Dieticians

I need to consult a dietician.

I have a medical condition (kidney failure, cardiovascular problems, lactose intolerance, etc.) that requires a special diet. I can be advised and monitored by a dietician.

If my doctor considers it necessary because of my condition, they will prescribe a prescription and the sessions will be covered by health insurance.

In a nutshell

Consultations with a dietician are only covered if prescribed by a doctor.

I must be suffering from a medical condition that warrants the advice and monitoring of a dietician. A precise list of these conditions has been drawn up by the health insurance scheme.

After an initial assessment session, and a second session where my dietician gives me a nutritional plan, follow-up sessions are scheduled.

Everything I need to know

How does it work?

Types of consultation

My initial treatment consists of:

  • An initial consultation with anamnesis (reminder of my health history) and nutritional assessment. The session lasts at least 60 minutes (code ZD11).
  • An advice and documentation consultation, during which my dietician gives me my nutritional plan. The session lasts a minimum of 30 minutes (code ZD12).
  • Four follow-up consultations as part of the initial treatment. The sessions also last a minimum of 30 minutes (code ZD13).

If the dietary treatment is continued, an extension of the dietary treatment is prescribed, comprising four further follow-up consultations. These sessions last at least 30 minutes (ZD21).

Personalised treatment

The dietician's services (advice, follow-up, assessment, etc.) are individual and personalised. Consequently, parallel treatments involving several people and group treatments are not covered by health insurance.

End of treatment

At the end of my last follow-up consultation, the dietician will draw up a final report and send it to the doctor who prescribed the sessions. The dietician will do the same if the treatment is stopped early. The final dietetic report must include an assessment of the results obtained, the actions decided with me and the changes in my diet.

What are the conditions and procedures for reimbursement?

The medical prescription and the pathologies

For my dietary treatment to be covered, my doctor must write me a medical prescription before the start of the treatment. In addition, I must have at least one of the pathologies for which reimbursement is possible (appendix E). My doctor will be able to tell me if I fulfil the criteria to benefit from a dietary treatment covered by the CNS and, if this is the case, they will be able to give me a prescription with the necessary information (in particular the pathology in question).

Validation of the prescription

My medical prescription must be validated by the CNS within 90 days of being issued. This validation allows the CNS to issue a certificate of coverage (=validation of the prescription). Although I have 90 days to receive the authorisation (=the certificate of coverage), it is strongly recommended that I obtain it before starting treatment, so that I am informed in time as to whether or not the treatment will be covered.

I can either let my dietician take care of the validation, or I can request it myself:

Request by my dietician: If I present the prescription directly to my dietician (in Luxembourg), they will enter the information into their software and forward it to the CNS within the deadline.

> In this case, the third-party payment system applies and I do not need to make any upfront payment!

Application by myself: If I apply myself, I must send the original medical prescription by post to the CNS within 90 days.

> In this case, the third-party payment does not apply, so I must make an upfront payment and request reimbursement from the CNS!

Limitations

The CNS only covers one initial dietary treatment per pathology every three years.

Each initial treatment can be extended once with a medical prescription, except for the treatment of obesity or eating disorders (codes D09, D10 and D15 listed in appendix E), where two extensions are possible.

For the extension of my dietary treatment (code ZD21) to be covered, the medical prescription must be issued:

  • Within a maximum deadline of 6 months after the 4th follow-up consultation for initial treatment (code ZD13);
  • Within a maximum deadline of 18 months after the prescription for the initial dietary treatment has been issued, provided that the initial consultation (code ZD11), the consultation for advice and documentation (code ZD12) and a follow-up consultation (code ZD13) have been paid for;
  • After the 4th follow-up consultation as part of an extension of dietary treatment (code ZD21) for obesity or eating disorders (codes D09, D10, and D15 of appendix E).

Quelles sont les pathologies de l'annexe E qui me donnent droit à une prise en charge ?

Les actes et services prévus dans la nomenclature des actes et services des diététiciens ne sont pris en charge que pour les pathologies suivantes :

D01

Facteur de risque des maladies cardiovasculaires : hypertension artérielle avec prise d’au moins deux molécules conjointes et non combinées et dont la période de prise en charge par l’assurance maladie est consécutive et supérieure à six (6) mois

D02

Insuffisance rénale chronique (IRC) sévère et terminale avec un résultat biologique retrouvant une clearance à la créatinine < 30ml/min

D03

Maladies inflammatoires chroniques de l’intestin (MICI) dont l’étiologie retrouvée répond aux diagnostics de la maladie de Crohn (MC), la rectocolite hémorragique (RCH), la stéatohépatite non alcoolique (NASH) et l’œsophagite à éosinophiles

D04

Maladie cœliaque

D05

Intolérance alimentaire avérée au lactose (avec méthode de diagnostic clinique préalable par « breath test »)

D06

Intolérance alimentaire avérée au fructose (avec méthode de diagnostic clinique préalable par un test respiratoire H2)

D07

Mucoviscidose

D08

(abrogé)

D09

Obésité de l’adulte avec un indice de masse corporelle (ci-après « IMC ») ≥ 30 kg/m2 en association avec au moins l’un des critères suivants :

  • diabète sucré avec HbA1c > 7 %
  • hypertension résistante au traitement et définie comme une pression sanguine supérieure à 140/90 mmHg, malgré un traitement pendant un an au moyen d’une prise simultanée de trois (3) antihypertenseurs
  • syndrome d’apnée du sommeil objectivé via un examen polysomnographique réalisé dans un hôpital disposant d’un laboratoire de sommeil
  • type morphologique androïde : tour de taille dépassant 88 cm chez la femme (en dehors de la grossesse) et 102 cm chez l’homme
  • antécédents cardiologiques (coronaropathie/ cardiomyopathie documentée)

D10

Obésité de l’enfant ou de l’adolescent : à déterminer selon les courbes de distribution de l’IMC en fonction de l’âge et du sexe. L’obésité correspond à un IMC > au seuil IOTF-30*.

*Définition de l’International Obesity Task Force (IOTF).

D11

Diabète de type I

D12

Diabète de type II ou diabète gestationnel

D13

Prédiabète (glycémie ≥ 106 mg/dl)

D14

Prise en charge de la dénutrition sévère et/ou sarcopénie (enfant, adolescent et adulte) :

Pour les enfants et les adolescents, un des critères suivants :

  • IMC ≤ seuil IOTF-17 ;
  • Perte de poids > 10 % en 1 mois ou > 15 % en 6 mois par rapport au poids habituel avant le début de la maladie ;
  • Stagnation pondérale aboutissant à un poids situé au moins 3 couloirs en dessous du couloir habituel.

Pour les adultes, un des critères suivants :

  • IMC ≤ 17 kg/m2 ;
  • Perte de poids ≥ 10 % en 1 mois ou ≥ 15 % en 6 mois ou ≥ 15 % par rapport au poids habituel avant le début de la maladie ;
  • Mesure de l’albuminémie par immunonéphélémétrie ou immunoturbidimétrie ≤ 30g/L.

D15

Troubles des conduites alimentaires (TCA) : prise en charge uniquement de l’anorexie mentale dans une des deux situations suivantes :

1. Soit les critères suivants doivent être cumulativement remplis :

  • Âge de la personne protégée : entre 13 et 19 ans inclus ;
  • Suivi pluridisciplinaire de plus de 3 mois par un médecin généraliste ou un pédiatre et par un psychiatre ou pédopsychiatre ou neuropsychiatre ;
  • Critères anthropométriques : Poids < à 85 % du poids corporel idéal ou IMC ≤ 17,5 kg/m2.

2. Soit après une hospitalisation dans le cadre d’une prise en charge des conséquences de l’anorexie mentale avec un diagnostic associé, les critères suivants doivent être cumulativement remplis :

  • Âge de la personne protégée : entre 13 et 19 ans inclus ;
  • Critères anthropométriques : Poids < à 85 % du poids corporel idéal ou IMC ≤ 17,5 kg/m2.

 

How does coverage work?

The third-party payer

If my dietician has sent the prescription validation request to the CNS, the services can be covered directly by the CNS through the third-party payer system: but it is up to me to make the request to my dietician.

Under the third-party payment system, I pay the dietician only the part for which I am responsible (i.e. the percentage not covered by health insurance).

Upfront payment

If it is I (instead of my dietician) who has requested validation of the prescription from the CNS, I must pay the costs upfront because the third-party payment system does not apply.

In this case, at the end of the treatment, my dietician will present me with an invoice showing the total amount to be paid, i.e. the part to be paid by health insurance and any part remaining to be paid by me. After payment, I ask my competent fund (CNS or public sector health insurance fund) for reimbursement.

In order to be eligible for reimbursement, the request must include:

  • the dietitian's invoice. It must be validly paid and mention my 13-digit identification number, my surname and first name and the number of the certificate of coverage;
  • the prior and original medical prescription.

Coverage rate

My dietary treatment is covered at 88% of the official rates in the nomenclature.

If my child (who has not reached the age of 18 on the date the prescription is issued) is undergoing dietary treatment, the level of coverage is 100% of the official rates in the nomenclature.

Frequently asked questions (FAQ)

Can I receive dietary treatment abroad?

Yes, if the dietician is established in a country of the European Union, Norway, Iceland, Liechtenstein or Switzerland. The conditions and reimbursement rates are the same as if I were to consult a dietician in Luxembourg.

I refer to the section 'Everything I need to know' above.

What about cross-border workers?

If I am a cross-border worker and I consult a healthcare provider in my country of residence, the fund in my country of residence is responsible for coverage. I therefore contact my local fund directly.

Can I be reimbursed if my doctor, who prescribed the dietary treatment, is based abroad?

Yes, the medical prescription can be issued by a doctor established in a country of the EU, Norway, Iceland, Liechtenstein or Switzerland.

In general, the prescription must indicate:

  • the code or description of the nomenclature relating to the acts prescribed;
  • the pathology or pathologies justifying the coverage of dietary care, according to the codification provided in appendix E of the CNS statutes;
  • if applicable, the precise number of consultations.

In the event of a prescription for one of the two types of treatment defined under the points 'Course of treatment', the doctor also has the option of omitting the details relating to the codes, wording and precise number of acts. In this case, it is sufficient to indicate either the concept 'initial dietary treatment' or 'prolongation of a dietary treatment' supplemented by the pathology code(s) justifying the treatment.

What are the pathologies in appendix E that entitle me to coverage?

The acts and services provided for in the nomenclature of acts and services of dieticians are only covered for the following pathologies:

D01

Risk factor for cardiovascular diseases: arterial hypertension requiring at least two concomitant and non-combined medications, with a consecutive coverage period by health insurance exceeding six (6) months.

D02

Severe and end-stage chronic kidney disease (CKD) with a biological result showing a creatinine clearance < 30ml/min.

D03

Chronic inflammatory bowel diseases (IBD) with a confirmed etiology corresponding to the diagnoses of Crohn's disease (CD), ulcerative colitis (UC), non-alcoholic steatohepatitis (NASH), and eosinophilic esophagitis.

D04

Celiac disease

D05

Confirmed lactose intolerance (with prior clinical diagnosis using a breath test).

D06

Confirmed fructose intolerance (with prior clinical diagnosis using an H2 breath test).

D07

Cystic fibrosis

D08

(revoked)

D09

Adult obesity with a body mass index (BMI) ≥ 30 kg/m², combined with at least one of the following criteria:

  • Diabetes mellitus with HbA1c > 7%;
  • Resistant hypertension, defined as blood pressure exceeding 140/90 mmHg despite one year of treatment with three (3) antihypertensive drugs taken simultaneously;
  • Obstructive sleep apnea syndrome confirmed through polysomnographic examination conducted in a hospital with a sleep laboratory;
  • Android-type morphology: waist circumference exceeding 88 cm in women (excluding pregnancy) and 102 cm in men;
  • History of cardiovascular disease (documented coronary artery disease/cardiomyopathy).

D10

Childhood or adolescent obesity: determined according to BMI distribution curves based on age and sex. Obesity corresponds to a BMI > IOTF-30* threshold.

*Definition of the International Obesity Task Force (IOTF).

D11

Type 1 diabetes

D12

Type 2 diabetes or gestational diabetes

D13

Prediabetes (blood glucose ≥ 106 mg/dl)

D14

Management of severe malnutrition and/or sarcopenia (children, adolescents, and adults):

For children and adolescents, one of the following criteria:

  • BMI ≤ IOTF-17 threshold;
  • Weight loss > 10% in 1 month or > 15% in 6 months compared to habitual weight before illness onset;
  • Weight stagnation resulting in a weight at least 3 centile curves below the usual curve.

For adults, one of the following criteria:

  • BMI ≤ 17 kg/m²;
  • Weight loss ≥ 10% in 1 month, ≥ 15% in 6 months, or ≥ 15% compared to habitual weight before illness onset;
  • Serum albumin measurement by immunonephelometry or immunoturbidimetry ≤ 30g/L.

D15

Eating disorders (ED): coverage limited to anorexia nervosa in one of the following situations:

1. The following criteria must all be met:

  • Protected individual’s age: between 13 and 19 years old;
  • Multidisciplinary follow-up for more than 3 months by a general practitioner or pediatrician and a psychiatrist, child psychiatrist, or neuropsychiatrist;
  • Anthropometric criteria: Weight < 85% of ideal body weight or BMI ≤ 17.5 kg/m².

2. Or, after hospitalization for the management of anorexia nervosa-related complications with an associated diagnosis, the following criteria must all be met:

  • Protected individual’s age: between 13 and 19 years old;
  • Anthropometric criteria: Weight < 85% of ideal body weight or BMI ≤ 17.5 kg/m².

Are teleconsultations covered?

No. Teleconsultations, whether in Luxembourg or abroad, are not covered. They are not included in the dieticians' nomenclature.

What are the codes and tariffs applied?

The complete list of dietetic acts and services covered is set out in the nomenclature of dieticians' acts and services. I click here to access the nomenclature of dieticians (list in PDF format).

Why did my dietitian charge me a fee for loss of earnings and extraordinary constraints (code DCP2)?

My dietician is entitled to a fee for loss of earnings if I do not cancel my appointment 24 hours in advance or if I arrive at least 15 minutes late.

Personal convenience, for which my dietician may charge an additional fee, is when, at my express request, my dietician gives me an appointment on a given day before 8 a.m. or after 7 p.m., or on a Saturday, Sunday or public holiday.

This compensation is invoiced under the code DCP2.

The fee provided for in these different cases are not covered by health insurance. They will therefore be invoiced to me (and will appear on the invoice).

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