Reimbursement for a medical consultation
Verified 10 March 2020 - Directorate for Legal and Administrative Information (Prime Minister)
When you see a doctor, the amount of the reimbursement varies according to several criteria: coordinated care pathway, discipline (general or specialist) and the doctor's agreement.
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.
Fees for physician visits differ depending on whether the physician is a general practitioner or a specialist. In addition, some specialists benefit from special tariffs: psychiatrists, neuropsychiatrists, neurologists, pediatricians and cardiologists.
Reimbursement for your consultation also varies depending on the type of doctor's agreement. 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.
The correspondent doctor may be consulted for an ad hoc opinion with the agreement of your treating doctor. The doctor's rates are specific.
When you have declared a attending physician, you can consult directly some specialists (not need the agreement of your attending physician).
A contract for access to care is gradually being introduced. This contract governs fee overruns (they are authorized but limited). You can find out if your doctor has adhered by consulting the ameli.direct site.
Répondez aux questions successives et les réponses s’afficheront automatiquement
Attending physician
General Practitioner
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €25 | €25 | €16.50 |
Sector 1 (complex consultation) | €46 | €46 | €31.20 |
Sector 1 (very complex consultation) | €60 | €60 | €41 |
Adhering to the contract for access to care | Fees with controlled overrun | €25 | €16.50 |
Sector 2 | Fees available | €23 | €15.10 |
FYI
these rates apply if you have reported a treating physician.
Specialist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €25 | €25 | €16.50 |
Sector 1 (complex consultation) | €46 | €46 | €31.20 |
Sector 1 (very complex consultation) | €60 | €60 | €41 |
Adhering to the contract for access to care | Fees with controlled overrun | €25 | €16.50 |
Sector 2 | Fees available | €23 | €15.10 |
FYI
these rates apply if you have reported a treating physician.
Psychiatrist, neurologist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €39.70 | €39.70 | €26.79 |
Sector 1 (very complex consultation) | €60 | €60 | €41 |
Adhering to the contract for access to care | Fees with controlled overrun | €39.70 | €26.79 |
Sector 2 | Fees available | €39 | €26.30 |
FYI
these rates apply if you have reported a treating physician.
Corresponding (regular) physician
General Practitioner
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €26 | €26 | €17.20 |
Adhering to the contract for access to care | Fees with controlled overrun | €26 | €17.20 |
Sector 2 | Fees available | €23 | €15.10 |
FYI
these rates apply if you have reported a treating physician.
Specialist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €28 | €28 | €18.60 |
Adhering to the contract for access to care | Fees with controlled overrun | €28 | €18.60 |
Sector 2 | Fees available | €23 | €15.10 |
FYI
these rates apply if you have reported a treating physician.
Corresponding physician (one-time)
Specialist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €50 | €50 | €34 |
Adhering to the contract for access to care | Fees with controlled overrun | €50 | €34 |
Sector 2 | Fees available | €50 | €34 |
FYI
these rates apply if you have reported a treating physician.
Psychiatrist, neurologist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €62.50 | €62.50 | €42.75 |
Adhering to the contract for access to care | Fees with controlled overrun | €62.50 | €42.75 |
Sector 2 | Fees available | €62.50 | €42.75 |
FYI
these rates apply if you have reported a treating physician.
Specialist
Gynecologist and ophthalmologist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €28 | €28 | €18.60 |
Sector 1 (very complex consultation) | €46 | €46 | €31.20 |
Adhering to the contract for access to care | Fees with controlled overrun | €28 | €18.60 |
Sector 2 | Fees available | €23 | €15.10 |
FYI
these rates apply if you have reported a treating physician.
Psychiatrist (16 to 25 years)
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €43.70 | €43.70 | €29.59 |
Sector 1 (very complex consultation) | €60 | €60 | €41 |
Adhering to the contract for access to care | Fees with controlled overrun | €43.70 | €29.59 |
Sector 2 | Fees available | €39 | €26.30 |
FYI
these rates apply if you have reported a treating physician.
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%.
Off-course
All beneficiaries of Health Insurance are reimbursed partially for the costs of consulting a doctor. Outside the care pathway, the reimbursement rate is 30% of the conventional tariff and the user fee is 70%.
Répondez aux questions successives et les réponses s’afficheront automatiquement
General Practitioner
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €25 | €25 | €6.50 |
Adhering to the contract for access to care | Fees with controlled overrun | €25 | €6.50 |
Sector 2 | Fees available | €23 | €5.90 |
Specialist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €33 minimum | €25 | €6.50 |
Adhering to the contract for access to care | Fees with controlled overrun | €25 | €6.50 |
Sector 2 | Fees available | €23 | €5.90 |
Psychiatrist, neurologist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €52 minimum | €39.70 | €15.71 |
Adhering to the contract for access to care | Fees with controlled overrun | €39.70 | €15.71 |
Sector 2 | Fees available | €39 | €14.9 |
Cardiologist
Sector | Rate | Reimbursement Basis | Amount refunded (after deduction of the €1) |
|---|---|---|---|
Sector 1 | €58 minimum | €45.73 | €21.01 |
Adhering to the contract for access to care | Fees with controlled overrun | €45.73 | €21.01 |
Sector 2 | Fees available | €45.73 | €21.01 |
Who can help me?
Find who can answer your questions in your region
- Social Security Code: Articles L162-1 to L162-58Conditions for the sickness insurance to cover an act or a benefit (Article L162-1-7)
- Social Security Code: Articles L162-5 to L162-5-4Content of the agreements defining the relationship between sickness insurance and doctors (Article L162-5)
- Social Security Code: Article L162-5-10Reimbursement by the Sickness Insurance on the basis of an authority fee for non-contracted doctors (Article L162-5-10)
- Social Security Code: Articles L160-13 to L160-16Participation of the insured (Article L322-2)
- Social Security Code: Articles R160-5 to R160-20Amount of the insured's contribution
- Order of 20 October 2016 approving the national convention on the organization of relations between liberal doctors and health insurance signed on 25 August 2016
- Decision of 21 June 2017 of the National Union of Health Insurance Funds on the list of acts and benefits covered by health insuranceComplex and very complex consultations
- Ameli Online
Online service
- Reimbursement of a medical consultation for a childService-Public.fr
- Conventional physician ratesNational Health Insurance Fund (Cnam)
- Medical consultations: rates and reimbursement rulesNational Health Insurance Fund (Cnam)
- Reimbursement rateNational Health Insurance Fund (Cnam)
- Health Directory - Ameli SiteNational Health Insurance Fund (Cnam)