OBJECTIVES: Fibromyalgia (FM) is characterized by persistent, widespread pain and associated with substantial health care costs.  This study examined medical resource use (MRU) and costs associated with FM by severity level, in Germany. METHODS: This cross-sectional, observational study recruited 211 FM subjects during routine office visits to community-based physicians in Germany. Subjects completed questions about their pain, health-related quality-of-life, productivity, and out-of-pocket expenses related to FM; site staff recorded MRU based on medical records.  FM severity was defined using subjects’ FIQ total scores: 0 - <39 (mild), 39 - <59 (moderate), and 59 - 100 (severe). Annual costs from a societal perspective were calculated in 2008 Euros and included direct (e.g., physician office visits, medications, out-of-pocket, home health care services), and indirect (e.g., lost productivity due to absenteeism and disability) costs. RESULTS: The mean age (SD) of subjects was 53.7 (12.9) years, and 79% were female. Most patients reported moderate (38%) or severe (43%) FM. Subjects had a mean (SD) of 4.9 (3.2) physician office visits over the past 3 months, with the highest proportion of patients visiting Orthopedists (49%), Rheumatologists (31%), General Practitioners (15%), and Neurologists (13%).  Most subjects (94%) were receiving at least one prescription medication for FM.  The highest proportions of subjects were prescribed anti-inflammatories (67%), other analgesics (34%), and anti-depressants (33%). Subjects employed full- or part-time missed a mean (SD) of 2.1 (3.8) days from work due to FM over the past 4 weeks, corresponding to 25.2 and 32.4 work days missed annually.  Total costs were €7256 (direct = €1765; indirect = €5491), and significantly increased as FM severity worsened (p=0.0002). CONCLUSIONS: FM imposes a substantial economic burden on society in both direct and indirect costs, which increases as FM severity worsens.  Indirect costs due to lost productivity accounted for the largest proportion of total FM costs.