Invoice Surgeon in Germany Frankfurt –Free Word Template Download with AI
Dr. med. Klaus Weber, Chief Surgeon
Opernplatz 10, 60313 Frankfurt am Main
Germany
Tel: +49 69 12345678 | Fax: +49 69 12345679
Email: [email protected]
USt-IdNr.: DE123456789
Invoice No: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Reference: Surgery Case #8842-F
Bill To (Insurance / Payer)
AOK Hessen
Health Insurance Provider
Wilhelm-Leuschner-Straße 48
60329 Frankfurt am Main
Germany
Policy Holder ID: AOK-H-998877
Patient Information
Name: Mr. Thomas Müller
Date of Birth: 15.05.1978
Address: Mainzer Landstraße 100, 60327 Frankfurt
Procedure Date: October 10, 2023
Diagnosis Code (ICD-10): M54.5 (Low back pain)
| Item No. | Description of Surgical Services | GOÄ / Fee Code | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|
| 1 | Pre-operative consultation and assessment by the lead surgeon in Frankfurt. Includes review of MRI scans and surgical planning. | GOÄ 2010 | 150.00 | 150.00 |
| 2 | Primary surgical procedure: Microdiscectomy L5/S1. Performed by Dr. Weber at Frankfurt Surgical Center. | GOÄ 2030 x 2.5 | 1,200.00 | 3,000.00 |
| 3 | Use of specialized surgical instruments and navigation system during the operation. | GOÄ 2040 | 450.00 | 450.00 |
| 4 | Anesthesia services provided by certified anesthesiologist during the procedure. | GOÄ 2050 | 600.00 | 600.00 |
| 5 | Post-operative monitoring and immediate care in the recovery unit for 4 hours. | GOÄ 2060 | 300.00 | 300.00 |
| 6 | Follow-up consultation one week post-surgery to assess healing progress. | GOÄ 2070 | 120.00 | 120.00 |
| 7 | Medical documentation and official discharge report for insurance purposes. | GOÄ 2080 | 80.00 | 80.00 |
| Subtotal (Net) | 4,700.00 EUR |
| VAT (19%) | 893.00 EUR |
| Total Amount Due | 5,593.00 EUR |
Payment Instructions
Please transfer the total amount to the following bank account within 30 days of the invoice date:
Bank Name: Commerzbank AG, Frankfurt am Main
Account Holder: Frankfurt Surgical Center GmbH
IBAN: DE89 5004 0000 0012 3456 78
BIC: COBADEFFXXX
Reference: INV-2023-10-045
Terms and Conditions
1. This invoice is issued in accordance with the German Fee Schedule for Physicians (GOÄ) applicable in Frankfurt, Germany.
2. Payment is due within 30 days. Late payments may incur interest charges as per German commercial law.
3. All surgical procedures were performed with the highest standard of care by qualified surgeons at our Frankfurt facility.
4. Please retain this invoice for your records and for submission to your health insurance provider.
5. For any questions regarding this invoice, please contact our billing department at [email protected].
Authorized Signature:
Dr. med. Klaus WeberChief Surgeon & Director ⬇️ Download as DOCX Edit online as DOCX
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