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Journal of Craniomandibular Function
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J CranioMand Func 12 (2020), No. 1     11. Mar. 2020
J CranioMand Func 12 (2020), No. 1  (11.03.2020)

Page 53-64, Language: German/English


Billing of dental services pertaining to condylar position analysis
Raff, Alexander
Dental functional analysis and treatment specialists have also been impacted by a growing number of disputes over the legal basis for billing various examination and treatment services in recent years. This problem is rooted in the fact that the German Dental Fee Schedule (GOZ), which was reformed by the Federal Government in 2012, is generally binding, so dentists are legally obligated to abide by its provisions without exception (Article §1 GOZ) unless otherwise provided by law. As craniomandibular function and disorders-related services do not fall under the contract dental services provided for under Article §28 (2) 8 of German Social Code V, this impacts all patients in need of functional analysis and treatment. In and of itself, this regulation is clear. Nevertheless, the billing of functional analysis and treatment services is problematic because the fee schedule contains a table of fees for a list of services that is incomplete, especially in this area. This peculiarity is formally recognizable by the fact that Article §6 (1) of the GOZ contains a provision that expressly allows dentists to set fees for independent services not included in the Dental Fee Schedule commensurate with the fees charged for similar analogous services included in the fee schedule ('analogous billing' procedure). The legislators inserted this provision to circumvent the need for periodic short-term updates to the fee schedule; at the same time, the analogous billing procedure allows dentists to meet their obligation to provide treatment consistent with the standards of the current state of science, as specified in the Dentistry Act. The 'List of Analogous Dental Services' published by the German Dental Association serves as a reference for dentists who provide independent services not included in the GOZ fee schedule and thus do their invoicing based on the analogous billing procedure. The list is updated semiannually but is presented without commentary or explanations of the contents. The Commentary to BEMA & GOZ1, a detailed independent fee schedule commentary introduced decades ago and recognized by the German Dental Chambers and courts, is one publication that takes on this task. The present article, written by one of its co-authors, describes the extent to which condylar position analysis is an independent dental service, and the billing procedure for this service.

Keywords: craniomandibular dysfunction (CMD), instrumental functional analysis, condylar position analysis, German Dental Fee Schedule, GOZ, fee schedule, analogous billing