RLV and QZV explained

As of: September 2026

This article provides a general overview. The specific rules depend on the fee distribution scheme (Honorarverteilungsmaßstab, HVM) of the respective Association of Statutory Health Insurance Physicians (KV) and change regularly. It does not replace billing or legal advice. The rules and notifications of your KV are binding.

What this is about

In Germany, services for patients with statutory health insurance are not simply paid by quantity. The health insurers essentially pay a morbidity-based total remuneration to the regional Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung, KV). The KV distributes this budget to practices according to its fee distribution scheme (HVM). The legal basis is Section 87b of the German Social Code Book V (SGB V); each KV sets its own HVM in consultation with the regional associations of health insurers and the substitute health insurance funds (Ersatzkassen).

To make distribution predictable, many HVMs work with service volumes: each quarter, a practice is allocated a volume up to which services are paid at the prices of the regional euro fee schedule.

Standard service volume and additional volumes

• Standard service volume (Regelleistungsvolumen, RLV): the basic volume of a practice for the typical services of its specialty. It is often calculated from case numbers of a previous-year quarter and specialty-specific case values.
• Qualification-based additional volume (qualifikationsgebundenes Zusatzvolumen, QZV): additional volumes for certain services that require a specific qualification or approval.

Which services belong to a volume, how volumes are calculated and whether they can be offset against each other is governed by the respective HVM. Terms and boundaries differ between KVs.

What happens when a volume is exceeded?

Services beyond the allocated volume are usually no longer paid at the full price but at graduated or quota-based rates. The level of this residual payment is not fixed; it depends on how much money remains after the volumes have been distributed. For planning, this means: once a volume is used up, the marginal revenue of further exams assigned to that volume collapses.

Services outside the volumes

Not all services are subject to volumes. Certain services are paid outside the morbidity-based total remuneration (extrabudgetary services), and others are regulated separately in the HVM. Services for privately insured patients and self-payers are billed under the GOÄ and are not affected by RLV and QZV.

For an economic calculation these are three revenue sources that have to be looked at separately: budget-bound EBM, extrabudgetary EBM and GOÄ.

What this means for scheduling

• Monitoring during the quarter: knowing the expected utilisation early allows the scan mix to be adjusted in time, rather than finding out from the fee statement. What is meaningful is utilisation relative to progress through the quarter, not the absolute figure.
• Mix, not just volume: the economic effect of an additional exam depends on which volume it is assigned to and how much of that volume is already used.
• Regional differences: models and metrics must be adapted to the HVM of the respective KV. A practice with sites in several KV regions needs separate views.
• Framework: the mandate to provide care and medical urgency apply regardless of volume utilisation.

How we take these factors into account is described on cost and revenue per scanner hour and economic scheduling.

Austria and Switzerland

RLV and QZV are part of statutory physician reimbursement in Germany. Austria and Switzerland have different reimbursement systems that need to be considered separately.