General practitioners and specialists

Procedure for allocating a service provider code

In order to practise as a doctor in Luxembourg, I must obtain authorisation from the Ministry of Health and Social Security.

In accordance with the laws in force, which impose compulsory agreements, the CNS provides me with a service provider code.

Thus, the agreements concluded between the CNS and the Association of Doctors and Dentists, as well as their mandatory provisions, apply to me as a doctor practising in Luxembourg.

Before starting to practise, I must therefore obtain this individual service provider code from the CNS.

Flat rates for device usage costs

New flat rates for device usage are about to be introduced in the nomenclature of medical acts and services, replacing the tariffs for device costs marked with the letter X. These changes concern the medical specialities of obstetrics and gynaecology, hepatogastroenterology and otorhinolaryngology. Click here to consult the page ‘Flat rates for device usage costs’ and find out about the changes coming in 2025.

Documents to be sent to the CNS:

  • The ‘Information sheet on the establishment of a doctor/dentist in Luxembourg’(Fiche de renseignement sur l'établissement d'un médecin/médecin-dentiste au Luxembourg)
  • A copy of the ‘authorisation to practise’ (autorisation d'exercer) or the ‘service provision declaration’(déclaration des prestations de service) issued by the Ministry of Health and Social Security, and, where applicable, the authorisation relating to radiation protection (autorisation relative à la radioprotection).
  • A copy of an identity document
  • Bank details

Documents should be sent in PDF format to gefo.cns@secu.lu.
Requests in JPEG and HTM format cannot be opened and will therefore not be accepted.

Liberal association

You can practise either individually in a private practice or join forces with other colleagues in a shared medical practice.

The practice of medicine in a liberal association with pooling of fees is linked to the creation of a common service provider code. All acts performed by the members of the association can be invoiced under this code.

A liberal association is characterised by greater stability and transparency between its members. Each member of the association receives an annual statement of the amounts charged to the association for the period during which they were a member.

To request a common service provider code or to communicate a change in the composition of an existing association to the CNS, the form ‘Practising medicine in a liberal association’( Pratique de la médecine en association libérale), available under ‘Focus on forms’ should be used.

Currently, only doctors who practise the same medical speciality are authorised to form a liberal association.

Electronic data exchange

This section does not concern exchanges that will be made progressively compulsory under the new AMMD-CNS agreement! Useful information on this subject will be communicated shortly. Subscribe to our monthly CNS update newsletter here.

In certain agreements between the CNS and various healthcare professionals, the organisation of the management, transmission and storage of documents is provided for exclusively in digital and electronic form. These include agreements between the CNS and laboratories for medical analysis and clinical biology, physiotherapists and dieticians. For healthcare professions other than doctors and dentists, electronic data exchange is optional.

To participate in the electronic exchange of data, the service provider must connect remotely to a secure space to upload their request files and retrieve the response files that the CNS has uploaded there. To do this, a service provider must:

  • Connect to the ‘HealthNet’ secure network to access the CNS server
  • Be able to generate application files that comply with the specifications forming part of the agreement and to import the CNS return files into their own database.

In order to ensure an exchange that respects confidentiality and data protection, the service provider must connect to ‘HealthNet’, a highly secure computer network provided by the eHealth Agency. The service provider must then request a username and password to access the CNS server, which is also connected to HealthNet.

The relevant forms and user guides are available below. New service providers wishing to connect for the first time are advised to first consult the ‘User guide for activating a new electronic connection with the CNS’(Guide utilisateur pour activer une nouvelle connexion électronique avec la CNS).

IMPORTANT NOTE: Access to HealthNet and the CNS server is reserved for service providers who have a valid service provider code. If you do not yet have such a code, please follow the procedure for obtaining a service provider code.

Documents

Forms

Featured topics

The healthcare system in Luxembourg is based on the principle of free choice of healthcare provider by the patient, allowing everyone to freely select their doctor or healthcare establishment.

In Luxembourg, the term ‘doctors’ encompasses both general practitioners and medical specialists (with the exception of dentists). The medical specialities recognised in the country are defined by a Grand-Ducal regulation. Among these specialities are cardiology, general surgery, dermatology, gastroenterology, ophthalmology, paediatrics and urology.

The care pathway is structured in three levels:

  • Primary care (first line): General practitioners are the first point of contact. They are responsible for prevention, the diagnosis of common illnesses and the treatment of less complex conditions. If necessary, they refer patients to medical specialists.
  • Secondary care (second line): This level includes specialised care, provided by medical specialists and hospitals. They are involved in in-depth diagnoses, specialised treatments and more complex care.
  • Tertiary care (third line): After hospitalisation, rehabilitation and follow-up care are provided by care and assistance institutions or via home care networks. These organisations provide patients with continuous assistance in their recovery.

In addition, in Luxembourg, a general and compulsory agreement system is in place. This means that all healthcare providers authorised to practise in the country are automatically contracted. They are therefore required to respect the fixed nomenclatures and tariffs, thus guaranteeing uniformity of costs for medical services.

As a doctor practising in Luxembourg, it is useful to know the conditions for reimbursement of services provided to patients. In fact, anyone working in the country is obliged to be affiliated to the National Health Fund (Caisse nationale de santé-CNS) or the competent public sector fund. This affiliation also makes it possible, under certain conditions, to co-insure family members, thus enabling them to benefit from medical care in Luxembourg.

Each patient receives a social security card, which includes a 13-digit national identification number. This number must be presented during consultations to facilitate the management of benefits and reimbursement of care.

For health insurance to cover the benefits, the following conditions must be met:

  • Membership to health insurance must be current.
  • The procedures and services provided must be listed in the nomenclature of doctors.

As a doctor practicing in Luxembourg, it is important to know the limits and conditions of coverage of services by health insurance.

Authorisation required

Some acts or services require authorisation from the National Health Fund (CNS), after approval from the Social Security Medical Board (Contrôle médical de la sécurité sociale-CMSS) for coverage. In the nomenclature of acts and services, these acts are identified by the mention ACM (authorisation from the medical board required) or APCM (prior authorisation from the medical board required). It is important to check whether this is a necessary condition for coverage of the costs before providing the services.

Number of consultations/visits

The CNS limits the number of reimbursed consultations or visits according to the following criteria:

  • Per 24-hour period: Only one consultation or visit to the general practitioner or medical specialist of the same medical discipline, except in the case of intervention by the emergency medical service (SAMU).
  • Per 7-day period: A maximum of two consultations or visits to the general practitioner or medical specialist of the same medical discipline.
  • Per semester (6 months): Maximum of twelve consultations or visits to the general practitioner or specialist in the same medical discipline, except for consultations or visits in long-term geriatric care or in-patient hospital care.

These restrictions do not apply to prescription renewals, or to serial injections and dressings.

Personal convenience

In accordance with the agreement between the CNS and the AMMD, doctors may invoice an additional fee for personal convenience, provided that they inform the patient in advance. Treatment only begins when the patient agrees to cover the additional fee, which is at their expense.

We are pleased to inform you that Immediate Direct Payment (Paiement Immédiat direct-PID) is now available!

With PID, you can now receive an instant transfer of the amount covered by health insurance for acts and services provided to your patients in a matter of seconds.

Detailed information on the PID can be found by clicking on this link

What is social third-party payment?

From 1 January 2013, people on a modest income will be able to apply to the relevant social welfare office for third-party payment of social security benefits. The aim of this scheme is to facilitate access to medical and dental care for people in difficulty.

Upon presentation of a time-limited certificate, issued to the beneficiary by the relevant social welfare office, the beneficiary will no longer have to advance their healthcare expenses and then request reimbursement, but medical and dental services will be covered directly by the National Health Fund.

« La prise en charge directe est encore accordée en cas d’indigence de la personne protégée dûment documentée par une attestation établie par l’office social en charge, suivant les modalités déterminées par les dispositions statutaires et conventionnelles. »

Who can benefit from the social third-party payment system?

In accordance with the law of 18 December 2009 organising social assistance, any person legally resident in the Grand Duchy of Luxembourg may apply to the competent social welfare office in their municipality.

It is the exclusive responsibility of the social welfare office to determine whether the applicant fulfils the conditions required to benefit from social third-party payment.

Which social welfare office is responsible?

30 social welfare offices provide social assistance throughout the country. The competent social welfare office is determined according to the applicant's municipality of residence. Each social welfare office is responsible for the residents of one or more municipalities.

Consult the list of competent social welfare offices on the website of the Ministry for Family Affairs, Integration and the Greater Region.

What conditions must be met to benefit from social third-party payment?

Affiliation to health insurance is a condition for granting social third-party payment. Thus, upon receipt of the application, the social welfare office first ensures that the applicant is affiliated to health insurance and, if necessary, proceeds with the affiliation.

The social welfare office can find out about an applicant's affiliation by contacting the CNS via the email address: affiliation_tps.cns@secu.lu

Then it is the exclusive competence of the social welfare office to judge, on a case-by-case basis, whether the granting of social third-party payment is necessary.

Which services are eligible for coverage under the social third-party payment system?

The social third-party payment system currently applies to services provided by doctors and dentists.

Where can the acts and services of doctors and dentists be consulted?

You can consult our ‘Nomenclatures’ tool available on our website

What documents are provided by the social welfare office if the social third-party payment is granted?
  • Time-limited certificate
  • Booklet of labels

If the social third-party payment is granted, the social welfare office will hand deliver a time-limited certificate to the applicant, together with a booklet of labels.

The certificate and the booklet of labels are issued in the name of the beneficiary.

They contain the beneficiary's social security number and the authorised period, known as the validity period, of the social third-party payment.

Labels are issued separately for each family member. In other words, invoices for care provided to a child are not accepted under the TPS if they bear a label of the father or mother. The invoice must bear a label of the child.

How long is the social third-party payment valid for?

The period of validity of the social third-party payment is determined by the social welfare office and may not exceed 3 months. In exceptional circumstances, social third-party payment may be authorised for a period of 6 months.

The start and end dates of the social third-party payment constitute the period of validity and are entered on the social third-party payment certificate and the accompanying labels.

No service provided on a date outside the period of validity of the social third-party payment system as stated on the certificate and labels can be taken into account under the social third-party payment system.

When does the social third-party payment system end and can it be renewed?

The benefit of the social third-party payment ends automatically at the end of the period of validity which is indicated on the label and on the certificate.

Beyond this period, the benefit of the social third-party payment may be extended or renewed at the request of the beneficiary and with the approval of the social welfare office according to the stipulated procedures.

The social third-party payment system may be revoked by the social welfare office before the expiry date. In this case, the social welfare office will endeavour, as far as possible, to recover the certificate and labels still remaining in the hands of the beneficiary.

What is the procedure for granting Social Third Party Payment?

Anyone wishing to benefit from social third-party payment must contact the social welfare office in the area where they live and submit an application.

The social welfare office will determine whether or not the applicant fulfils the conditions for granting social third-party payment.

If social third-party payment is granted, the social welfare office will give the person concerned a time-limited certificate, together with a Booklet of yellow labels.

The social welfare office agent informs the person about the practical arrangements relating to the social third-party payment system and ensures that the beneficiary's obligations are reiterated, in particular the obligation to identify themselves to the service provider by means of their social security card or identity document and to bring the certificate and labels.

The person signs a declaration of commitment which will be attached to their file. This declaration can be used in the event of a dispute by the social welfare office over the amounts charged by the CNS.

On presentation to the doctor or dentist of the social third-party payment certificate and the issue of a label, the period of validity of which must cover the date of the services provided, the beneficiary is entitled to the services of doctors and dentists under the social third-party payment scheme.

Please note: double validation by the social welfare office is mandatory for certain medical and dental services

 

What does the beneficiary of the social third-party payment system have to give to the doctor?

The person benefiting from the social third-party payment system goes to the doctor or dentist with the social third-party payment certificate from the social welfare office and the booklet of labels, both in their name. They must be able to prove their identity with a piece of ID and their social security card.

What are the beneficiary's obligations?

The beneficiary must respect the same rules that apply to anyone who wishes to benefit from health insurance services.

For example: Avoid excessive consumption by seeking the services of more than two different doctors in the same medical discipline within a period of six consecutive months, without justification accepted by the Medical Board.

If the beneficiary wishes to obtain the dispensation of services from doctors and dentists within the framework of social third-party payment, they are obliged to identify themselves to the service provider by means of an identity document or their social security card and must have the documents entitling them to social third-party payment, namely the time-limited certificate and the labels received.

How do I pay for the care I receive? Who pays what?

In the event of a visit to the doctor or dentist, the beneficiary of the social third-party payment takes the certificate and labels received from the social welfare office.

On presentation to the doctor or dentist of the social third-party payment certificate and the provision of a label, the validity period of which must cover the date of the services provided, the beneficiary is entitled to the services of doctors and dentists under the social third-party payment scheme.

In the case of third-party payment, the CNS is competent for all insured persons, even those insured by the 3 public sector health insurance funds.

The CNS pays the service provider the full rate for the act invoiced, in accordance with the provisions of the nomenclature of acts and services of doctors, the nomenclature of acts and services of medical analysis and clinical biology laboratories covered by health insurance and this agreement.

The full rate corresponds to the rate of the act, including the contribution resulting from the application of the coverage rates provided for in the statutes of the CNS to the rate in question.

It then goes to the competent social welfare office to recover the part of the costs that are entirely the responsibility of the patient in accordance with the statutes of the CNS.

The social welfare office pays the patient's share to the CNS and then checks whether the beneficiary is able to reimburse the social welfare office for the part they paid personally.

Please note: additional fees for personal convenience (CP1-CP7) are excluded from the social third-party payment procedure and are payable by the beneficiary. Only an additional fee (CP8) for dental services and supplies agreed with the insured person in excess of the health insurance coverage rates can be covered by the social third-party payment.

When does the beneficiary of the social third-party payment have to go to the social welfare office for double validation?

Double validation by the social welfare office is compulsory in the following cases:

Prior estimate

Dental services that require a prior estimate (e.g. certain acts of orthodontics or care related to dental prostheses) require a second validation by the competent social welfare office. The dentist attaches a label to the estimate and gives it to the beneficiary, who then submits the estimate to the welfare office for prior validation, i.e. the welfare office determines the amount of its intervention and enters this amount on the estimate. When authorisation by the Social Security Medical Board (CMSS) is mandatory, the beneficiary sends the estimate to the CNS for authorisation. The social welfare office only validates after this authorisation. Coverage of these services under the social third-party payment system can only take place after double validation by the social welfare office.

Personal convenience (CP8)

CP8: Supplement invoiced by dentists for the cost of materials agreed with the insured (e.g. porcelain, gold, etc.) in excess of the rates in the nomenclature and not covered by health insurance.

When this personal convenience exceeds an amount of 25 euros per session, coverage under the social third-party payment system can only take place after validation by the social welfare office. The social welfare office thus determines the amount of its intervention, i.e. the amount exceeding that of the CNS coverage. This prior validation is not necessary when the excess of the tariffs is equal to or less than 25 euros.

Please note: supplements for personal convenience (CP1-CP7) that may be charged by the doctor or dentist are excluded from the social third-party payment procedure and are the personal responsibility of the beneficiary.

The involvement of several specialised doctors can complicate the coverage of a patient suffering from serious, chronic or long-term pathologies. In this context, the role of the referring doctor is central. As a general practitioner or paediatrician, you are often the main contact person, responsible for coordinating care and ensuring optimal medical follow-up for your patients.

The referring doctor uses the shared care record (Dossier de soins partagé-DSP), a secure electronic record, to centralise the patient's medical information. Thanks to this tool, each authorised healthcare professional can add relevant data such as test results, consultation reports or prescriptions. As the referring doctor, your role is to monitor this information to ensure consistent coverage and avoid redundancies in treatments or examinations.

You also draw up the patient summary (résumé patient), an essential document that brings together key information on the patient's state of health. This summary, updated at each consultation, is shared via the DSP with other authorised healthcare professionals, providing them with an up-to-date overview.

Which patients are covered by the referring doctor scheme?

In order to be able to choose a referring doctor, the patient must fulfil the following two conditions:

  • they must have at least one long-term illness (Affection de longue durée-ALD) whose severity or chronic nature requires prolonged treatment and a significant need for coordination due to the intervention of several healthcare providers;
  • they must have a shared care file (DSP) activated with the eHealth Agency.

Long-term illnesses (ALD) are defined in appendix 1 of the agreement between the CNS and the AMMD. It is a list of 32 long-term illnesses, such as multiple sclerosis, Alzheimer's and Parkinson's diseases, cystic fibrosis, etc.

What is a referring doctor?

The referring doctor is the doctor who knows the patient best and whom the patient consults as a priority in the event of a health problem. He plays a central role in the medical follow-up of patients targeted by the referring doctor scheme (see question 1). His missions include:

  • coordinating care and ensuring optimal medical follow-up;
  • referring their patients, if necessary, to other healthcare professionals (specialist doctors, physiotherapists, etc.);
  • managing the medical file by centralising all the information concerning the care and state of health of their patients (examination results, diagnoses, treatments, etc.);
  • regularly monitoring the content of the shared care file (DSP).

These tasks have been defined in Article 19bis of the Social Security Code.

What is a shared care file (Dossier de soins partagé-DSP)?

The shared care record (DSP), managed and made available by the eHealth Agency, is the patient's secure electronic health record, between and for the healthcare professionals involved with the patient. The patient has direct control over their DSP, which is made available to them free of charge. Access to the DSP is reserved solely for the patient and for healthcare professionals authorised in Luxembourg who are treating the patient and to whom the patient has granted access rights.

The main objective of the DSP is to promote exchanges between healthcare professionals and thus enable better coordinated coverage of the patient through centralisation of all essential information relating to his or her state of health. The DSP thus brings together the relevant health data necessary for optimal patient coverage, including the results of radiological and/or biological examinations, consultation and hospitalisation reports, prescriptions, etc.

The DSP is a collaborative tool between health professionals and is available to the patient.

In order to guarantee a high level of data security and protection, the eHealth Agency has implemented strict technical security measures.

For more information, consult the information and documents on the eHealth Agency website, including the leaflet ‘The Shared Care Record (DSP) - Discover the essentials about your electronic, personal and secure health record’.

More information on the website of the Agence eSanté

Does the patient have to have a referring doctor?

No, there is no obligation. The patient can continue to consult their GP or specialist without having to sign a declaration.

What are the advantages of the referring doctor scheme?

The referring doctor helps to improve the quality of care provided to the patient and the performance of the healthcare system as a whole.

By supervising the patient's journey through the healthcare system, the referring doctor makes it possible to:

  • avoid duplication or interactions of medicines, i.e. optimise the consumption of medicines;
  • avoid unnecessary consultations;
  • limit the examinations and/or analyses to be carried out.

By committing to the patient for a long-term relationship, the referring doctor contributes to:

  • enhance their role as a trusted doctor;
  • promote the patient's health and safety;
  • guide the patient through the healthcare system by becoming their privileged agent;
  • provide the patient with appropriate long-term support in the event of a complex or prolonged health problem.

Who can be a referring doctor?

The doctor to whom the patient refers cannot accept the tasks of the referring doctor unless:

  • he provides primary care with a holistic approach outside the hospital environment, and
  • he is a general practitioner or paediatrician.

Is the patient obliged to go through their referring doctor in order to consult another doctor or a medical specialist?

No. The patient can consult a medical specialist or any other doctor of their choice directly without going through their referring doctor.

What are the procedures for declaring the start of a referring doctor/patient relationship?

Fill in and sign the form ‘Déclaration médecin référent’ (referring doctor's declaration)

The referring doctor declaration is the document completed jointly by the patient and the referring doctor during a consultation and by which the patient adheres to the referring doctor system, in accordance with the amended Grand-Ducal Regulation of 15 November 2011 determining the procedures for appointment, renewal, change and replacement in the absence of the referring doctor.

In order to be registered with the CNS, this declaration must comply with the standard model appended to the agreement between the AMMD and the CNS.

If the patient is a minor or under guardianship, their legal representative or duly authorised person must sign the form.

Inform the CNS

The form, duly completed, dated and signed, should be returned by the referring doctor to the ‘Referring Doctor Service’ of the National Health Fund.

For further details, see: Explanatory note« Déclaration médecin référent (Referring Doctor Declaration).

 

What are the main documents and tools related to the referring doctor scheme?

The referring doctor's statement

  • Completed jointly by the patient and the referring doctor.
  • Validated, registered and managed by the CNS.
  • Unique for each patient.
  • Once validated, it automatically triggers the relationship between the patient and the Referring Doctor in the patient's DSP.

The DSP

The shared care record (DSP), managed and made available by the eHealth Agency, is the patient's secure electronic health record, between and for the healthcare professionals involved with the patient. The patient has direct control over their DSP, which is made available to them free of charge. Access to the DSP is reserved solely for the patient and for healthcare professionals authorised in Luxembourg who are treating the patient and to whom the patient has granted access rights.

The main objective of the DSP is to promote exchanges between healthcare professionals, and thus enable better coordinated coverage of the patient by centralising all essential information relating to their state of health. The DSP thus brings together the relevant health data necessary for optimal patient coverage, including the results of radiological and/or biological examinations, consultation and hospitalisation reports, prescriptions, etc.

The DSP is a collaborative tool between healthcare professionals and is available to the patient.

In order to guarantee a high level of data security and protection, the eHealth Agency has implemented strict technical security measures.

For more information, see the information and documents on the website of the eHealth Agency, including the eHealth Agency leaflet ‘The Shared Care Record (DSP) - Discover the essentials about your personal and secure electronic health record’.

Summary of benefits

  • Summary of health benefits covered by health, maternity, accident and long term care insurance over the last three years, then annually on the anniversary of one year of benefits.
  • Prepared by the CNS and paid annually to the DSP from the effective date of the MR relationship, and at the earliest from 1 July 2016.

The patient summary

  • Drawn up by the referring doctor and integrated into the DSP within three months of the date on which the referring doctor relationship takes effect (the 1st day of the month following validation of the declaration by the CNS) based on the medical information available to them: medical file, reports and accounts of colleagues involved in the patient's follow-up, etc.
  • Made available to the patient free of charge to guarantee continuity of care in the event of coverage by other doctors.
  • Updated by the referring doctor during each contact with the patient, to include any new relevant clinical or therapeutic element related to the patient's state of health and useful for the coordination of care between health professionals.

What is the summary of benefits (résumé des prestations)?

From the date the MR relationship takes effect (the 1st day of the month following validation of the declaration by the CNS), the CNS sends the patient's DSP a yearly summary of the benefits covered by the health, maternity, accident and long term care insurance.

What is the patient summary (résumé patient)?

Within three months of the date on which the referring doctor relationship takes effect (the 1st day of the month following validation of the declaration by the CNS), the referring doctor shall include a patient summary in the DSP. At the patient's request, the referring doctor shall explain the content of the patient summary to the patient and provide the patient with a free copy thereof.

The referring doctor must update the patient summary in the DSP at each contact with the patient. The referring doctor shall at that time record in the patient summary any new relevant clinical or therapeutic element relating to the patient's state of health and useful for the coordination of care between healthcare professionals.

When does the referring doctor/patient relationship take effect?

The relationship is effective from the 1st day of the month following validation of the declaration by the National Health Fund.

Upon receipt of the MR declaration, the CNS proceeds to check the file. After validation, the CNS generates a unique MR declaration number which it communicates in writing - together with the date on which the MR declaration takes effect - to the referring doctor, the patient and, if applicable, the legal representative or duly authorised person. The existence of the referring doctor relationship is communicated by the National Health Fund to the eHealth Agency.

Example: a declaration validated on 10 November 2024 by the CNS takes effect on 1 December 2024.

How long is the referring doctor's statement valid for?

The relationship with the referring doctor is established for an indefinite period. The declaration therefore remains valid as long as the patient and the doctor are authorised to continue this patient/referring doctor relationship.

In one of the following scenarios, the patient is no longer bound by the referring doctor declaration and is free to choose a new referring doctor:

  • if their referring doctor dies;
  • if they revoke the referring doctor declaration.

What procedures are necessary to terminate the relationship between referring doctor and patient?

During the first twelve months, the authorisation may only be revoked by mutual agreement between the referring doctor and his patient, with two months' notice.

In the event of mutual revocation, the referring doctor and the patient shall jointly complete the form “Revocation of the referring doctor's declaration by mutual authorisation”. The referring doctor then returns the form, duly completed, dated and signed, to the referring doctor department of the National Health Fund.

Example: A declaration received by the National Health Fund on 10 March 2024 and validated by the Fund in March 2024 takes effect on 1 April 2024. If, on 5 May 2024, the CNS receives the form ‘Revocation of the referral doctor declaration by mutual authorisation’ signed on 3 May 2024, the revocation will be effective from 3 July 2024. A new referral doctor declaration may then be taken into account by the CNS.

From the second year onwards, the revocation can be made at any time and unilaterally either by the referring doctor or by the patient, with two months' notice.

If the referring doctor decides to terminate the declaration, they will use the form “Revocation of the referring doctor declaration by the referring doctor” and send it to the patient, copying in the National Health Fund.

If the patient is the originator of the revocation, they will use the form ‘Revocation of referring doctor declaration by the protected person’ which they will send to the referring doctor, copying in the National Health Fund.

The referring doctor must enable the patient to communicate to a new referring doctor all the data useful for the continuation of the referring doctor's mission.

For more details, see the explanatory note ‘Revocation Referring doctor declaration’.

When can the patient appoint a new referring doctor?

After revoking the previous referring doctor declaration, the patient can designate a new referring doctor. To inform the National Health Fund of their new choice (of referring doctor), the patient must complete a ‘Referring doctor declaration’ form with the new referring doctor chosen.

Note: A new declaration can only be taken into account (by the CNS) after the revocation of the old one. It will only take effect after the legal notice deadlines (2 months) have elapsed.

The referring doctor must enable the patient to communicate to a new referring doctor all the data useful for the continuation of the referring doctor's mission.

What are the current rates?

MR03

Package for the coordination of care in cases of serious or chronic pathologies or long-term care and for the regular monitoring of the content of the shared care file of the protected person suffering from at least one serious chronic pathology classified as a long-term condition and whose severity and/or chronic nature require prolonged treatment as well as a substantial need for coordination due to the intervention of multiple healthcare providers:

  1. The MR03 act can only be applied to the following medical specialities: general practitioner and paediatrician.
  2. The first application of the MR03 act can be made at the earliest six months after the effective date of a referring doctor declaration as provided for in Article 19bis of the Social Security Code.
  3. Only one MR03 position may be invoiced per six months.
  4. Serious chronic pathologies categorised as long-term conditions are listed in article 20 of the aforementioned grand-ducal regulation.

This flat rate has a coefficient of 24.71; the current rate can be consulted in the nomenclature of acts and services of doctors.

The new MR03 act is therefore invoiced on a six-monthly basis and can be invoiced at the earliest six months after the MR declaration takes effect. Invoicing is conditional on the presentation of a ‘Certificate of update of the patient summary by the protected person’. The MR notifies the certificate to the CNS as soon as possible. This certificate will no longer be necessary once the patient summary has been integrated into the DSP.

Which serious chronic conditions justify the MR03 rate?

Long-term conditions, listed in appendix 1 of appendix V of the agreement between the CNS and the AMMD, may give rise to the MR03 position being applied.

To find out more about chronic conditions

Where can the legislation and documents concerning the referring doctor be found?

You can access the links to the legislation concerning the referring doctor under For more information.

The various forms relating to the referring doctor are available under Focus on forms, explanatory notes under For more information.

If I have patients who are on long-term sick leave and I think that a progressive return to work could, from a therapeutic point of view, improve their state of health or promote their recovery, I can offer them the progressive return to work for therapeutic reasons (RPTRT).

Since 2019, progressive return to work has replaced the former therapeutic part-time work (mi-temps thérapeutique).

This measure allows patients who are unable to work to gradually return to work during their recovery phase, particularly after a long period of illness.

The aim is to enable a smooth reintegration into daily work at the patient's own pace and thus make a decisive contribution to improving the patient's state of health.

As the attending physician, you are familiar with the situation of your patients and can initiate the procedure for a progressive recovery.

How to apply - who does what?

1. Medical consultation

As the attending physician, I can submit the request for progressive return to work if I believe that such a return can have a positive effect on my patient's recovery. After discussing it with my patient, we can fill in the standard form ‘Request for progressive return to work for therapeutic reasons’ available under Focus on forms.

Conditions:

  • My patient must be unable to work at the time of the request to the CNS.
  • My patient must have been unable to work for at least one month in the three months preceding the request.

2. Employer's authorisation

Once the form has been completed and signed by me and my patient, the patient must request authorisation from their employer.

The employer gives his authorisation by signing the form.

3. Sending the request to the CNS for authorisation

Once the form has been completed and signed by myself, my patient and the employer, the request for authorisation can be sent by the patient by post to the CNS (postage free from Luxembourg):

Caisse nationale de santé
Indemnités pécuniaires
L-2980 Luxembourg

Before the patient can begin the progressive return to work, they must have received authorisation in advance from the CNS, with a favourable opinion from the Social Security Medical Board. The CNS will communicate the decision in writing to the patient and the employer as soon as possible.

 

If any of the three parties refuse the request, the request for a progressive return to work is not admissible.

Is a medical certificate required during the measure in addition to the standard form?

Yes, for the duration of the return-to-work measure, a medical certificate of full-time incapacity for work must be provided and the patient is considered unable to work from an employment law perspective.

It is not necessary to issue a new certificate if my patient cannot work during the period of the measure.

However, any interruption of the incapacity for work terminates the measure, such as statutory leave or early return to full-time work (100% of normal working hours according to the employment contract).

What percentage can or should my patient go to work during the measure?

The measure does not provide for fixed rates. My patient can therefore adapt his return to work progressively to his state of health in order to promote improvement. It is up to the patient to decide how many hours he will be able to work according to his needs and to discuss this with his employer. As soon as the patient can return to work full time (according to his employment contract), this puts an end to the measure.

Do the rules on sick leave apply during the period of the measure?

No, during the period of the measure, the patient exit scheme does not apply.

Prior authorisation from the CNS for a transfer abroad is mandatory in the following situations:

  • the patient is expected to stay for scheduled care for at least one night in a hospital abroad,
  • the patient must use highly specialised and expensive facilities during their stay, such as national competence centres, national services and specialised rehabilitation, convalescence and spa establishments,
  • the patient must use highly specialised and expensive medical equipment and apparatus determined at the national hospital level.

In these cases, I fill out a request for prior authorisation for my patient to be transferred abroad.

All authorisations must be requested from the CNS well before the start of the scheduled treatment. This is done using the standard form ‘Application for prior authorisation of a transfer abroad’, which must be completed by you.

The application must be completed in accordance with the provisions of Article 27 of the CNS statutes. Thus, it is essential that I indicate the ICD10 code, which I can look up at this link.

The application can then be submitted to the CNS by post, fax or email. More information on our page Insured Scheduled treatment abroad.

For the effective processing of the request for prior authorisation for a transfer abroad, it is important that:

  • the corresponding requests are sent to the CNS within the appropriate deadlines. The request and the related agreement from the CNS must be established prior to the start of the treatment covered by the transfer abroad;
  • the means of transport required for the transfer abroad is duly indicated on the standard request form.

From 1 August 2019, the terms ‘prescription’ or ‘medical prescription’ are no longer applicable to a request for an imaging examination, since the decision to perform the exposure is the responsibility of the examining doctor, who must, in particular, order the exposure when he considers it justified, or else modify or refuse it.

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