International self-pay patients often see German billing terms without enough context. A hospital estimate may be informed by inpatient case-based reimbursement structures such as the aG-DRG system, while separately billed private physician services can involve the official physician fee schedule known as GOÄ. These systems are not a simple consumer price list and do not let a patient calculate a reliable final treatment price from a diagnosis alone.
What aG-DRG means
Germany's InEK publishes the annual aG-DRG case-based payment catalogue together with supplementary-payment and nursing-revenue catalogues. DRG assignment depends on coded diagnoses, procedures and other case characteristics. For an international patient, the important practical point is that a DRG label is part of a billing framework, not a guaranteed all-inclusive retail price for a planned medical trip.
What GOÄ means
GOÄ is the official physician fee schedule used for privately billed medical services where other statutory remuneration rules do not apply. Bundesärztekammer continues to publish guidance for the currently applicable GOÄ. A proposed replacement has been under reform work, but a draft proposal should not be treated as if it were already the legally effective fee schedule.
Why one treatment can involve several financial components
A hospital proposal can include different parts depending on the case and contractual arrangement.
- Hospital inpatient treatment and procedure-related charges
- Nursing-related reimbursement components
- Supplementary payments for selected high-cost services or materials
- Privately billed physician or elective medical services where applicable
- Optional accommodation or other elective services
- Interpreter, translation, rehabilitation or other services arranged separately
Why the hospital estimate is still the document that matters
Trying to reverse-engineer a price from DRG or GOÄ tables is not a substitute for a hospital quotation. LMU states that final costs are only known after treatment and that estimates depend on complexity and additional services. International self-pay patients should therefore compare written hospital estimates built around the actual treatment plan rather than internet calculations based on billing codes.
Advance payment and final settlement
LMU requires advance payment according to its estimate in its international self-pay pathway. It also explains that overpayment can be refunded after the final invoice is issued, while actual care can produce a different final amount from the preliminary estimate. Confirm the individual hospital's current rules before transferring funds.
Official sources
Last source-reviewed 2026-08-29. Administrative, insurance, reimbursement, billing and visa rules can change. Follow current official instructions before acting.
- aG-DRG Fallpauschalen-Katalog 2026 — InEK – Institut für das Entgeltsystem im Krankenhaus ↗
- GOÄ guidance – basic principles — Bundesärztekammer ↗
- Cost Plan — LMU Klinikum International Patient Office ↗
- International Patient Office FAQ – final bill and estimate — LMU Klinikum International Patient Office ↗