Since 1 January 2022, patients receive a copy of the invoice from the service provider for every consultation. This came into effect together with adjustments to the Health Insurance Act (KVG) in connection with the cost-containment package. It is meant to encourage patients to check the costs of their medical consultations and, if necessary, raise an objection. Unfortunately, understanding a doctor's invoice requires knowledge that the average patient does not have. To avoid misunderstandings, we try here to break down and explain the most important items on an ophthalmologist's invoice.
Since 1 January 2026, the previous tariff TARMED has been replaced by the new outpatient physician tariff TARDOC. The position numbers and, in some cases, the billing logic itself (e.g. per-minute instead of five-minute blocks) have changed as a result, but the underlying services have largely remained the same.
Measurements and examinations are also regularly carried out that cannot be billed but nevertheless belong to state-of-the-art ophthalmological care (e.g. fitting of glasses, automatic refractometry).
On the one hand, it is the treating physician's responsibility not to order unnecessary examinations; they must be able to justify their services to the health insurer if required. On the other hand, the physician is also responsible for ensuring that the examination is correct and complete, so as not to endanger the patient's health or miss anything. Patients can of course decline costly measurements. The physician will however note this accordingly in the medical record, in order to avoid liability, or may decline to continue treating the patient altogether.
Compared to general practitioners, psychiatrists or other specialists, ophthalmologists need an above-average number of costly devices, which also have to be amortised. As a result, the bill for a short examination at the ophthalmologist tends to be above average compared to other physicians.
The exact amount charged for the corresponding position can be looked up online in the Tarifbrowser and is made up of a medical and a technical service, which is settled using the point value (Taxpunktwert) of the relevant canton.
Some health insurers send patients a letter in which they use the billed minutage to calculate how long the examination "should actually" have taken, and question the invoice on that basis. This calculation often reflects the time actually required only inadequately: history-taking, explanations, preparation of measurements and the complexity of the respective condition vary considerably from patient to patient and cannot simply be forced into a rigid time scheme. In addition, the minutage used by health insurers is partly based on outdated assumptions and does not take into account that individual examination steps are delegated to and carried out by non-physician staff (e.g. medical practice assistants or orthoptists), which additionally affects effective time planning in practice.
Tariff positions are also based on a normatively defined time (a flat-rate, typified assumption of how long a service usually takes), not on the time actually measured in the individual case. A position may therefore still be billed even if the time actually spent in the specific case was shorter – except for genuine "time tariffs", where remuneration is directly linked to the actual duration (which is not the case for most ophthalmological positions).
Greeting
Unlike previously under TARMED, where billing was done in 5-minute blocks, under TARDOC each individual minute from the 6th minute onward is billed separately – up to a maximum of 15 times per consultation.
Example: A consultation with a total duration of 30 minutes is billed as follows:
First 5 min. + 25 further minutes individually.
For young children or elderly patients, other positions may apply, as this group of patients is assumed to require more time.
Vision test performed by the optician/optometrist/ophthalmologist to determine the best possible visual acuity, including subjective testing on the autorefractometer.
Vision test performed by the optician/optometrist/ophthalmologist to determine the best possible visual acuity, including binocular balancing if necessary.
When is this needed?
As soon as the refraction, i.e. the correction of vision, changes, an extended refraction determination is needed to find out whether the glasses are still correct or whether new glasses need to be prescribed. Before an eye operation, the maximum visual capacity must be determined, as well as after the eye has recovered from an operation.
Discussing and explaining a planned procedure or diagnostic test (process, chances and risks), including adequate documentation of the patient information provided. Under TARDOC, this same position now also covers the follow-up discussion (up to 14 days postoperatively) and is billed per minute rather than, as before, per 5 minutes (maximum 60 times per 90 days).
To explain to the patient the use and operation of technical aids (e.g. eyelid margin care). Now billed per minute instead of per 5 minutes (maximum 15 times per consultation, maximum 30 times per 90 days).
Measurement of intraocular pressure by the optician/optometrist/ophthalmologist and assessment of the optic nerve at the slit lamp.
When is this needed?
As a rule, intraocular pressure is measured at all routine examinations. Elevated intraocular pressure can lead to glaucoma and thus directly threaten eyesight. Regular pressure measurement is also particularly important during postoperative checks after an intravitreal injection, after cataract surgery, or when the patient is using cortisone preparations.
Examination of the central retina is performed at the slit lamp using a lens (fundoscopy) and is also part of the routine ophthalmological examination. Macular oedema, haemorrhages, retinal detachments and inflammation inside the eye are detected in this way.
Here, not only the optic nerve and the central retina but also the peripheral areas of the retina are examined.
When is this needed?
In patients with conditions such as diabetes or high blood pressure, the outer retinal areas should also be examined for, e.g., haemorrhages or vascular changes. By administering tropicamide eye drops, the pupil can be dilated and the far peripheral retina assessed as well. This is necessary, among other things, as soon as there is a suspicion of posterior vitreous detachment, retinal tear or detachment.
Fundus photography is a kind of photograph of the retina.
When is this needed?
As soon as an abnormality such as a retinal naevus, retinal tear, retinal haemorrhage, etc. is detected, or a systemic disease is present that could affect the retina (e.g. diabetes mellitus), fundus photography is performed to document the finding. In later examinations, the images can be compared to detect a worsening or improvement.
As soon as an abnormality is discovered during biomicroscopy, i.e. during fundoscopy of the macula or the optic nerve, cross-sectional imaging is performed using the OCT device.
This produces layered images of the retinal tissue, which serve both for diagnosis/documentation and for determining the indication for surgery.
When is this needed?
As a rule, all patients with diabetes mellitus undergo an examination with the OCT device in order to detect diabetic macular oedema at an early stage, as well as before intraocular procedures such as cataract surgery.
Before and during therapy with medications that can alter the retina as a side effect (e.g. chemotherapeutics, anti-rheumatic drugs), an OCT measurement is also carried out so that therapy can be discontinued or adjusted at an early stage.
In patients with glaucoma, an OCT measurement of the nerve fibre layers at the optic nerve is also performed at every consultation and compared with previous measurements. This is the only way to assess the progression of the disease and the success of intraocular pressure-lowering medication or treatments.
For routine examinations in patients aged 50 and over with a known family history of retinal or glaucoma disease, OCT measurements as part of a screening also make sense. However, these have for some time no longer been reimbursable by health insurance. Whether the measurements are therefore not performed, are performed and a fundus photo is billed instead, or are billed as a self-pay service, is up to the service provider to decide.
Here, a contrast agent is injected into the patient's vein and the retina is then photographed with specially filtered light. This is used to examine the blood flow in the retina and whether there are vessels that leak and can thus lead to, for example, macular oedema.
When is this needed?
After a vascular occlusion or in diabetic retinopathy
New, harmful vessels that can cause macular oedema, for example, can also be detected by angio-OCT without the use of contrast agent.
New (since TARDOC), a dedicated tariff position now exists for this examination – under TARMED it could not yet be billed separately. It cannot be combined with fluorescein angiography.
The Amsler grid is a grid of fine black lines on a white background with a central fixation point. It is an inexpensive and efficient means of subjectively checking the central retina and macula. If the macula is thickened (e.g. in macular oedema, epiretinal membrane), the patient perceives the grid lines as distorted or wavy. Defects in the macula result in central visual field defects. After a positive Amsler grid test, an OCT measurement is usually performed to determine the exact cause.
In gonioscopy, the anterior chamber angle is assessed at the slit lamp, if necessary with the aid of a gonioscopy lens.
When is this needed?
This examination is indicated especially in cases of glaucoma, intraocular inflammation, diabetes mellitus, or after trauma to the eye.
The contact lens examination is also used to assess the peripheral retina.
Visual field examination is an important part of glaucoma diagnostics. In glaucoma, there is progressive degeneration of the retinal nerve fibres, which follows a typical pattern. This degeneration causes defects in the visual field. An increase in this defect indicates elevated intraocular pressure and requires corresponding therapeutic measures.
Degeneration of the nerve fibre layer can be objectively demonstrated directly by OCT measurement at the optic nerve.
Through perimetry and OCT measurement, it is possible to assess the progression of glaucoma and the success of intraocular pressure-lowering medication or other glaucoma treatments. These can be billed provided there is advanced glaucoma or an operation follows the measurement.
For routine examinations in patients aged 50 and over with a known family history of retinal or glaucoma disease, OCT measurements as part of a screening also make sense. However, these have for some years no longer been reimbursable by health insurance.
Some ophthalmologists therefore bill OCT measurements as a self-pay service, which must be communicated before the measurement.
If a neurological cause of eye symptoms is suspected, a neurological assessment by the ophthalmologist is indicated. This includes tests to examine the function of various cranial nerves, such as gaze, visual field, eye and eyelid movements, corneal sensitivity and pupillary motor function.
In the Schirmer test, tear production in the eye is measured with a paper strip.
In the fluorescein clearance test, the tear film and its stability on the cornea, as well as the drainage of tear fluid, are examined.
In corneal topography, the surface of the cornea is measured. This produces a kind of elevation map, similar to a hiking map, where the elevation differences are described by the deviation from a spherical surface (best-fit sphere).
When is this needed?
Pachymetry precisely measures the thickness of the cornea. This can be done using ultrasound, OCT or a Scheimpflug camera.
When is this needed?
This produces high-resolution cross-sectional images of the cornea to determine corneal thickness, the depth of corneal scars, and to document corneal melting. New (since TARDOC), a dedicated tariff position now exists for this examination.
Measurement of corneal sensitivity.
In cases of ocular herpes, corneal sensitivity is reduced; here the measurement helps confirm the diagnosis. Before numerous procedures on the anterior segment, corneal aesthesiometry is performed in order to make a prognosis, e.g. regarding dryness of the eyes after a refractive procedure.
This examination can no longer be billed as a separate position under TARDOC and is now included in the basic consultation.
Patients who experience glare usually suffer from turbidity of the optical media, e.g. turbidity in or on the cornea, or turbidity of the natural or artificial lens.
When is this needed?
The endothelial cells line the back of the cornea and continuously pump water out of the cornea. In corneal diseases or after intraocular procedures (e.g. cataract surgery), the number of endothelial cells may be reduced.
When is this needed?
Assessment and counting of the endothelial specular microscopy image.
E.g. expression of secretion from the meibomian glands in meibomian gland dysfunction.
Emergency and urgency flat rates
TARDOC newly distinguishes two levels: urgency flat rates (treatment indicated within 2 hours) and emergency flat rates (genuine emergency). How is the emergency nature of a consultation defined?
With direct physician-patient contact: any patient in whom, regardless of the triggering cause, a disturbance of vital functions has developed, is to be feared, or cannot be ruled out. This also applies to patients in whom an acute illness, trauma or poisoning can cause or result in organ damage.
Without direct physician-patient contact: medically necessary and/or considered obviously necessary by the patient, relatives or third parties.
Depending on the time of the service, different flat rates are billed:
For emergency consultations
Monday to Friday 7 a.m. to 7 p.m.
Saturday 7 a.m. to 12 p.m.
Monday to Friday 7 p.m. to 10 p.m., Saturday 12 p.m. to 7 p.m., Sunday 7 a.m. to 7 p.m. (plus 25% surcharge on the medical service, AA.30.0050).
Monday to Friday 10 p.m. to 7 a.m. as well as Sunday 7 p.m. to 7 a.m. (plus 50% surcharge on the medical service, AA.30.0070).
For consultations that are needed promptly (within 2 hours) but are not indicated as a genuine emergency, there are additionally the lower urgency flat rates A (Mon–Fri 7 a.m.–7 p.m., Sat 7 a.m.–12 p.m., AA.30.0010) and B (Mon–Fri 7 p.m.–10 p.m., Sat 12 p.m.–7 p.m., Sun 7 a.m.–7 p.m., AA.30.0020).
Unlike under TARMED (a flat fee per 11–35 lines), under TARDOC report writing is billed per minute and differentiated by recipient:
Reports to referring or co-treating physicians as well as therapists.
Reports sent directly to the patient or relatives.
Reports to the health insurer or other insurers. The first report to the insurer cannot be billed separately; completing pre-formulated questionnaires for insurers can only be billed if a recommendation results from it.
