Psychomotricians

My child or I must attend sessions with a psychomotrician.

Rehabilitation and relaxation acts delivered by a psychomotrician may be covered, but only if they are prescribed by a doctor and the National Health Fund (CNS) has given its authorisation.

Everything I need to know

What are the conditions and terms of coverage?

My general practitioner must first give me a prescription for psychomotor therapy. I can now make an appointment with a psychomotor therapist of my choice in Luxembourg and present the prescription to them.

During my first session, the psychomotrician will draw up a report containing a treatment plan. This report must be sent to my GP to obtain written consent to the treatment plan, and to the CNS for authorisation. My treatment will then be validated by the Contrôle médical de la sécurité sociale (CMSS). Or not.

Treatment may also be started without a certificate of coverage from the CNS if no response or opinion is given within 15 days of the transmission of the assessment with treatment plan to the attending physician and, where applicable, to the CNS.

However, the treatment thus begun ceases to be covered by health insurance as soon as the examination is cancelled by the attending physician, or upon receipt of the refusal of authorisation of the treatment by the CNS.

The costs of treatment already incurred before obtaining authorisation or refusal are covered by the CNS.

A special case: if it is not possible to obtain an appointment quickly

Treatment should in principle begin within six months from the date of issue of the prescription, unless the medical prescription indicates otherwise.

However, in the event of waiting deadlines exceeding six months, the above provision does not apply if the psychomotrician confirms this.

What are the specific procedures?

STEP 1

I receive a prescription from my general practitioner for an initial visit to the psychomotor therapist of my choice. During this first appointment, the psychomotor therapist carries out an initial examination and draws up a report including a treatment plan.

STEP 2

I then send this report to my doctor, who must give their prior consent to the report by giving me a treatment prescription. With this prescription, I can go back to the psychomotrician to begin treatment after a certificate of coverage has been issued.

In general, it is the psychomotrician who is responsible for submitting the request for prior authorisation to the National Health Fund, together with the necessary documents (medical prescription from the prescribing doctor, report from the psychomotrician). The CNS checks that the file is in order. If so, the request is forwarded by the CNS to the CMSS to request authorisation.

STEP 3

If the CMSS gives a favourable opinion, the CNS issues a certificate of coverage, which it sends either to the psychomotrician or directly to me if I am the one who applied for prior authorisation.

Is there coverage for travel expenses?

If I can provide a medical prescription to justify the need to provide care at home, health insurance will cover the service provider's travel expenses.

Travel expenses include travel allowance and travel expenses per kilometre.

The travel expenses per kilometre can only be charged for a journey outside the locality where the service provider has established his practice or inside it, if the journey exceeds one kilometre. However, the travel expenses charged cannot exceed the expenses corresponding to the distance actually travelled.

Travel expenses incurred for treatments in the following are excluded from coverage:

  • in hospitals,
  • in care homes,
  • in centres for the disabled,
  • in health spas and functional rehabilitation centres.

How does coverage work?

Third-party payment

Generally speaking, the services are covered directly by the health insurance through the third-party payment system: I therefore only pay the psychomotrician the part that I have to pay.

Upfront payment

If the third-party payment system has not been applied, at the end of the treatment the psychomotrician will give me an invoice showing the total amount to be paid, i.e. specifying the amount covered by health insurance and any amount to be paid by me. After payment, I will apply to the CNS for reimbursement of the amount covered by my health insurance.

To be eligible for reimbursement of a psychomotricity invoice, the invoice must:

  • include my 13-digit identification number and full name
  • be validly paid
  • be accompanied by the CNS certificate of coverage

The coverage rate

The acts and services in the psychomotrician nomenclature, having been previously authorised by the CNS on the advice of the Contrôle médical de la sécurité sociale (CMSS), as well as the assessments, benefit from coverage of 88% of the official rates.

Acts related to relaxation are covered at a rate of 80%.

However, for my child who has not yet reached the age of 18 on the date the prescription is issued, the coverage rate is 100%.

Frequently asked questions (FAQ)

Et si je suis travailleur frontalier, qu'en est-il de la prise en charge des soins de psychomotricité ?

Si je suis travailleur frontalier et que mes enfants ou moi-même recevons des soins de psychomotricité dans notre pays de résidence, les prestations seront exclusivement remboursées par notre caisse locale, conformément aux taux, tarifs et conditions en vigueur dans ce pays.

Quels sont les codes et tarifs appliqués ?

La liste complète des actes et services des psychomotriciens pris en charge est fixée par la nomenclature des actes et services des psychomotriciens. Je clique ici pour accéder à la nomenclature des psychomotriciens (liste au format PDF).

Pourquoi mon psychomotricien m'a facturé une indemnité pour perte d’honoraires et contraintes extraordinaires ?

Indemnité pour perte d'honoraires

Si je n'informe pas le psychomotricien de mon absence moins d'un jour ouvrable avant le rendez-vous fixé ou si je ne suis pas à la maison à l'heure convenue pour bénéficier du traitement, le psychomotricien a droit à une indemnisation pour la perte d'honoraires. Il en va de même, le cas échéant, pour les frais de déplacement.

Ces indemnités et frais ne sont pas pris en charge par l'assurance maladie et sont donc à ma charge. Je dois régler ces montants directement.

Indemnité pour contraintes extraordinaires

Si, à ma demande expresse, le psychomotricien accepte de fixer un rendez-vous après 19 heures ou un samedi, dimanche, ou jour férié légal, je dois payer une indemnité pour « contrainte extraordinaire ». Cela dépend du  fait si le rendez-vous est planifié en dehors des jours ou crénaux horaires normaux de travail communiqués par le psychomotricien et si le rendez-vous est respecté par ce dernier.

Attention ! Les prestations données en cas d'urgence ne peuvent donner lieu à une indemnité pour « contrainte extraordinaire ». Il en est de même lorsque les prestations sont indispensables aux heures et dates convenues en raison de l'état de santé de l'assuré. Les indemnités prévues ci-dessus ne sont pas à charge de l'assurance maladie. Elles sont facturées, le cas échéant, avec les prestations sur un même mémoire d'honoraires.

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