Who this page is for
Practices with prescribed services, longer treatments, or payer review
In practice, KOGU usually means Kostengutsprache: a payer confirms before or during treatment that specific services will be covered under defined conditions.
One KOGU rule does not apply to all therapies. Psychotherapy, physiotherapy, hospital services, accident insurance, disability insurance, supplementary insurance, and cantonal processes can differ significantly.
What a cost approval does
A cost approval clarifies scope, period, and conditions of coverage. It is used especially when treatments continue for longer, exceed normal limits, or require additional documents.
For the practice, the evidence matters alongside the approval: who requested it, when, what was approved, until when, and for how many sessions or services?
Examples from therapy contexts
For psychological psychotherapy under the Swiss prescription model, the FOPH describes insurer cost approval before continuation after 30 sessions. For physiotherapy long-term treatment, Physioswiss describes insurer cost approval for treatment beyond 36 sessions.
These examples vary by context. The concrete rule always depends on insurance branch, tariff, prescription, specialty, and payer.
- Psychotherapy: check continuation after the defined number of sessions.
- Physiotherapy: document long-term treatment and prescription completely.
- Other services: use insurer, association, or authority information as the reference.
Documentation in practice software
Information related to KOGU is stored with the case. Practice software keeps case, patient, prescription, approved period, session count, documents, and billing status together.
The practice can then see when a case is close to the approved amount, when a follow-up request is needed, and which documents are already available for questions.
Document a KOGU case
- Determine specialty and payer.
- Check the applicable limit, session count, or deadline from an official source.
- Store request, medical documents, and insurer response.
- Record the approved scope in the case or dossier.
- Start follow-up clarification before approval expires.
Common mistakes
- Transferring KOGU rules from one specialty to another.
- Treating verbal statements as binding approval.
- Not comparing approved session count with services already provided.
- Not storing documents by case.
Practice questions
Is cost approval always needed before treatment starts?
No. It depends on specialty, insurance branch, tariff, and specific case. For longer or special treatments, check the responsible source early.
Is an email from the patient enough as cost approval?
Usually the practice stores traceable confirmation from the payer or the formally required documents. Patient statements alone are not a reliable basis for billing.
What needs to be documented?
At least case reference, documents, approved scope, validity, and case notes. The professional and legal assessment remains with the practice and responsible bodies.
Place KOGU and prescriptions in PRAXSYS
Cost approvals and prescriptions are part of the PRAXSYS X-Large package; appointments, patient data, services, and invoices remain linked to the case.
View physiotherapy and X-Large featuresRelated topics
Identification
ZSR Number
The ZSR number identifies medical service providers in the Swiss provider register. For billing and insurer communication it must match the practice, activity, and current register status.
Practice setup
Practice Setup
Before launch, more than permits need to be clarified. Practice software depends on master data, services, tariffs, payment process, data protection roles, and a tested workflow.
Payments
QR-Bill
The QR-bill combines readable payment data with the Swiss QR Code. It only becomes reliable when master data, invoices, and payment tracking fit together.
Sources and further reading
Status, responsibilities, and details can change. For binding information, consult the responsible authorities, registries, insurers, associations, and professional advisors.