a health insurance provider to pay for treatment classed as therapeutic services, they must have been medically prescribed. You can receive a prescription if the therapeutic services are necessary to

• heal an illness, prevent its deterioration or alleviate its symptoms
• avoid or reduce the need for care
• avoid an impending developmental disorder in children
• eliminate a health impairment that is likely to lead to an illness

The doctor uses a specific form for the prescription and indicates the prescribed type of therapeutic service, how many treatment sessions should be provided and how many times a week treatment should be received. The diagnosis requiring treatment is also specified in the form of the ICD code.

This prescription can be used to arrange treatment appointments at the desired practice. The therapy must begin within 28 days of the prescription being issued. The doctor will indicate any urgent need for treatment on the prescription. In such cases, a 14-day deadline applies.

The therapeutic services directive and the therapeutic services directive for dentists from the Joint Federal Committee (Gemeinsamer Bundesausschuss, G-BA) indicate the therapeutic services that can be prescribed by a doctor or dentist and that are therefore covered by health insurance providers.

The therapeutic service directory (Heilmittelkatalog) is a key part of the therapeutic services directives. This describes which therapeutic services in which quantities are regarded as medically appropriate and economical care for certain diagnoses. The therapeutic services directory specifies the maximum number of sessions per prescription for each health condition, for example six. If this does not suffice, the treatment can be continued but a new prescription is required to this end.

However, there are also health conditions that result in a need for several months of therapeutic services. In such cases, the doctor can prescribe the therapeutic services for twelve weeks if medically necessary. The patient must visit the doctor for a medical check-up and a new prescription for therapeutic services after a maximum of twelve weeks. This is known as a “special healthcare need”.

If it is foreseeable that treatment will be required for at least one year, special regulations for patients with a “long-term need for therapeutic services” apply.

The cases in which there is a special or long-term healthcare need can be seen from the joint diagnosis list of the National Association of Statutory Health Insurance Providers (Kassenärztliche Bundesvereinigung – KBV) and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband).

If the diagnosis list indicates a long-term need for therapeutic services for a health condition, the same applies as for a special healthcare need: the doctor can prescribe the therapeutic services for twelve weeks. At the end of this period, a new prescription must be issued following a medical check-up. No application has to be submitted to the health insurance provider for either a special or a long-term need for therapeutic services.

Information about a long-term need for therapeutic services can be found in the patient information provided by the Joint Federal Committee (B-GA).

Private health insurance companies (PKV) reimburse the costs of therapeutic services in line with the conditions for the relevant tariff.

What co-payments are due for therapeutic services? 

People with statutory health insurance (GKV) have to pay a personal contribution toward many medical services. This is known as a co-payment. In the case of therapeutic services, the co-payment is ten percent of the cost of the therapeutic services plus ten euros per prescription. Children and adolescents under the age of 18 are exempt from co-payments for therapeutic services.

Information about which co-payments are incurred for which services and under what conditions people can be exempted from them can be found in the overview text “Co-payments and exemption from co-payment”.

The Independent Patient Advice Service for Germany (UPD) offers free advice on issues relating to healthcare and healthcare legislation, including questions about therapeutic services. All contact details can be found on the UPD website.

Some consumer advice centers also offer legal advice on healthcare and general care.

The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) publishes a list of therapeutic service providers that can be used to find nearby therapeutic service practices.