GOÄ no. 491: Local infiltration anaesthesia, large area

By Dr. Pascal Bafteh, board-certified dermatologist and internist · Updated 10/2026

Section D – Anaesthesia · Category: Injection, infusion, infiltration, anaesthesia

Official German wording: „Infiltrationsanästhesie großer Bezirke - auch Parazervikalanästhesie -“

121 points · €7.05 (1.0×) · €16.22 (2.3×, threshold) · €24.68 (3.5×, maximum)

Fees

Factor	Amount
1.0×	€7.05	single rate
2.3×	€16.22	threshold – above it a written justification (§ 12(3))
3.5×	€24.68	maximum

Personal medical service: range 1.0 to 3.5, threshold 2.3 (§ 5(2) GOÄ). A factor above the threshold is only allowed for particular circumstances of the individual case (difficulty, time, circumstances) and must be justified in writing.

Exclusions and rules

Nr. 490 – Several anaesthesia methods together: only the highest-valued (section D).
If several anaesthesia methods are used together, only the highest-valued one is billable (section D, general provisions).

Typical occasions in dermatology

Local anaesthesia of a large area, e.g. before removing a larger tumour or performing a flap.

More items in this category

490 – Local infiltration anaesthesia, small area 290 – Infiltration of sclerosing agents 284 – Autologous blood injection incl. sampling 272 – IV infusion over 30 minutes 271 – IV infusion up to 30 minutes 270 – Subcutaneous infusion 267 – Therapeutic infiltration 253 – Intravenous injection

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Source: German fee schedule for physicians (GOÄ), schedule of fees – gesetze-im-internet.de.

Applies to private medical services under the GOÄ; not to statutory health insurance (EBM). New GOÄ: the German Medical Association considers entry into force on 1 January 2028 realistic. Official wording and points: gesetze-im-internet.de; amounts = points × €0.0582873 × factor (§ 5(1) GOÄ). Data checked: 09/10/2026.