Diagnostics as a Service for German practices: how ordering blood tests affects the laboratory bonus
Under the German statutory scheme, ordering laboratory tests reduces what a practice is paid, through a bonus that slides to zero between two thresholds. For general practice those are 1.42 and 3.37 euro of laboratory cost per case. Here is the mechanism, what is left out of it, and where a self-pay test sits.
Written by
Robert Jakobson
Published on
September 25, 2026
Long before anybody sold Diagnostics as a Service to a German practice, the statutory fee schedule already reduced what a practice was paid for ordering laboratory tests. That reduction is deliberate and public. It has nothing to do with who supplies the kits or who runs the laboratory.
Because the calculation behind it is published in full, a practice can work out for itself what a given test does to its pay. This article sets out the mechanism first. It then gives the figures in force for general practice, lists what the calculation leaves out, and ends with the case that matters for a service like this one, a test a customer asked for rather than one you needed.
Why does ordering more laboratory work reduce what a practice is paid?
Because of a payment the fee schedule calls the "Wirtschaftlichkeitsbonus", the economy bonus, billed as position 32001. It is paid once per statutory treatment case. How much of it is paid depends on the practice's laboratory cost per case in that quarter.1
Cost per case is the figure that governs the bonus, not the number of tests. The practice case value is the total laboratory cost divided by the number of statutory treatment cases. So a practice that orders more tests for proportionally more people can end the quarter with the same case value as before.1
That case value is then measured against two thresholds, a lower one and an upper one, set for each speciality. Below the lower threshold the practice receives the whole bonus, and at or above the upper threshold it receives nothing. Between the two, the bonus is reduced in proportion to how far the case value is above the lower one.1
Below a laboratory cost of 1.42 euro per statutory case a general practice receives the whole economy bonus, and at or above 3.37 euro it receives nothing. Sources: Beschluss des Bewertungsausschusses of 1 April 2018 for the mechanism, KBV of 13 March 2025 for the thresholds, and the Beschluss of 17 September 2025 for the point value.
How much is at stake for a general practice?
That depends on four published figures, the two thresholds, the size of the bonus in points, and the value of a point. For general practice the lower threshold is 1.42 euro of laboratory cost per case and the upper one is 3.37 euro. Both have been in force since 1 July 2025.2
The bonus itself is 19 points for that speciality, and a point is worth 12.7404 cent from 1 January 2026.3
Multiplying the two gives about 2.42 euro a case. That figure is our own arithmetic from the points and the point value, because nobody publishes the bonus as a euro amount. For a practice with a thousand statutory cases in a quarter, a case value at or above the upper threshold therefore means about 2,420 euro less in bonus.
The two thresholds are as low as they are because of a reform that took effect earlier the same year. The next section explains that reform.
What changed in the laboratory reform?
The valuation of the tests themselves changed first. Until the end of 2024, transport, materials and electronic ordering were funded out of the test valuations. The reform of 1 January 2025 introduced separate flat rates for those three items and cut the valuations to match.4
That cut had a side effect on the bonus. A lower valuation per test means a lower laboratory cost per case, so practices above the lower threshold would have gained bonus without changing what they ordered. To prevent that, the thresholds were lowered for every speciality on 1 July 2025. The Kassenärztliche Bundesvereinigung gives the aim as keeping the bonus unchanged.2
The two thresholds given above are the result of that lowering. We could not find a further change to them published for 2026.
What is left out of the calculation?
Quite a lot, and the list matters because it changes what a practice writes on the requisition. Certain marked cases are left out entirely. They include diagnostics before an antibiotic is started, pregnancy care, diagnosed diabetes, cancer under treatment, chronic kidney failure below a stated clearance, and HIV under therapy.5
Some positions are left out as well as some cases. Preoperative laboratory work, the coronavirus test position and the health check positions are excluded, so a health check billed under those positions never reaches the calculation.6
What does count is broader than the word laboratory suggests. The statutory fee schedule has two laboratory sections, and everything billed under either of them is summed. Where the test is run makes no difference to that sum. It counts the same whether you run it in your own rooms, get it through a laboratory community, or send it to an external laboratory. So sending the work away does not take it off your case value.1
Tests ordered through the statutory scheme add to the case value whether run in house, bought through a laboratory community or sent out. Marked cases such as pregnancy care and diagnosed diabetes are left out. Sources: the 412th session Beschluss and the KV Hessen list of marking numbers of 1 October 2024.
Does a test the customer pays for count?
On the wording of the rule, it does not. The calculation sums the costs billed under the two laboratory sections of the statutory fee schedule. It then divides them by the practice's statutory treatment cases, which are the cases in which a statutory consultation fee was billed.1
A privately paid test produces neither of those two things, because it is billed under the separate private fee schedule. That is what the rule text says when read plainly. No association or regional body has published a statement confirming that reading, though.
So treat it as a reading of the rule rather than as settled guidance. Check it with your own regional association before you build a service on it.
What this means for a Diagnostics as a Service arrangement
The obvious worry is how to keep a privately paid test off the case value. On the reading above, that worry is misplaced. Nothing has to be kept off the case value, because a privately paid test was never on it.
The opposite case is the one that costs you. Suppose a customer asks for a test they would have paid for, and you put it through the statutory scheme instead. The cost of that test is then added to your case value. Once that value is above the lower threshold, your bonus is reduced.
Through the statutory scheme a requested test adds to laboratory cost per case and can reduce the bonus. Billed privately it generates no statutory consultation fee and, by the wording of the rule, is outside the calculation. Source: Beschluss des Bewertungsausschusses, 412th session, effective 1 April 2018.
What should a practice ask before signing anything?
Four questions settle most of it. Two of them are for your regional association, because they are questions about billing rather than about the service. The other two are for the supplier.
Questions for your regional association
Can a customer who asks for a test be billed privately for it, without touching our statutory billing?
Which of our routine orders would have to stay on the statutory route, whatever the customer would prefer?
Questions for a Diagnostics as a Service supplier
Who issues the invoice for a privately billed test, the practice or the supplier?
What does the practice have to do on the day, and what do you do instead?
Of the two supplier questions, only the one about the invoice has a published answer already. The Bundesärztekammer's GOÄ guidance states that for work sent out to an external laboratory, the laboratory performing the service bills the customer directly.7
The other supplier question has no published answer, because it depends on the arrangement. It is also the one that changes your working day. An arrangement that leaves your staff doing more than the draw itself saves them little.
Where Aniva is on this
The practice keeps the blood draw and its own name on the service. Everything around the draw is what Aniva runs, meaning the ordering, the kit, the courier, the laboratory booking and the screen that shows the result. Where a customer is not drawn in your own rooms, the collection happens in Aniva's own network rather than a subcontracted one.
All of that is on one contract, which covers the laboratory, the kits, the logistics, the software and the data agreement. The service is white label, so the customer sees your practice's name and never ours.
What the arrangement cannot settle is the billing question above. Whether a given test can be billed privately is a matter for your regional association and your own adviser rather than for a supplier. The reading above is not settled either, because no association has published a statement that would settle it.
The arrangement itself is easier to judge seen than described. Book a demo if you want to see it from the booking to the result.
Notes and sources
Beschluss des Bewertungsausschusses in its 412th session, effective 1 April 2018, which introduced the current mechanism, defines the practice case value as laboratory costs divided by treatment cases, and sets the sliding economy factor between the two thresholds. www.aerzteblatt.de/archiv/195621/
Kassenärztliche Vereinigung Rheinland-Pfalz, Laborreform, 19 December 2024, which describes the end of cross-financing and the matching reduction in valuations from 1 January 2025. www.kv-rlp.de/nachricht/laborreform
Kassenärztliche Bundesvereinigung, Wirtschaftlichkeitsbonus Labor, which names the further exempt positions for preoperative diagnostics, the coronavirus test and the health check examinations. www.kbv.de/praxis/abrechnung/wirtschaftlichkeitsbonus-labor
This article describes how the German statutory fee schedule treats laboratory ordering. It is general information and not billing or legal advice, and your own billing is a question for your regional association and your own adviser.
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