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03100 check: does the care flat rate apply?

Eight short questions show whether the Versorgungspauschale 03100 (care flat rate) can be billed for a patient, or whether billing stays with 03000 and, where their conditions are met, the chronic-care surcharge. Every question follows the Bewertungsausschuss decision of 11 March 2026, and every rule carries its source.1 The check asks for no name and no patient data, and your answers never leave this page.

1How old is the patient?

In the decision’s words, from the start of the 19th to the completion of the 75th year of life.1

2Which condition is being treated?

It must be on the claim as a confirmed ICD‑10‑GM diagnosis.1

3Is this the only chronic condition?

Meaning a long-lasting, life-changing chronic condition that needs GP treatment.1 A non-chronic illness such as an infection does not count against it.3

4How many prescription drugs does the patient get for it?

Continuously, for this condition, prescribed at the health insurer’s expense. Two drugs with one prescription-only active ingredient each are allowed if a combination product of exactly those two ingredients exists, for example an ACE inhibitor and a diuretic.1, 3

5Has your practice billed 03100 for this patient before?
6Did the patient have contact with your practice for this condition in three of the last four quarters?

The four quarters include the current one. At least one contact for this condition in at least three of them, in person in at least two quarters, and one of those contacts may be a video consultation.1 Contacts at another GP practice do not count.1, 3

7Was there a doctor-patient contact this quarter?

In person or as a video consultation under Annex 31b BMV‑Ä.1

8Has 03100 already been billed for this patient, last quarter or by another practice?

Only one practice can bill 03100 in a quarter, no other practice can bill it in the following quarter, and it is never billed in two consecutive quarters.1

Value

What 03100 and its surcharges are worth.

GOPContentConditionValue
03100Care flat rateAge 18 to 53356 points · €45.36
03100Care flat rateAge 54 to 74403 points · €51.34
03110Surcharge in the following quarter for intensive care needsFor at most 8% of the previous quarter’s 03100 cases152 or 173 points · €19.37 or €22.04
03043Practice availability flat rate (Vorhaltepauschale) for patients with the care flat rateAdded by the KV179 points · €22.81
 Points from the decision of the 828th meeting, euro amounts at the 2026 orientation value of 12.7404 cents.1, 4 The decision sets further surcharges.

meda Billing

Diagnosis and medication are in the documentation.

The hard part is not knowing the rule but the moment, because the question now comes up with every chronically ill patient, on a full day. meda writes the documentation down from the consultation, the audio is deleted straight after transcription, and meda suggests the billing codes it supports, each with the sentence that backs it. The doctor decides, and nothing enters your PVS unless you approve it.

How meda Billing works

03100 questions

Can I bill 03100 by video?

Yes. The required content is an in-person contact or a video consultation under Annex 31b BMV‑Ä. For the first billing, though, there must be in-person contacts in at least two of the last four quarters, and only one of them may be a video consultation. If the treatment case has only video consultations, 03100 and 03110 are cut by 10%.1, 5

What if the patient does not come in the second quarter?

Nothing. The flat rate covers the half year and is paid even if the patient was only in the practice in one of the two quarters.1, 2

Do I have to bill 03100 when a patient qualifies?

Where the conditions are met, 03100 is to be billed instead of 03000 and 03220 to 03222; that is what the reasons for the decision say. Whether a patient meets the conditions is your decision.1

Are my answers stored?

No. The check runs in your browser. Your answers are neither sent nor stored, and it asks for no name and no patient data.

Sources (5)
  1. Bewertungsausschuss, 828th meeting: decision on the care flat rate (GOP 03100), 11 Mar 2026, parts A and B with protocol notes and reasons for the decision (PDF, in German). kbv.de
  2. KBV: KBV and GKV-Spitzenverband agree on a new care flat rate for chronically ill patients, practice news of 12 Mar 2026 (in German). kbv.de
  3. KBV: chronic-care surcharge, section on the care flat rate (in German). kbv.de
  4. Bewertungsausschuss, 803rd meeting: orientation value 2026, 17 Sep 2025 (PDF, in German). kbv.de
  5. Bewertungsausschuss, 778th meeting, part D: video consultation, general provision 4.3.1(5) (PDF, in German). kbv.de

The official text is what counts. Not legal advice.

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