GKV Cost-Cutting Act 2026: What It Means for ENT Practices
The GKV Contribution Rate Stabilisation Act has been passed. From 2027, extra-budgetary remuneration for referred appointments and open consultation hours will be discontinued, among other changes. We explain what this means for ENT practices and where room for manoeuvre remains.
Reading time approx. 5 min · As of: August 2026 · Professional information for practices
Key points at a glance
- The GKV Contribution Rate Stabilisation Act was passed in July 2026. Many provisions relevant to medical practices will apply from 1 January 2027. These include the discontinuation of special remuneration for appointment-service cases, GP-referred cases and open consultation hours.
- According to calculations by the Central Institute, ENT practices could face average fee losses of more than €44,000 per physician per year.
- Audiometry and hearing tests remain included in the EBM, including GOP 09320 and 09321. Budget-related reductions may still apply.
- The abbreviated care pathway under Section 128(4) SGB V remains contractually regulated and is not remunerated through the regular EBM budget. The three-percent reduction for care episodes started in 2027 or 2028 generally applies to the medical-aid contract price under Section 127 SGB V, not automatically to physician remuneration.
The new cost-cutting law: the BStabG from 2027
The GKV Contribution Rate Stabilisation Act was passed by the Bundestag and Bundesrat in July 2026. Some provisions entered into force on 30 July 2026, while many of the changes relevant to medical practices will apply from 1 January 2027.
The core change in outpatient care: extra-budgetary surcharges for appointments arranged through appointment service centres, GP-referred appointments and open consultation hours will be discontinued and transferred to the morbidity-adjusted total remuneration (MGV), making them subject to budget limits.
The aim is to stabilise SHI contributions, not to target savings at a single specialty. The effect is felt broadly across the outpatient sector; ENT practices are indirectly affected via the eliminated surcharges.
What is changing for ENT practices
Extra-budgetary surcharges are eliminated (from 2027)
The special remuneration for appointment-service cases, GP-referred cases and open consultation hours will end in 2027. According to calculations by the Central Institute, ENT practices could face average fee losses of more than €44,000 per physician per year. The abolition of the new-patient rule in 2023 had already reduced the financial flexibility of many specialist practices.
Hearing tests and audiometry: retained, but budgeted
Audiometric services such as pure-tone audiometry under GOP 09320 and speech audiometry under GOP 09321 remain included in the EBM and can continue to be billed. Budget-related reductions may apply where case volumes are high. According to the German professional association of ENT physicians, the current valuation does not fully cover the actual staffing costs.
This assessment is a position of the professional association, not an objective consequence of the law – and should be understood as such.
Important to clarify: what is not true
Economic room to manoeuvre is narrowing while the need for hearing care is rising. However, this does not mean that ENT services are being cut across the board.
Hearing tests and audiometry are not being removed from the SHI catalogue. The reform cuts extra-budgetary surcharges, not the audiometric services themselves.
Where ENT practices retain extra-budgetary room
While the reform transfers the special TSVG remuneration into the budget, the abbreviated care pathway under Section 128(4) SGB V remains governed by selective contracts. Physician remuneration continues to be settled outside the regular EBM budget and is determined by the relevant health-insurance contract, for example €150 for monaural and €250 for binaural provision under the vdek contract, depending on the applicable contract. In this way, structured hearing aid provision can become an additional, clearly regulated pillar of care — organisationally lean, with medical responsibility remaining in the practice.
Hearing aid provision as an additional pillar of your ENT practice
How Mr. Hear implements this together with ENT practices – structured, digital and reimbursed outside the budget. Medical responsibility stays with your practice.
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Call the hotline: 0800 234 4321Frequently asked questions
- Are hearing tests being removed from the SHI catalogue?
- No. There is no sound basis for this. The changes concern remuneration and budgeting, not the service itself.
- What changed with the removal of the new-patient rule?
- Since 1 January 2023, the extra-budgetary remuneration for new patients has been discontinued. This reduces the economic room to manoeuvre of outpatient specialist care in general.
- Does the reform mean concrete cuts for ENT practices?
- Yes. By 2027 at the latest, the BStabG will end the special remuneration for appointment-service cases, GP-referred cases and open consultation hours. This also affects ENT practices. Audiometric services themselves will not be removed from the EBM.
- Is the abbreviated care pathway affected by the reform?
- Not as a result of the removal of TSVG remuneration. The abbreviated care pathway under Sections 128(4) and 128(4a) SGB V remains contractually regulated; the separate remuneration of the ENT practice continues outside the regular EBM budget. The three-percent reduction for 2027 and 2028 generally applies to the medical-aid contract price agreed under Section 127 SGB V, not automatically to physician remuneration. This may change, however, if the relevant health-insurance contract is amended.
Sources include: BMG – ministerial draft BStabG (29.04.2026); Health Finance Commission, First Report (30.03.2026); KBV press release (30.04.2026); Zi analysis / Medical Tribune (fee loss); KVB EBM catalogue (audiometry codes); National Association of Statutory Health Insurance Physicians, Effects of the GKV Cost-Cutting Act on Outpatient Care, updated 30 July 2026; GKV-Spitzenverband (2026 orientation point value); Section 128 SGB V; hno-aerzte.de (association positions). Updated: August 2026. Some provisions still require further specification by the Evaluation Committee or the Federal Joint Committee. This article provides general information for professional audiences and does not replace legal, tax or billing advice.