Insurance Coverage: Will My German Health Insurance Cover physical therapy?
The good news first: Yes, physical therapy is covered by all statutory health insurance companies (gesetzliche Krankenkassen) in Germany when medically necessary. The requirement: You need a doctor's prescription (Heilmittelverordnung).
Your insurance covers 90% of the treatment costs. As a statutory insurance holder, you pay:
10% of treatment costs as co-payment
Plus a one-time €10 prescription fee per referral
Co-payments: How Much Does physical therapy Cost with a Prescription in Germany?
With a doctor's prescription, statutory insurance holders must pay the following amounts directly to the physiotherapist:
1. Prescription fee: €10 one-time This applies per prescription – whether 6 or 20 sessions are prescribed.
2. Co-payment: 10% of treatment costs With typical insurance rates of €20–40 per session, this means about €2–4 additional per session.
Example calculation:
Physical therapy (20 min) costs insurance about €27.80
Your co-payment: €2.78 per session
For 6 sessions: €10 prescription fee + €16.68 (6 × €2.78) = €26.68 total co-payment
Info Box: Co-payments at a Glance Prescription fee: €10 (one-time per prescription) Plus: 10% of treatment costs per session Applies to everyone over 18 without exemption
Exemptions: Who Doesn't Have to Pay Co-payments?
You're exempt from co-payments if you belong to one of these groups:
Children and teenagers under 18
Pregnant women for pregnancy-related conditions
Accident victims when covered by employers' liability insurance
People with co-payment exemption after reaching their burden limit
The burden limit:
Standard: 2% of gross family income per year
Chronically ill: 1% of gross family income per year
Once you reach this limit, you can apply for exemption from your health insurance. Then you pay no co-payments for the rest of the year.
Special Case: Physical Therapy Costs for the Unemployed in Germany
Unemployed and need physical therapy? The key information upfront: You pay the same co-payment as everyone else (€10 prescription fee + 10% of treatment costs). Unemployment alone doesn't automatically exempt you from co-payments.
But: The good news is you'll reach your burden limit much faster:
ALG I recipients (unemployment benefit):
Burden limit: 2% of your annual income
With €1,200 ALG I monthly = only about €288 burden limit per year
You often reach this with just 6-10 physical therapy prescriptions
Bürgergeld/social welfare recipients:
Fixed burden limit: €135.12 per year
Chronically ill: only €67.56 per year
Tip: You can pay this amount in full at the beginning of the year and receive an exemption certificate for the entire year
How to proceed:
Collect receipts – every co-payment counts (physio, medication, hospital)
Calculate burden limit – quickly reached with low income
Apply for exemption – form available from your health insurance
Chronically ill? – Get it certified, then only 1% burden limit applies
Practical example: You receive Bürgergeld and need regular physical therapy? Pay €135.12 to your health insurance in January. You'll be exempt from all co-payments for the entire year – no matter how many treatments you need.
Self-payers: What Does Physical Therapy Cost Without a Prescription in Germany?
Without an insurance prescription, you pay the full treatment costs yourself. Prices vary by practice and region, but typically range between €30 and €80 per session:
Price overview for common treatments:
Physical therapy (20 min): €30–55
Manual therapy (20 min): €40–65
Classic massage (15 min): €22–26
Classic massage (30 min): €30–45
Manual lymphatic drainage (30 min): €35–55
Neurological treatment (PNF, Vojta, 20 min): approx. €45–75
House call: €20–35 flat fee plus travel costs
Private insurance holders bill according to their individual plan. Prices are often similar, sometimes slightly lower than pure self-payer rates.
Additional Costs: What Extra Expenses Might I Face?
Beyond the actual treatment, additional costs may arise:
Non-reimbursable services:
Osteopathy, chiropractic, or acupuncture (usually not covered by statutory insurance)
Shockwave therapy • Special wellness treatments
Materials and aids:
Kinesio tapes
Special bandages
Exercise equipment for home use
Therapy balls or bands
Other possible costs:
Travel costs for house calls (according to fee schedule or practice agreement)
Additional appointments without new prescription
Individual health services (IGeL)
Tip: Clarify potential additional costs with your therapist in advance. Many practices offer discounted package prices for self-payers.
Price Increase: New Physical Therapy Prices from April 2025 – What's Changing?
Reimbursement rates for physical therapy in Germany increase by 4.01% on April 1, 2025. This means:
Health insurance pays more per session
Your 10% co-payment increases minimally (a few cents per treatment)
The €10 prescription fee remains unchanged
Transition period April–June 2025: There was even a temporary 8.02% increase to compensate for delays. From July, the regular rate of 4.01% increase applies.
For self-payers, practice prices may adjust accordingly. The increase remains moderate – expect €1–3 more per session.
Special Case: Physical Therapy for Dogs – Costs and Coverage
Dogs can also benefit from physical therapy – especially after surgery, with arthritis, or neurological problems. Key facts:
Not covered by health insurance: Your health insurance only pays for you, not your pet
Costs: €40–70 per session (similar to human rates)
Special treatments: Underwater treadmill etc. can be more expensive
Reimbursement: Only possible through private pet health insurance
Cancellation Fee: What Happens If I Miss My Appointment?
Missed your appointment? That can be expensive. Physiotherapists in Germany may charge a cancellation fee for no-shows (§ 615 BGB):
The rules:
For short-notice cancellation or no-show: up to 100% of the treatment price
Many practices have their own policies (50–100% depending on notice period)
Cancellation fees may also apply for extreme lateness
How to avoid costs:
Cancel appointments at least 24–48 hours in advance
Inform the practice immediately if you're sick
Agree on clear cancellation rules at your first appointment
Important: You have no right to make up the missed appointment. You must pay the cancellation fee yourself – insurance won't cover it.
Prescription Requirement: Do I Need a Prescription for physical therapy in Germany?
Yes, for insurance coverage you absolutely need a medical prescription (Heilmittelverordnung). Without a prescription, you must pay for the entire treatment yourself.
Prescription details:
Your GP or specialist issues the prescription
It includes diagnosis, treatment type, and number of sessions
You only pay the €10 prescription fee once per prescription
For follow-up prescriptions for the same diagnosis, the prescription fee is waived
Tip for privately insured: Clarify with your insurance in advance whether and to what extent physical therapy is covered. Some plans require prior notification.
Direct Access: Physical Therapy Without a Prescription – Is It Possible in Germany?
Want to start physical therapy immediately without seeing a doctor first? In Germany, this is only possible under certain conditions.
The legal situation: physical therapy is considered medical treatment. Regular physiotherapists cannot treat illnesses without a doctor's prescription – that would be illegal. But there's an exception: the sectoral alternative practitioner for physical therapy (sektoraler Heilpraktiker für Physiotherapie, sHP-PT).
Your options without prescription:
1. Sectoral Alternative Practitioner physical therapy
Physiotherapist with additional alternative practitioner license
May diagnose and treat independently
Costs: €35–70 per session (purely private service)
Initial assessment often €50–70 additional
Health insurance does NOT pay – not even partially
2. Wellness and Prevention
Pure relaxation massages or prevention courses
No treatment of illnesses • Costs: €30–60 per session
Prevention courses under § 20 SGB V: Insurance often reimburses 80%
Decision guide: Prescription or direct access?
Direct access via sHP-PT makes sense when:
You have acute complaints and need immediate help
The wait for a doctor's appointment is too long
You're willing to pay €200–300 yourself
Your private insurance covers alternative practitioner services
Better see a doctor first when:
Your budget is under €150
You have chronic or complex complaints
Red flags are present (severe pain, numbness, after accident)
You need a sick note
Important: The politically discussed "direct access" for all physiotherapists hasn't been implemented as of 2025. Pilot projects are running, but nationwide introduction is still pending.
Bottom line: physical therapy costs in Germany are quite predictable. With a prescription, your expenses remain manageable – expect about €3–5 per session plus a one-time €10 prescription fee. Without a prescription, it's significantly more expensive, but prices are still fair. What's important is not to postpone your treatment due to cost concerns. Talk to your doctor about a prescription and use the insurance benefits you're entitled to.
Quick Overview: Physical Therapy Costs in Germany at a Glance
Treatment Path | Your Costs | Advantages | Disadvantages |
With insurance prescription | €10 prescription fee + approx. €3-5 per session | Affordable, quality assured | Waiting time for doctor appointment |
With private prescription | €30-80 per session | Medical assessment available | Full costs self-paid |
Direct access (sHP-PT) | €35-70 per session + initial assessment | Start immediately, no doctor needed | No insurance reimbursement |
Wellness/Prevention | €30-60 per session | Uncomplicated, no waiting time | No illness treatment |
Money-Saving Tips: How to Reduce Your Physical Therapy Costs in Germany
1. Don't forget your tax return You can deduct physical therapy costs as extraordinary expenses (außergewöhnliche Belastungen). Collect all receipts – co-payments count too! The reasonable burden ranges from 1-7% of your annual income depending on your tax bracket.
2. Use prevention courses Back school, Pilates, or yoga as prevention courses under § 20 SGB V: Health insurance often reimburses 80% of costs (up to €150 per course). You can usually use two courses per year.
3. Health insurance bonus programs Many insurers reward health-conscious behavior. Regular check-ups, exercise, or non-smoking earn points – redeemable as subsidies for health services.
4. Optimize prescriptions:
Get the maximum number of sessions prescribed to minimize prescription fees
Use all prescribed appointments – expired sessions you'll have to pay for yourself later
For long-term therapy: Ask about "prescriptions outside standard care" (Verordnung außerhalb des Regelfalls)
5. Compare prices As a self-payer, price comparison pays off. Some practices offer:
Volume discounts for 10-session packages
Reduced rates for off-peak hours (early morning/late evening)
Student rates or social rates
