The CNS covers all acts and services carried out by midwives at the provided rates and tariffs, as long as a doctor has prescribed them. The insured person is free to choose any midwife.
Services and medical prescriptions
Services by midwives
Midwives may invoice all acts and services listed in the table of the nomenclature of acts and services provided by midwives.
Midwives may also invoice acts and services from the nomenclature of acts and services provided by nurses.
Medical prescriptions for midwifery care
Acts and services provided by midwives can only be reimbursed upon presentation of a medical prescription issued by a doctor, with the exception of the following acts:
- one single consultation during the pregnancy (code S13)
- the flatrate for postpartum care at home, for a period of 15 days after childbirth, including the travel allowance (code S25)
- one single consultation after childbirth (code S31)
Hence, medical prescriptions for these specific acts are not required.
If the prescription does not indicate a period within which the treatment should begin, the treatment has to begin within 30 days of the prescription’s issuance.
Prescriptions issued by midwives
Midwives may prescribe, under their own responsibility, certain acts or medical supplies.
Midwives may issue prescriptions for certain medications.
Midwives may also prescribe acts and services from the nomenclature of laboratories.
If the prescription does not indicate a precise validity deadline, the prescribed medical supplies and acts have to be delivered within 3 months following the prescription’s issuance.
Authorisations by the Medical Board of the Social Security
Acts that are not listed in the nomenclature
If the medical prescription provides for treatments that are not found in the nomenclature, the act in question can be reimbursed, if the Medical Board of the Social Security issues a prior authorisation. The authorisation is issued case-by-case upon request of the midwife, upon presentation of a detailed medical certificate of the referring doctor.
The rates for acts, apart from home care, can be increased by:
- 25%, if the act is delivered:
- on a Saturday after 12.00 p.m. (act marked with the letter “T”)
- on a Sunday (act marked with the letter “D”)
- on a public holiday (act marked with the letter “F”)
- between 8.00 p.m. and 10.00 p.m. (act marked with the letter “G”)
- 50%, if the act is delivered between 10.00 p.m. an 7.00 a.m. (act marked with the letter “N”)
These increases require the agreement from the Medical Board of the Social Security.
When an insured person asks for their treatment to begin after the validity deadline of the prescription, the services are only covered by health insurance after prior agreement by the Medical Board of the Social Security.
Midwives refrain from delivering care when they notice that the prescription has expired. In this case, they inform the insured person as well as the prescribing doctor.
Generally, the CNS pays the fees for the delivered care directly to the midwife as part of the third-party payment system.
If the insured person receives an invoice, they have to pay the costs upfront and send the paid and receipted invoice together with the medical prescription, if necessary, to their competent fund.
Compensation for lost fees
If the insured person failed to keep an appointment or was away from home at the time they were supposed to receive the treatment, and if the insured person failed to notify the midwife at least during the day before the appointment, the midwife is entitled to a compensation for lost fees
This compensation, as well as potential travel costs incurred, are not covered by health insurance.
The travel expenses include the travel allowance as well as the travel costs per kilometre driven.
The travel costs per kilometre driven can only be invoiced if the journey took place outside of the locality where the midwife has established their practice or within the locality, if the journey exceeds one kilometre. However, the incurred travel costs cannot exceed the costs corresponding to the distance actually travelled.
Travel expenses for midwives can be covered, provided that:
- the doctor indicates on the prescription that the insured person is unable to leave their home for medical reasons;
- the journey takes place on Luxembourg territory. Journeys beyond the borders cannot be covered;
- the treatment has been carried out in a non-hospital setting.
Midwifery care abroad
When it comes to midwifery care delivered in the country of residence of a cross-border worker, these services are exclusively reimbursed by the local health fund of the country of residence, in accordance with the rates, tariffs and conditions of that country.
Midwives established in Luxembourg may only provide care in Luxembourg.