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Reimbursement of a medical consultation

Verified 10 mars 2020 - Directorate for Legal and Administrative Information (Prime Minister)

When you see a doctor, the amount of the refund will vary according to several criteria: compliance coordinated care path, discipline (general practitioner or specialist) and medical procedure..

Respect the coordinated care path

All Medicare beneficiaries are partially reimbursed for the cost of a doctor's visit.

The reimbursement rates for medical consultations differ depending on whether the doctor is a general practitioner or a specialist. In addition, some specialists benefit from special rates: psychiatrists, neuropsychiatrists, neurologists, pediatricians and cardiologists.

The refund for your consultation also varies depending on the type of medical procedure.. The Area 1 Medical Practitioner applies the rate set by agreement with Health Insurance. The Area 2 physician practices a free fee.

The physician may be consulted for a one-time opinion with the agreement of your attending physician. This doctor's fees are specific.

When you have declared a attending physician, you can consult some specialists directly (no need for the agreement of your attending physician).

A contract for access to care is being put in place gradually. This contract provides for fee overruns (they are authorized but limited). You can find out if your doctor has joined by consulting the ameli.direct site ..

Attending physician

Generalist

Rates and reimbursement of a consultation with a general practitioner

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€25

€25

€16.50

Sector 1 (complex consultation)

€46

€46

€31.20

Sector 1 (complex consultation)

€60

€60

€41

Adhering to the Care Access Agreement

Fees with controlled overrun

€25

€16.50

Sector 2

Free fees

€23

€15.10

  FYI : these rates apply if you have declared a attending physician..

Specialist

Rates and reimbursement of a consultation with a specialist

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€25

€25

€16.50

Sector 1 (complex consultation)

€46

€46

€31.20

Sector 1 (complex consultation)

€60

€60

€41

Adhering to the Care Access Agreement

Fees with controlled overrun

€25

€16.50

Sector 2

Free fees

€23

€15.10

  FYI : these rates apply if you have declared a attending physician..

Psychiatrist, neurologist

Rates and reimbursement of a consultation with a psychiatrist or neurologist

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€39.70

€39.70

€26.79

Sector 1 (complex consultation)

€60

€60

€41

Adhering to the Care Access Agreement

Fees with controlled overrun

€39.70

€26.79

Sector 2

Free fees

€39

€26.30

  FYI : these rates apply if you have declared a attending physician..

Corresponding doctor (regular)

Generalist

Rates and reimbursement of a consultation with a general practitioner

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€26

€26

€17.20

Adhering to the Care Access Agreement

Fees with controlled overrun

€26

€17.20

Sector 2

Free fees

€23

€15.10

  FYI : these rates apply if you have declared a attending physician..

Specialist

Rates and reimbursement of a consultation with a specialist

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€28

€28

€18.60

Adhering to the Care Access Agreement

Fees with controlled overrun

€28

€18.60

Sector 2

Free fees

€23

€15.10

  FYI : these rates apply if you have declared a attending physician..

Corresponding doctor (punctual)

Specialist

Rates and reimbursement of a consultation with a corresponding specialist on an ad hoc basis

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€50

€50

€34

Adhering to the Care Access Agreement

Fees with controlled overrun

€50

€34

Sector 2

Free fees

€50

€34

  FYI : these rates apply if you have declared a attending physician..

Psychiatrist, neurologist

Fees and reimbursement of a consultation with a psychiatrist or a corresponding neurologist

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€62.50

€62.50

€42.75

Adhering to the Care Access Agreement

Fees with controlled overrun

€62.50

€42.75

Sector 2

Free fees

€62.50

€42.75

  FYI : these rates apply if you have declared a attending physician..

Specialist

Gynecologist and ophthalmologist

Rates and reimbursement of a consultation with a gynecologist or an ophthalmologist

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€28

€28

€18.60

Sector 1 (complex consultation)

€46

€46

€31.20

Adhering to the Care Access Agreement

Fees with controlled overrun

€28

€18.60

Sector 2

Free fees

€23

€15.10

  FYI : these rates apply if you have declared a attending physician..

Psychiatrist (patient 16 to 25 years)

Rates and reimbursement of a consultation with a psychiatrist (patient aged 16 to 25)

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€43.70

€43.70

€29.59

Sector 1 (complex consultation)

€60

€60

€41

Adhering to the Care Access Agreement

Fees with controlled overrun

€43.70

€29.59

Sector 2

Free fees

€39

€26.30

  FYI : these rates apply if you have declared a attending physician..

  Please note : some complex consultations with a high public health issue (such asmother consultation with a girl aged 15 to 18 who wishes to obtain contraception) are taken care of at 100%..

Out of coordinated care

All Medicare beneficiaries are partially reimbursed for the cost of a doctor's visit. Off-course of care the reimbursement rate is 30% from conventional rate and the user fee is 70%..

Generalist

Rates and reimbursement of a consultation with a general practitioner (out of care)

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€25

€25

€6.50

Adhering to the Care Access Agreement

Fees with controlled overrun

€25

€6.50

Sector 2

Free fees

€23

€5.90

Specialist

Rates and reimbursement of a consultation with a specialist (out of care)

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€33 minimum

€25

€6.50

Adhering to the Care Access Agreement

Fees with controlled overrun

€25

€6.50

Sector 2

Free fees

€23

€5.90

Psychiatrist, neurologist

Rates and reimbursement of a consultation with a psychiatrist or a neurologist (out of care)

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€52 minimum

€39.70

€15.71

Adhering to the Care Access Agreement

Fees with controlled overrun

€39.70

€15.71

Sector 2

Free fees

€39

€14.9

Cardiologist

Rates and reimbursement of a consultation with a cardiologist (out of care)

Sector

Rate

Reimbursement basis

Amount refunded (after deduction of the lump-sum €1)

Sector 1

€58 minimum

€45.73

€21.01

Adhering to the Care Access Agreement

Fees with controlled overrun

€45.73

€21.01

Sector 2

Free fees

€45.73

€21.01