Consultation Report Psychotherapy: Private Patients

No, not automatically. A medical evaluation prior to psychotherapy is mandatory. The form used to document it is not. In the statutory health insurance system (GKV), this form is called Pattern 22 and is required under guideline-based psychotherapy. Those with private insurance operate under a different system.

The Association of Private Health Insurance (PKV) states on its own patient portal clearly: „In private health insurance, there is no standard or regulated application process for psychotherapy.“

Not every insurance plan requires a consultation report as defined by the health insurance system. The documents your insurance company needs are specified in your contract. The situation is different for those eligible for government-subsidized health care; in that case, there is a set procedure with its own forms.

The definition itself is found in the Psychotherapist Act (PsychThG), and the sentence is brief: „As part of psychotherapeutic treatment, a somatic evaluation should be conducted.“

This applies to every treatment—whether you have public health insurance, private health insurance, are eligible for government-subsidized health care, or are a self-paying patient who does not submit your bill anywhere. It is Not an insurance requirement, but a professional obligation the therapist.

The rationale behind this is medical, not bureaucratic. Hypothyroidism can feel like depression. A vitamin B12 deficiency, an emerging neurological disorder, or a side effect of medication: All of these can cause symptoms that do not improve with therapy because the underlying cause lies elsewhere. Such possible causes or contributing factors should be evaluated by a doctor. The appropriate tests depend on the patient’s symptoms, medical history, and the doctor’s assessment.

The insurance issue is separate from this. Your plan determines whether a written report is required, who submits it, and whether an expert assessment is underway. The evaluation takes place in any case.

Three paths that are often lumped together in everyday life. They differ significantly.

Private health insurance. There is no standard procedure; everything is specified in the rate schedule. Some contracts cover the first sessions without requiring approval, while others require written approval in advance. The PKV Association cites as an example rate schedules in which „only five trial sessions or the first 20 therapy hours are covered without requiring approval.“.

Subsidy. There is a set procedure for this. Section 18(6) of the Federal State Aid Regulation requires that the physical examination be conducted no later than after the preliminary hearings. If an expert evaluation is underway, the medical report is explicitly included in the documentation: The Federal Administrative Office states in its Fact Sheet on Psychotherapy the required report from a physician, which must be sent to the benefits office in a sealed envelope marked “confidential medical information.” The states have their own forms; Bavaria, for example, uses Form 3 of the Bavarian benefits regulations.

Self-paying patients. If you don't submit anything, you don't need a form for anyone. The medical evaluation is still mandatory, however, because it is required by law and not by the contract.

A doctor. In practice, this is usually your primary care physician, though sometimes it may be a psychiatrist. The doctor who is to complete the consultation report will examine you in person for that purpose. The guidelines explicitly require this within the health insurance system, and outside of it, a medical finding without a personal examination would be of little value anyway.

The options are more limited under the public health insurance system. In that case, the practitioner must be a physician contracted with the health insurance provider, and the psychotherapy guidelines specify which specialties are eligible. This restriction does not apply to those with private insurance, because the guidelines do not apply to them.

In practice, this doesn't change much. The term “consulting physician” comes from the health insurance system and refers precisely to this role: conducting a medical assessment before treatment begins. The same factors are considered, regardless of your insurance status: current symptoms, physical findings, medications you’re currently taking, prior treatments, and any potential contraindications for psychotherapy.

Not Form 22. This form is part of the system of care provided by physicians under the Federal Framework Agreement for Physicians, as governed by Annex 2 to that agreement, and may be used exclusively within that context. The same applies to the Form PTV 11, which people with public health insurance receive after a psychotherapy session.

In practice, two approaches have become established.

One of them is a Informal medical report. The medical practice records the information it has collected and signs the document. The insurer’s guidelines determine what form and content are required.

The other one is a Template from the German Association of Psychotherapists (DPtV), which is available in their knowledge database under the title „Consultation Report on Psychotherapy in Private Health Insurance“ and is accessible to members. It asks the same questions as the insurance form and includes a second page for the evaluator. Some practices provide this exact form to the primary care physician.

This does not apply to the subsidy. In that case, use the form provided by your subsidy office.

To qualify for federal assistance, the physical evaluation must be completed before psychotherapy begins, no later than preliminary hearings, take place. For those with private insurance and self-pay patients, there is no generally mandated deadline before treatment begins; in addition, specific plan requirements may apply.

The number of preliminary sessions required beforehand depends on the system. Federal assistance covers up to five sessions; if followed by analytical psychotherapy, up to eight. For those under 21, the numbers are seven and ten, respectively. In private health insurance, there is no set number because there is no standard procedure.

In practical terms, this means: Check with the practice and your insurance provider early on to determine when the evaluation—and, if necessary, a report—is required.

The bill will be sent to you, not to your insurance company. Private medical services are billed according to the Schedule of Fees for Physicians (GOÄ). For the completed form, the German Medical Association Number 75 or Number 60, with the practice having the option to choose which of the two to apply.

Whether your insurance will reimburse this bill depends on your plan and is not guaranteed. Certificates and reports are not covered as reimbursable services in every policy. Check with your insurer beforehand if you want to be sure.

Since July 1, 2024, the treatment itself has been governed by joint billing guidelines issued by the German Medical Association, the German Chamber of Psychotherapists, the Private Health Insurance Association, and the federal and state health insurance providers. These guidelines cover sixteen services, including consultation hours, acute treatment, and short-term therapy. The Joint FAQ from the four institutions describes the benefit levels as „robust benefit levels“ that may be increased only in exceptional cases, and explicitly states that comorbidity and chronicity are not sufficient grounds for an increase.

Less than many people fear.

In the reimbursement process, the procedure is strictly defined. The report is sent to the reimbursement office in a sealed envelope marked “confidential medical information.” The office forwards it unopened to the medical reviewer. Instead of your name, it bears a pseudonymization code assigned by the assessment office. This ensures that the medical portion of the report is not disclosed to the case worker responsible for deciding on your reimbursement.

With private health insurance, it all depends on the policy. If this is important to you, ask before submitting your claim who will have access to which documents. That’s a legitimate question, and it’s rarely asked.

The appointment service center only schedules appointments for people with public health insurance. You can still call 116117, however: According to information from the National Association of Statutory Health Insurance Physicians We are here for patients with both public and private insurance. However, this won’t help you find a treatment spot.

The best way to do this is to contact the practices directly. For details on how this works, which directories are worth checking out, and what matters most during the first phone call, see a own article.