Reimbursement for a medical consultation
Verified 22 December 2024 - Directorate for Legal and Administrative Information (Prime Minister)
How much will you be reimbursed after going to the doctor? When you see a doctor, the amount of the reimbursement varies according to several criteria: coordinated care pathway, discipline (generalist or specialist) and doctor's agreement. We present you the regulations to know.
The rules are different for a child under 16 years.
Respect of the route
All beneficiaries of Health Insurance are reimbursed partially for the costs of consulting a doctor.
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 tariffs: psychiatrists, neuropsychiatrists, neurologists, pediatricians and cardiologists.
The correspondent doctor may be consulted for an ad hoc or regular opinion with the agreement of the treating physician. The doctor's rates are specific.
Reimbursement for the consultation varies also depending on type of agreement of the doctor. The contracted doctor of sector 1 applies the tariff fixed by agreement with the sickness insurance. The contracted doctor of sector 2 practices free fees.
You can consult some specialists directly without going through your doctor (examples: gynecologist, dental surgeon).
The situation varies depending on whether the doctor is adhering to Optam or not.
The Optam (controlled practical pricing option, formerly access to care contract) is an agreement between the contracted doctors and the health insurance. This agreement authorizes overcharging of regulated fees.
You can find out if your doctor has adhered by consulting the ameli.direct site.
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Attending physician
General Practitioner
Reminder
These rates apply if you have reported a treating physician.
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €30 | €30 | €19 |
Sector 1 (complex consultation) | €47.50 | €47.50 | €31.25 |
Sector 1 (very complex consultation) | €60 | €60 | €40 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €30 | €19 |
Sector 2 | Fees available | €23 | €14.10 |
Specialist
Reminder
These rates apply if you have reported a treating physician.
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 (Excluding pediatrician, geriatrician, medical gynecologist, psychiatrist, neurologist, physical medicine and rehabilitation) | €26.50 | €26.50 | €16.55 |
Sector 1 (complex consultation) | €47.50 | €47.50 | €31.25 |
Sector 1 (very complex consultation) | €60 | €60 | €40 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €26.50 | €16.55 |
Sector 2 | Fees available | €23 | €14.10 |
Psychiatrist, neurologist
Reminder
These rates apply if you have reported a treating physician.
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €55 | €55 | €36.50 |
Sector 1 (very complex consultation) | €60 | €60 | €40 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €55 | €36.50 |
Sector 2 | Fees available | €42.50 | €27.75 |
Corresponding (regular) physician
General Practitioner
Reminder
These rates apply if you have reported a treating physician.
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €31.50 | €31.50 | €20.05 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €31.50 | €20.05 |
Sector 2 | Fees available | €23 | €14.10 |
Specialist
These rates apply if you have declared a attending physician.
They concern the specialist health professional (except pediatrician, geriatrician, medical gynecologist, psychiatrist, neurologist, physical medicine and rehabilitation).
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €31.50 | €31.50 | €20.05 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €31.50 | €20.05 |
Sector 2 | Fees available | €23 | €14.10 |
Corresponding physician (one-time)
Specialist
Reminder
These rates apply if you have reported a treating physician.
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €60 | €60 | €40 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €60 | €40 |
Sector 2 | Fees available | €60 | €40 |
Psychiatrist, neurologist
Reminder
These rates apply if you have reported a treating physician.
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €67.50 | €67.50 | €45.25 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €67.50 | €45.25 |
Sector 2 | Fees available | €67.50 | €45.25 |
Specialist
Gynecologist and ophthalmologist
Reminder
These rates apply if you have reported a treating physician.
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €37 | €37 | €23.90 |
Sector 1 (very complex consultation) | €53 | €53 | €31.25 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €37 | €23.90 |
Sector 2 | Fees available | €23 | €14.10 |
Psychiatrist (16 to 25 years)
Reminder
These rates apply if you have reported a treating physician.
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2 for children over 18) |
|---|---|---|---|
Sector 1 | €67 | €67 | €44.90 |
Sector 1 (very complex consultation) | €60 | €60 | €40 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €62 | €41.40 |
Sector 2 | Fees available | €42.50 | €27.75 |
Please note
Some complex public health consultations (such as 1)era consultation with a girl aged 15 to 18 who wishes to obtain contraception) are taken care of at 100%.
To find out the price charged by a healthcare professional, see the health directory on the Ameli website.
Off-course
All beneficiaries of Health Insurance are reimbursed partially for the costs of consulting a doctor.
Outside the care pathway the refund rate is 30% of the conventional tariff and the user fee is 70%.
The rates and the basis of reimbursement vary according to the specialty of the doctor consulted directly.
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General Practitioner
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €30 | €30 | €7.00 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €30 | €7.00 |
Sector 2 | Fees available | €23 | €4.90 |
Specialist
These tariffs apply to specialist health professionals (except pediatricians, geriatricians, medical gynecologists, psychiatrists, neurologists, physical medicine and rehabilitation).
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €37 maximum | €26.50 | €5.95 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €26.50 | €5.95 |
Sector 2 | Fees available | €23 | €4.90 |
Psychiatrist, neurologist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €61 maximum | €50 | €13 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €50 | €13 |
Sector 2 | Fees available | €42.50 | €10.75 |
Cardiologist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €2) |
|---|---|---|---|
Sector 1 | €60 maximum | €52.50 | €13.75 |
Adhering to the Controlled Pricing Practice Option (OPTAM) Sector 2 | Fees with controlled overrun | €52.50 | €13.75 |
Sector 2 | Fees available | €47.73 | €12.32 |
To find out the price charged by a healthcare professional, see the health directory on the Ameli website.
Who can help me?
Find who can answer your questions in your region
Conditions for the sickness insurance to cover an act or a benefit (Article L162-1-7)
Content of the agreements defining the relationship between sickness insurance and doctors (Article L162-5)
Reimbursement by the Sickness Insurance on the basis of an authority fee for non-contracted doctors (Article L162-5-10)
Participation of the insured (Article L322-2)
Amount of the insured's contribution
Complex and very complex consultations
Online service
National Health Insurance Fund (Cnam)
National Health Insurance Fund (Cnam)
National Health Insurance Fund (Cnam)
National Health Insurance Fund (Cnam)