To be entitled to reimbursement from the National Health Fund or the competent public sector fund, all acts performed by a dietitian must be prescribed by a doctor. The insured person must also suffer from one of the 13 medical conditions for which coverage is provided.
Course of treatment
The dietary treatment consists of an initial dietary treatment including in the following order:
- one initial consultation about the person’s medical history and a nutritional assessment, with a minimum duration of 60 minutes (ZD11)
- one consultation to provide advice and documentation, including the presentation of the nutritional plan, with a minimum duration of 30 minutes (ZD12)
- four follow-up consultations as part of an initial treatment, with a minimum duration of 30 minutes (ZD13)
If dietary treatment is continued, an extended dietary treatment is prescribed including four follow-up consultations as part of an extended dietary treatment with a minimum duration of 30 minutes (ZD21).
The services provided by dietitians are individual and personalised. The dietitian provides his services on one person only. Parallel treatments of several people and group treatments are not covered by health insurance.
At the end of the final follow-up consultation, the dietitian writes a final dietary report that is sent to the prescribing physician. The same applies if the treatment is interrupted early. The final dietary report records the evaluation of the results obtained with regard to the dietary objectives, the actions negotiated with the insured person and the evolution of dietary behaviour.
Conditions of coverage
Services provided by dietitians are only covered by the CNS if they are provided following an original and prior medical prescription.
The prescription should indicate:
- the code or wording of the nomenclature relating to the prescribed acts,
- the pathology or pathologies justifying the coverage of dietary care, in accordance with the codification provided for in Annex E of the CNS statutes,
- if applicable, the precise number of consultations.
If one of the two types of treatment described under the section "Course of treatment" is prescribed, the prescribing doctor may also omit details relating to the codes, wording and precise number of acts. In this case, it is sufficient to indicate either the terms "initial dietary treatment" or "extension of a dietary treatment" completed by the pathology code(s) justifying the treatment.
The acts and services listed in the dietitians’ nomenclature are covered only if the insured person suffers from one of the following pathologies (defined in Annex E of the CNS statutes):
- D01: High blood pressure
- D02: Chronic renal failure with creatinine clearance < 30ml/min
- D03: Chronic inflammatory bowel disease (IBD: Crohn's disease and hemorrhagic rectocolitis)
- D04: Celiac disease
- D05: Proven food intolerance to lactose
- D06: Proven food intolerance to fructose
- D07: Mucoviscidosis
- D08: Severe adult obesity: BMI > 35
- D09: Adult obesity with BMI > 30 in combination with at least one of the following criteria:
- diabetes mellitus with HbA1c > 7%;
- hypertension resistant to treatment and defined as blood pressure greater than 140/90 mmHg, despite one year of treatment with three antihypertensive drugs taken simultaneously;
- objective sleep apnea syndrome via a polysomnographic examination performed in a hospital with a sleep laboratory;
- android morphological type (waist circumference exceeding 88 cm in women and 102 cm in men);
- cardiological history (coronary artery disease/cardiomyopathy documented).
- D10: Child and adolescent obesity: to be determined according to BMI distribution curves by age and gender
- D11: Type I diabetes
- D12: Type II diabetes
- D13: Prediabetes (blood glucose ≥ 106 mg/dl)
The prescription must indicate the pathology afflicting the insured person that is the reason the dietary treatment was prescribed.
The CNS only covers one initial dietary treatment per pathology every three years. Each initial treatment can, with a medical prescription, be extended only once.
The extension of dietary treatment is only covered:
- if the initial treatment is completed;
- if less than three years have passed since the beginning of the initial treatment. After this period, a new initial treatment may be requested.
Validation of the prescription and certificate of coverage
The medical prescription must be validated by the CNS. This validation must be requested within 90 days of the prescription’s issuance. Through this validation, the CNS issues a certificate of coverage that guarantees coverage of services under the statutory conditions.
This validation can be requested either by the dietitian or by the insured person himself from the National Health Fund (Service Prestations des autres professions de santé).
Request for validation by the dietitian: If the insured person submits the medical prescription directly to the dietitian, the dietitian enters the information provided on the prescription into a dedicated software and sends it to the CNS within the required time limit.
Request for validation by the insured person: If the insured person requests validation, they must send the original medical prescription by post to the CNS within the required time limit.
The CNS checks the medical prescription and, in the event of validation, sends the certificate of coverage to the applicant (either electronically to the dietitian or by post to the insured person).
When a certificate of coverage cannot be issued because the administrative conditions are not met, the CNS informs the applicant (either the dietitian electronically or the insured person by post). This information includes the reasons for the non-validation. If the dietitian has made the request, they inform the insured person that they may request a decision from the CNS subject to appeal.
Compensation for loss of fees and extraordinary circumstances
The dietitian is entitled to compensation for loss of fees if the insured has not cancelled his appointment 24 hours in advance or if the insured is at least 15 minutes late.
It is considered a personal convenience, for which the dietitian is entitled to receive an additional fee, if the dietitian schedules an appointment at the insured's explicit request on a specific day before 8.00 a.m. or after 7.00 p.m. or on a Saturday, Sunday or statutory holiday.
The compensation may not exceed 50% of the coefficient of the act(s) in the dietitians' nomenclature of acts and services that are performed during this appointment. It is invoiced under the code DCP2.
The benefits provided for above are not covered by health insurance. They are invoiced with the services on the same invoice.
Method of payment
Third-party payment system
If the dietitian has sent the request for validation of the prescription to the CNS, the services provided for in the dietitians' nomenclature of acts and services may be paid directly by the CNS through the third-party payment system, at the request of the insured person.
Under the third-party payment system, the insured person pays the dietitian only the part for which he is responsible (the part that is not reimbursed by health insurance).
Advance of costs
The third-party payment system is not applicable when the insured person requested to receive the certificate of coverage from the CNS personally.
In this case, at the end of the treatment, the dietitian presents an invoice to the insured person showing the total amount to be paid, i.e. the portion to be covered by health insurance as well as any part to be paid by the insured person. After payment, the insured person requests a reimbursement with their competent fund (CNS or public sector health fund).
To be eligible for reimbursement, the insured person must send to their competent health insurance fund a request for reimbursement including:
- the dietitian's invoice. This invoice must be validly paid and bear the insured's 13-digit identification number, surname and first name and the number of the certificate of coverage;
- the original medical prescription.
The acts and services listed in the dietitians’ nomenclature are covered at the rate of eighty-eight percent (88%) provided that these acts are prescribed to a person who presents one of the pathologies provided for in Annex E of the CNS statutes.
By derogation, the coverage rate is one hundred percent (100%) when the insured person has not reached the age of 18 years on the issuance date of the medical prescription.
Any personal contribution that the insured person may have to pay for dietary acts delivered in a hospital by a dietitian employed by the hospital is invoiced to them by the hospital.