Addendum to the AMMD-CNS agreement

We would like to remind you that the Addendum to the Agreement of 13 December 1993, as amended, concluded between the AMMD and the CNS, signed on 21 October 2024, entered into force on 1 June 2025.

The central element of this Amendment is, of course, mandatory digital transmission. However, in addition to the obligation of digital transmission, the amendment covers many other elements and adjustments.

Here are the main elements of the amendment.

1. Digital transmission of structured and standardised data

Digital transmission becomes mandatory for all standardised forms published in the specifications forming an integral part of the agreement. The fee statement/invoice (excluding third-party payments) will be the first document that must be transmitted in digital form, with effect from 1 January 2026.

The digital transmission of a standardised formula in the form of structured and standardised data is mandatory three months after the publication of the relevant reference documents. At the express request of the AMMD, the reference documents relating to the fee statement, the first document to be transmitted digitally in structured and standardised data format, will not be published until 1 October 2025, which is why the digital transmission of fee statements will be mandatory from 1 January 2026.

According to the current schedule, the certificate of incapacity for work and the prescription must be transmitted digitally in structured and standardised data format during the first quarter of 2026 and the last half of 2026, respectively.

The CNS will keep you informed about the progress of the various stages of digitisation and any other developments and adjustments.

6. Exemption from mandatory digital transmission

The Amendment provides for the possibility of an exemption from the digital transmission requirement for doctors born before 1 January 1965 who meet all of the following conditions:

they do not work within an association of doctors or dentists as provided for in Article 3 of the agreement, and
they have an annual turnover of less than one hundred thousand euros (€100,000.00).

Those concerned who wish to obtain this exemption must submit a request for exemption before 1 August 2025 by registered letter to the CNS. To facilitate this process, the CNS will inform the doctors and dentists concerned of their possibility to request an exemption by sending them a letter or email.

Doctors who benefit from this exemption may nevertheless opt for digital transmission, without this terminating their exemption.

7. Provision of a paper copy

Doctors and dentists must continue to provide a paper copy free of charge at the patient's request. For example, if a doctor issues a digital certificate of incapacity for work but the person does not wish to receive it in digital form, the protected person must be able to receive a paper copy free of charge in order to assert their rights.

The production of a paper version does not entitle the patient to be charged. To offset the additional cost and neutralise the impact of the removal of the costs of standardised paper forms, which will no longer be covered by health insurance once the Agreement comes into force, the CNS has decided to maintain the compensation per digital document enforceable against the CNS, increasing it to €0.10 including VAT.