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RÉGIME COMMUN D'ASSURANCE MALADIE
Kinesitherapy, physiotherapy and osteopathy sessions
The Joint Sickness Insurance Scheme has recently noted a significant
increase in the fees charged by kinesitherapists, physiotherapists and
osteopaths, not only in Belgium but also in other Member States.
As the rules do not provide for a ceiling on reimbursement of such fees,
excessive bills must be submitted case by case to the medical officers
before the Settlements Office can establish individually the proportion of
the fee deemed to be excessive, and thus ineligible for reimbursement
(paragraph 3 of Section XV of the rules governing reimbursement).
In view of the number of cases involved, the Management Committee has
delivered a favourable opinion on the introduction of an amended
reimbursement procedure for kinesitherapy, physiotherapy and osteopathy
sessions. Henceforth, fees in excess of the amounts given below will be
automatically deemed to be excessive, and their reimbursement will be
limited.
The Medical Council has approved these maximum amounts which will give
nine out of ten members the maximum reimbursement foreseen.
Maximum amounts for Belgium and Luxembourg :1
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Treatment
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Fees in excess of:
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Maximum reimbursement
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Kinesitherapy Physiotherapy
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€26.60 /session
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€21.28 (at a rate of 80%)
€26.60 (at a rate of 100% for serious
illness)
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Osteopathy
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€43.72 /session
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€34.98 euros (at a rate of 80%)
€43.72 (at a rate of 100% for serious
illness)
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(For information, the maximum fees for a kinesitherapy session laid down
in agreements with national sickness insurance schemes are 17€ in
Belgium, 14.62€ in Luxembourg, 20.50€ in the Netherlands and 20.40 in
France).
Where a member feels that there are medical reasons justifying higher
fees, for example because of an exceptionally long session, that member
may ask for the case to be submitted to the medical officer for an
individual decision.
When sending in your claim form for reimbursement, please remember to
enclose the medical prescription specifying the number of sessions and the
reason for the treatment. No prior authorisation is needed as long as you
do not claim for more than 60 sessions of kinesitherapy or physiotherapy,
or 20 sessions of osteopathy, in any calendar year.
Maximum amounts (see also the corrigendum I.A.
014-2003)
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Kinesitherapy/Physiotherapy
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Osteopathy
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Fees in excess of:
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Maximum reimbursement (80%)
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Fees in excess of:
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Maximum reimbursement (80%)
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Austria
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52.93
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42.34
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58.38
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46.70
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Denmark
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37.94
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30.35
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*
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*
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Finland
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40.71
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32.57
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*
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*
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France
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26.60
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21.28
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52.92
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42.34
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Germany
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38.64
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30.91
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64.43
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51.54
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Greece
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44.81
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35.85
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*
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*
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Ireland
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33.14
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26.51
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45.84
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36.67
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Italy
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42.91
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34.33
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72.93
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58.34
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Netherlands
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26.60
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21.28
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51.91
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41.53
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Portugal
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30.80
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24.64
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56.25
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45
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Spain
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34.84
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27.87
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49.80
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39.84
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Sweden
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41.94
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33.55
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44.44
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35.55
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Switzerland
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58.66
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46.93
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67.20
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53.76
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UK
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57.84
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46.27
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73.35
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58.68
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The number of cases is too small for a maximum to be
calculated.
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Footnote
1For countries other than Belgium and
Luxembourg, these amounts have been adjusted as a function of the actual
cost of the treatment in those countries. The adjusted amounts are given
in the annexed table.
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