Which SGB V sections can diagnostics be financed through?

The most common routes: §140a (special care / selective contracts), §25 (early detection), §20a (health promotion), §20b (treatment steering). Which section applies depends on the care objective — prevention, primary prevention, treatment pathway or therapy monitoring.

What is a selective contract under §140a?

A direct contract between a statutory health insurer and service providers outside the collective contract. It allows structured programmes with defined modules, indications and billing logic to be set up — e.g. a prevention programme with home sampling, a telemedicine consultation and follow-up diagnostics.

Does home testing lower the uptake barrier?

Yes, significantly. Those who do not need a clinic appointment and receive the kit by post take up offers more often — especially in underserved regions or among low-threshold target groups. More in the article on the benefits of home sampling.

Do we receive an economic analysis?

Yes. Based on the structure of your insured population we prepare an individual model — with cost estimates, scaling scenarios and suitable financing routes. Not legal advice — it complements the legal review by your in-house lawyers.

Financing prevention: reimbursement and care models for diagnostics under SGB V

§140a SGB V — special care (selective contracts)

§140a allows statutory health insurers to enter into direct contracts with service providers outside the collective contract. This makes it possible to set up structured care programmes with clearly defined modules — for example:

A prevention programme “Metabolic Check 35+” with home blood count, a telemedicine results conversation and a physician’s recommendation.
A follow-up programme for insured members with metabolic risk factors — recurring diagnostics, AI-supported trend visualisation, medical follow-up.

An example from the Probatix portfolio: the programme for the KKH uses exactly this mechanism — insured members are guided directly into a structured diagnostics workflow, from kit dispatch through to digital result.

What an insurer needs for such a programme:

Concept — indication, objective, modules, billing logic.
Service providers — who delivers the medical service, who handles the diagnostics.
Member enrolment — GDPR-compliant onboarding and consent.
Evaluation — defined KPIs (participation rate, effectiveness, economic value).

In such contracts Probatix delivers the diagnostics module: kit dispatch, lab analysis, structured result. Routing into the telemedicine or contracted physician module via the API.

§25 SGB V — early detection

§25 obliges the statutory health insurance system to provide defined early-detection measures. This is where home testing opens up a central lever: the uptake rate for many standard prevention offers is low because a clinic visit is required. When the kit arrives by post, that hurdle drops away.

In the Probatix portfolio specifically:

Colorectal cancer early detection via the immunochemical iFOBT method (faecal occult blood, home kit).
HPV high-risk test as a self-swab for cervical cancer screening.
PSA screening for prostate cancer early detection — the first nationwide home-sampling programme for PSA in Germany.
Diabetes screening via HbA1c from liquid capillary blood.
In preparation: lipoprotein(a) [Lp(a)] for cardiovascular risk stratification.

§20a SGB V — health promotion

§20a allows insurers to finance health-promotion measures. Diagnostics with recommendations is a genuine differentiator here:

Member retention — a high-quality health check as a value-add offering.
Data-based recommendations — individualised guidance based on actual values.
Programme anchor — diagnostics as an entry point into structured follow-up programmes (e.g. nutritional advice, exercise).

§20b SGB V — treatment steering

§20b governs data-based care steering via valid biomarkers. In concrete terms: those who know early that an insured member has an elevated risk profile can intervene early — and avoid expensive late effects.

Examples:

Risk stratification — cardiovascular risk via lipid profile + HbA1c + hsCRP.
Adherence monitoring — e.g. blood-glucose trajectories in diabetics.
Steering into specific programmes — out-of-range values trigger automatic enrolment in a suitable follow-up programme.

Preconditions & selective-contract logic

A selective contract typically comes about like this:

Programme idea — the insurer defines indication, target group, care objective.
Service-provider chain — who delivers diagnostics, who telemedicine, who medical care.
Concept & economics — module plans, remuneration per module, KPI definition.
Contract draft — legal departments work out the details (data protection, liability, exclusions).
Pilot / roll-out — usually start with a small cohort, then scale.

Probatix’s role: we deliver diagnostics as a scalable module. You keep programme ownership, we carry the infrastructure load.

How Probatix supports implementation

White-label — kits and results in the branding of the insurer or programme.
Accredited laboratories — EU analysis, ISO 15189.
EU data processing — GDPR-compliant, no US processing without a legal basis.
Routing — automated handover of out-of-range results to telemedicine or contracted physicians (§116b, §117).

Note

This article describes the logic in general terms. It does not replace legal advice. The specific drafting of contracts belongs in the hands of your legal department — we provide the operational and technical foundation for it.