The care flat rate 03100: who it is for and what it replaces

The Versorgungspauschale 03100 (care flat rate) is a GP flat rate for patients aged 18 to 74 with only one chronic condition, one that is on a fixed list and treated with a single prescription drug or with two single-ingredient prescription drugs, if a combination product of exactly those two ingredients exists. It has applied since 1 July 2026, covers half a year, and is billed instead of the per-patient flat rate 03000 and the chronic-care surcharges 03220 to 03222.¹² For chronically ill patients who do not meet these conditions, your practice keeps billing as before.²

The legal basis is § 87(2b) SGB V as amended by the Gesundheitsversorgungsstärkungsgesetz. The flat rate is meant for patients without intensive care needs, who therefore do not have to come in every quarter.¹² This guide follows the Bewertungsausschuss decision of 11 March 2026. Where a KV notice differs from it, the decision applies.

Who qualifies for 03100

All conditions must be met together. If one is missing, billing stays as before: 03000 and, where their conditions are met, 03220/03221.

Contacts at another GP practice do not count towards the first billing. If a patient changes practice, the count starts again.¹³

The diagnoses

Only diagnoses from a fixed list qualify, which the KBV lists in four groups.² The diagnosis must be on the claim as a confirmed ICD-10-GM diagnosis, or 03100 cannot be billed.¹

Half a year instead of a quarter

• Two quarters, one flat rate. 03100 covers two consecutive quarters. It is paid even if the patient only comes in during one of them.¹²
• How often. Once per treatment case (Behandlungsfall), at most twice per illness case (Krankheitsfall), and never in two consecutive quarters. If it is billed twice in one illness case, there must have been at least one in-person contact in that illness case.¹
• Instead of, not on top of. It replaces 03000 and 03220 to 03222. In the following quarter, the practice that billed 03100 cannot bill a per-patient flat rate from chapter 3 for this patient.¹
• Billing it again. 03100 can also be billed again if more than one and at most three quarters without an in-person contact lie between the quarter it was last billed and the quarter it is billed again. Otherwise the contact conditions for the first billing must be met again.¹

For services outside the content of the flat rate, every EBM code with no exclusion stays billable during the half year.² The exclusions are listed below.

Points and surcharges

If a patient on 03100 needs more intensive care in the following quarter after all, the surcharge 03110 applies, in person or by video. It is capped per practice at 8% of the previous quarter's 03100 cases.¹ Same-specialty GP group practices (including partial group practices) and same-specialty GP practices with employed GPs get an 11% uplift on 03100 and 03110. On 03000 and 03030 it is 22.5%.¹

The Bewertungsausschuss reviews 03100 after the first quarter, after the following quarter and again after two years, and says changes are possible.¹ We update this page when anything changes.

What cannot be billed alongside

• Not alongside each other: 03100 cannot be billed alongside 01436, 38200 and 38205, sections 3.2.4 and 3.2.5, or chapter 37.¹ For geriatric and palliative care (3.2.4, 3.2.5) and chapter 37, the KBV says this only excludes the same session: within the treatment case and the following quarter, these services stay billable.³
• In the quarter and the following quarter, same practice: 01600, 01601, 01610, 01630, 03000, 03030, 11301, 19401 and 40091 to 40095.¹
• In the quarter and the following quarter, same practice, with an exception for specialist services: services under the oncology agreement, services under § 6 of Annex 5 BMV-Ä, certain codes from section 35.1, and sections 30.5, 30.7, 30.9 and 35.2. In cross-sector group practices, MVZ and practices with employed doctors, this exclusion does not apply when doctors in specialist care (fachärztlicher Versorgungsbereich) perform and bill the service.¹
• In the quarter and the following quarter, same doctor: 01430, 01431, 01435, 01437, 01700, 01701, 12222 to 12224, 37314 and 37714.¹

The full list is in the decision.¹ One everyday example is 01430: the same doctor cannot bill this administrative code, for example for a repeat prescription, for a 03100 patient in the quarter or the following quarter.

What changes for other practices

Only one practice can bill 03100 in a quarter, and no other practice can bill it in the following quarter. Once a practice bills 03100, no other practice can bill 03220 or 03221 for this patient in the same or the next quarter.¹ Other practices can still bill the per-patient flat rate, for example when covering for a colleague.³

In the other direction, treatment now also counts as continuous for the chronic-care surcharge 03220 if 03100 was billed for the same confirmed condition two quarters earlier.¹ Two quarters after 03100, treatment therefore still counts as continuous for 03220.

Checklist: 03100 or the chronic-care surcharge?

1. Is the patient 18 to 74 years old?
2. Do they have exactly one long-lasting, life-changing chronic condition that needs GP care, and is it on the list as a confirmed diagnosis?
3. Do they continuously get exactly one prescription drug for it, or two with one prescription-only ingredient each that exist as a combination product of exactly those two ingredients?
4. First billing: did they have contact with your practice for this condition in three of the last four quarters, in person in at least two (one of which may be a video consultation)? When billing it again, it is enough that more than one and at most three quarters without an in-person contact lie since the last 03100.
5. Did they have an in-person contact or a video consultation this quarter?
6. Did neither your practice nor any other bill 03100 last quarter, and no other practice this quarter?

Yes to all six: 03100, except in the organised out-of-hours service (Notdienst) or under a referral with a defined scope (Definitionsauftrag). If the only contact in the treatment case is an unforeseen contact in connection with a service under 01100, 01101, 01411, 01412 or 01415, 03030 applies. No to any of questions 1 to 4: as before, 03000 and, where their conditions are met, 03220/03221. No to question 5: no per-patient flat rate can be billed this quarter. A no to question 6 has its own consequences: If you billed 03100 yourself last quarter, neither a per-patient flat rate from chapter 3 nor the chronic-care surcharge can be billed this quarter, but the surcharge 03110 can for intensive care needs. If another practice billed it, you can still bill 03000, but not 03220/03221.¹³

Age, diagnosis, your own prescriptions and earlier contacts are in your records. Prescriptions from other doctors for the same condition are not, and neither is whether another practice has billed 03100. The hard part is not knowing the rule but the moment, because the question now comes up for chronically ill patients aged 18 to 74 with a diagnosis on the list, on a full day. meda writes the documentation from the consultation and suggests the billing codes the documentation supports, 03100 included, each with the sentence that backs it. Anything that is not in your records, you check yourself. The doctor decides, and nothing enters your PVS unless you approve it.