Introducing a skin-analysis IGeL service in your practice, from consent to billing

Offering a 3D skin analysis as an IGeL (Individuelle Gesundheitsleistung, an individual self-paid health service in Germany) is legally well defined. It is not about marketing a procedure but about offering patients clear, fairly priced value that the statutory health insurance does not cover. To do this seriously and without regulatory risk, there is a defined sequence laid out in the joint guide by the German Federal Medical Council (BÄK) and the Federal Association of Statutory Health Insurance Physicians (KBV). We walk through it step by step.

What IGeL actually means

IGeL stands for "Individuelle Gesundheitsleistung", an individual health service. These are services that are not part of the statutory health insurance catalogue and that patients pay for themselves. A 3D skin analysis for progress documentation of an aesthetic treatment or for extended skin-status assessment outside an acute illness is a classic IGeL case.

The distinction to statutory care matters. If a patient presents with a dermatological suspected diagnosis and a skin analysis serves as part of the diagnostic workup, that may be part of regular care, not strictly IGeL. If the trigger is progress documentation of an aesthetic treatment or a self-request by the patient, it is clearly IGeL.

The five steps of a clean IGeL introduction

KBV and BÄK recommend a sequence in their IGeL guide that protects patients while keeping the practice on the legal-safe side:

1. Clarify indication and trigger

Before offering a service as IGeL, the practice must internally clarify the constellations in which it makes sense and those in which it does not. For 3D skin analysis this typically means: progress documentation in aesthetic treatments, supplementary skin-status assessment in IGeL consultations (acne, anti-aging, pigment), capture before laser treatment. Non-indications are all care contexts already covered by statutory insurance.

2. Verbal patient briefing

The consultation must clarify: what the examination does and does not do (skin-image documentation, not cancer screening, not a diagnostic guarantee), why the health insurance does not cover it, what alternatives exist (including the option to decline), the approximate cost. Important: do not promise anything the examination does not deliver.

3. Written treatment agreement

Before the service is provided, a written agreement with the patient is mandatory. It contains: service description, expected cost and billing basis (typically GOÄ tariff number and multiplier), note that statutory health insurance does not cover the service, date, signatures of patient and practice. The agreement must be understandable, not hidden in fine print. Without a signed agreement, the bill can be contested.

4. Allow time to consider

Patients must have the opportunity to consider before agreeing to the IGeL. KBV explicitly recommends against creating "decide now" pressure situations. Practically, this means in skin-analysis practice: do not necessarily combine the consultation and the capture on the same appointment, or at least hand out written information that the patient takes home.

5. Service delivery and billing

Only after the previous steps does the actual skin analysis happen. Billing follows the German fee schedule for physicians (GOÄ), see our article on GOÄ billing of skin analysis. The bill must clearly itemize the service; the patient pays directly or via invoice.

What the practice must not do

A range of practices are considered improper in the IGeL context and can expose the practice to regulatory risks:

• Counter-sale at reception ("we can just do that now") without medical briefing
• Promises the service does not keep (cancer screening, guaranteed treatment results, healing)
• Concealing that an alternative (including "do nothing") exists
• Presenting the IGeL service as a condition for regular care (a serious breach of professional duty)
• Communicating costs only after treatment
• Using before/after photos for advertising, which since the German Federal Court ruling I ZR 170/24 (2025) violates § 11 HWG (Healthcare Advertising Act)

IGeL-Monitor and consumer-protection organisations watch this market. A poor public IGeL review carries reputational consequences.

Patient communication, how to talk about it

A serious IGeL skin analysis does not need to be "sold". It speaks for itself if the trigger fits. A proven phrasing from practices with long IGeL tradition: "We offer you the option to document your current skin status with a 3D capture. This is a service the statutory insurance does not cover, so you would pay it yourself. I am happy to explain what the examination shows and does not show, and you decide in your own time."

The opposite of that: "Let us just do it now, it is not expensive either." Such phrasings create pressure and are problematic from an IGeL perspective.

Where Dermalia fits into this sequence

Dermalia is the technical envelope for the actual skin-analysis capture and the report derived from it. We clearly sit on the service-delivery side. The IGeL workflow (briefing, written agreement, reflection time, billing) is the practice's responsibility and remains in the medical scope.

We support indirectly through:

• a professional report that shows the patient the value of the service without feeling marketing-driven
• language in the report that invites medical consultation rather than self-diagnosis
• clear technical metrics (with methodology sources in our knowledge articles) that make the service comprehensible
• the option to reopen the report at any time in the practice if the patient has questions

What we deliberately do not provide: billing-multiplier calculations, marketing slogans or promises about "patient acquisition". This is not appropriate in the IGeL context and not our job.

Sources and further reading

• KBV and BÄK, "Selbst zahlen? Ein Ratgeber zu Individuellen Gesundheitsleistungen": bundesaerztekammer.de
• Association of Statutory Health Insurance Physicians Baden-Württemberg, IGeL Code: kvbawue.de/igel-kodex
• Association of Statutory Health Insurance Physicians Westfalen-Lippe, IGeL overview: kvwl.de/igel
• Federal Ministry of Health, IGeL definition: bundesgesundheitsministerium.de
• BGH ruling on advertising ban with before/after images (I ZR 170/24, 31 July 2025): see BGH press release.

As of May 2026. This article is not legal advice. The practical implementation of an IGeL depends on the specific practice constellation, the professional code of the responsible regional medical board, and where appropriate consultation with the regional association of statutory health insurance physicians.