How much does therapy cost in Germany? A guide for expats
Written by Nastassja Volkov · Psychologische Psychotherapeutin
If you have moved to Germany and are looking for a therapist, one of the first questions is usually about money. The German system can be confusing at first, with public and private insurance, practices with and without a Kassensitz, and invoices full of numbers like 812a or 870. The good news is that the system follows clear rules, and once you know them, it becomes much easier to plan.
The short answer
With public health insurance (GKV), therapy is free if the therapist has a Kassensitz, a licence to bill the public insurers directly. Waiting times for these places are often several months. In a private practice, a 50-minute session usually costs between about €100 and €168. Private health insurance (PKV) and Beihilfe for civil servants usually reimburse these costs, depending on your policy. Without private insurance, you can pay yourself.
Public insurance (GKV)
Most people in Germany have public insurance, for example with TK, AOK or Barmer. Therapy is covered if you find a therapist with a Kassensitz. You usually start with a few initial consultation sessions (Sprechstunde), after which the therapist applies for therapy with your insurer. Finding a free place, especially with a therapist who speaks English, can take time.
If you cannot find a place within a reasonable time, there is a procedure called Kostenerstattung. In certain cases your public insurer may reimburse therapy in a private practice. You submit the application yourself, it involves a fair amount of paperwork, and the first session is always paid privately.
Private insurance (PKV) and Beihilfe
Many expats, especially self-employed people and higher earners, have private insurance. Most private insurers cover psychotherapy with a licensed psychotherapist, but the details depend on your policy. Before you start, it is worth asking your insurer how many sessions are covered, up to which multiplier they reimburse (more on that below) and whether you need prior approval. In my experience, online sessions have so far been reimbursed without problems. Beihilfe covers psychotherapy at the percentage that applies to you. International health insurance plans have their own rules, so check your policy there too.
How private fees are calculated: the GOP
Private practices bill according to the official fee schedule for psychotherapists, the GOP (Gebührenordnung für Psychotherapeuten). Every service has a number and a set number of points. The points are multiplied by a fixed value, which gives the base fee. The base fee is then multiplied by a factor, the Steigerungssatz.
The base fee is almost never charged as it is. The law sets a range from 1.0 to 3.5 times the base fee, depending on difficulty, time and circumstances, and treats 2.3 as the rate for a case of average effort (§ 5 GOÄ, which the GOP refers to). In addition, the point value has not changed since 1 January 1996: it was 11.4 Pfennig back then and became 5.82873 cents after the switch to the euro. Rents, salaries and practice costs have risen considerably in those 30 years, so the base fee today lies far below what a session actually costs.
Between 1.0 and 2.3 times the base fee, no justification is needed, which is why 2.3 counts as the standard rate. A higher rate is possible in two ways: either the invoice briefly explains why the treatment required more effort, for example because of particular difficulty or time, which allows up to 3.5, or practice and patient sign a written fee agreement before treatment begins. Only a fee agreement allows a rate above 3.5. Beihilfe and some private insurers do not always fully reimburse amounts above 2.3, so it is worth checking.
What changed in July 2024
The GOP remained almost unchanged for about 25 years. Services such as initial consultations or acute crisis treatment were not properly covered, and fees at the standard rate no longer reflected actual costs. Many practices therefore billed at 3.5, which often meant patients had to pay part of the costs themselves.
Since 1 July 2024, new joint billing recommendations have applied, agreed between the German chambers of psychotherapists and physicians, the association of private health insurers and the Beihilfe offices. The fee schedule itself was not changed, since only the federal government can do that and the reform has been pending for years. Instead, the recommendations use a rule that allows a service missing from the schedule to be billed like an existing service of equivalent type, cost and time (§ 6 (2) GOÄ). Short-term therapy, for example, has no number of its own and is billed using the points of the existing number 812, marked with a small “a” for “analogous”: 812a. This way, therapy can be billed fairly at the standard rate of 2.3. The aim is that insured patients usually no longer need to pay extra.
Example costs for a 50-minute session
At the standard rate of 2.3:
| Service | Number | Amount |
|---|---|---|
| Initial consultation or short-term therapy | 812a | €134.06 |
| Mental status assessment | 801a | €33.52 |
| Behavioural therapy session | 870 | €100.55 |
The mental status assessment is a documented assessment of how you are doing psychologically, including mood, drive, thinking, concentration and anxiety. Regardless of billing, psychotherapists are required by their professional code (§ 9) and by § 630f of the German Civil Code to keep a timely record of everything essential to the treatment, explicitly including findings. In practice, the mental state is therefore assessed in every session, with a particular focus on whether anything has changed. Number 801a covers the assessment itself, not the note-taking, and is usually billed in addition to the session. A short-term therapy session including this assessment therefore costs €167.58. Short-term therapy is limited to 24 sessions per year, and longer treatment is usually billed under number 870, which comes to €134.07 including the assessment.
Some practices bill a flat fee instead, for example number 870 at a multiplier of 3.5, which is €153.00 per session. This requires either a justification on the invoice or a written fee agreement signed beforehand, and how much is reimbursed depends on your policy.
In my practice, an individual session (50 minutes) for self-paying clients costs between €153 and €168, depending on which of the fee numbers described above are billed. All details are on the fees page.
Other services you may see on an invoice
Besides the therapy sessions themselves, some services mainly come up at the start of therapy or when your insurer requires an application. Tests count as technical services, so their standard rate is 1.8 and the maximum 2.5.
| Service | Number | Amount |
|---|---|---|
| Biographical history at the start of therapy, once, possibly over several sessions | 860a | €123.34 |
| Test battery of at least three tests, e.g. questionnaires on depression or personality (1.8x) | 855a | €75.75 |
| Structured clinical diagnostic interview (1.8x) | 855a | €75.75 |
| Shorter screening test, e.g. a single questionnaire (1.8x) | 857 | €12.17 |
| Report to the insurer’s reviewer for an application, per hour started | 85a | €67.03 |
| Detailed written report | 75 | €17.43 |
| Short certificate | 70 | €5.36 |
| Counselling of relatives or other close persons | 817a | €24.13 |
All amounts without a note are at the standard rate of 2.3. Which of these apply varies a lot: many therapies start with a history and a few questionnaires, and a report is only needed if your insurer asks for an application.
Paying yourself
If you have public insurance and do not want to wait, or prefer that no diagnosis is shared with your insurer, you can see a private therapist as a self-payer. You then pay the invoice yourself, based on the same GOP rules. Many people choose this for a limited period, for example to get support quickly while they are still looking for a place with a Kassensitz.
Sources
- German fee schedule for physicians (GOÄ), § 5 (point value and fee range) and § 6 (analogous billing)
- German Civil Code, § 630f (documentation of treatment), and the model professional code for psychotherapists, § 9
- Deutsche PsychotherapeutenVereinigung (DPtV): GOP fee table including the joint billing recommendations from 1 July 2024, as of December 2024
- Bayerischer Facharztverband: GOÄalt und GOÄneu (point value unchanged since 1 January 1996)
Nastassja Volkov is a German-licensed psychotherapist (behavioural therapy) with a private practice online across Germany and, from December 2026, in person in Cologne-Nippes. Sessions are available in English, German, Spanish and Russian. Her own fees and reimbursement information are on the fees page.