Immediate direct payment (PID)
We are pleased to inform you that Immediate Direct Payment (PID) is now available!
With this service, you can receive the amount covered by health insurance for acts and services provided to your patients in just a few seconds.
Find out everything you need to know about Immediate Direct Payment on this page.
News April 2025 - Ophthalmologists
Following questions received regarding the invoicing of bilateral operations via PID, particularly concerning IVT treatments and laser therapies, we would like to provide further clarification.
Under the PID, it is possible to invoice the same procedure for both eyes:
- For codes 4G74 and 4G75 (Treatment of retinal disorders (except detachment) by photocoagulation or laser), the doctor must enter OG4G74 and OG4G75 for the left eye and OD4G74 and OD4G75 for the right eye. The second act must be completed with the suffix R.
- For all other codes (except for examinations 4E11 to 4E18), the doctor may indicate that it is a bilateral procedure by adding the suffix B.
Both approaches result in a chargeable amount of 150% of the basic rate, as provided for in the nomenclature for a bilateral operation.
Frequently asked questions (FAQ)
- General questions about the PID
- Software and editor
- Payments and compensation
- How to activate MySecu.lu web services
What exactly is PID?
Immediate direct payment (PID) allows doctors to receive the portion of the amount covered by health insurance directly from the CNS. The transfer from the CNS is made instantly, allowing doctors to receive the corresponding amount in their bank account in just a few seconds.
For the few banks in Luxembourg that have not yet implemented instant transfers, the transfer is made within 48 hours (see the question and answer: When is payment initiated by the CNS?).
Any amount payable by the patient is paid directly by the patient.
Does the PID only apply to persons insured with the CNS?
The PID applies to all persons covered by health and maternity insurance in Luxembourg (CNS, CMFEP, CMFEC, EMCFL). The covering organisation is the CNS.
What about other means of reimbursement/coverage?
The PID is not intended to replace an existing coverage method. It is in addition to other coverage methods. Standard and accelerated reimbursements therefore continue to exist, in particular:
- if the doctor is not yet (technically) ready for the PID;
- if calls to the PID services fail;
- if the patient does not want to use the PID;
- in the event of disagreement with the CNS pricing (doctor and/or patient).
In other words, any fee invoice for which the insured person (or a third party) has made an upfront payment can be sent/submitted to the CNS for reimbursement.
What acts can DOCTORS charge via PID? What are the exclusions?
Nomenclature of doctors
From 19 March 2024, doctors will be able to use all acts and services in the nomenclature of doctors within the framework of the PID, with the following few exceptions currently:
- Acts not included in the nomenclature of doctors or the CNS-AMMD agreement
- Medical acts provided within the scope of the accident insurance association's competence
- Acts billed to a person covered by social security
- Acts subject to ACM or APCM
- Inpatient hospital treatment or treatment in a day hospital
- Medical flat rates for follow-up at a psychiatric day centre (D1 to D4)
- Hourly and mileage allowances for night duty in general medicine (K2)
- Medical flat rates for treatment at the national functional rehabilitation and rehabilitation centre (J9 and F43)
- Acts relating to multidisciplinary consultation in oncology (P1 to P3)
- Acts within the framework of the early breast cancer screening programme (E20, 8V53)
- Consultations, examinations and acts within the framework of the organised colorectal cancer screening programme (PDOCCR) (E30, E31, E32, 1G91 to 1G96)
- Radiotherapy (acts whose code begins with: KNQ--, KPK--, KQD--, KQQ--, KZQ--, KRQ--, KRB--)
- Reports to the Social Security Medical Board (R4, R5, R6, R8, R9, R11, R12)
- The following other acts: C46, FC45, MR03, R1, R20
- In general, acts that currently require manual verification by a CNS administrator (V101, V301, V401, V501, V601, V701, acts and services provided to patients who are in a period covered by Article 8 of the CNS statutes, etc.)
- In general, acts requiring the presentation of an attachment, prescription, etc. for coverage.
Nomenclature of laboratories
With regard to the nomenclature of acts and services provided by medical analysis and clinical biology laboratories, doctors will also be able to invoice via PID the acts they perform in their medical practice, namely:
- BC001, BC002, BC042, BC141, BC202, BC203, BC403, BC602, BD701, BG001, BG002, BG003, BG212, BH503, BH991, BH993, BH994, BH995, BH996.
What acts can DENTISTS charge via PID? What are the exclusions?
Nomenclature of dentists
From 19 March 2024, dentists will be able to use the acts and services listed in the nomenclature for dentists within the framework of the PID, with the following exceptions currently applying:
- Acts not included in the nomenclature for dentists or the CNS-AMMD agreement
- Medical acts provided within the scope of the accident insurance association's competence
- Acts billed to a person covered by social security
- Acts subject to ACM or APCM
- Acts subject to DSD - except those listed in Article 4 of the nomenclature (fee statement serves as quotation)
- Inpatient hospital treatment
- Placement of bone implant(s) in the skull and face (DB95 to DB98)
- Dental prosthesis (DA11 to DA75)
- Unfinished treatment for dental prosthesis (DA91 to DA96)
- Joint prosthesis (DB13 to DB54)
- Unfinished treatment for joint prosthesis (DB91 to DB93)
- Orthodontics (DT10 to DT62)
- Services reserved for accident insurance (DW18 to DW31)
- The following other acts: FD45, FD46
Note - DSD
For the sake of clarity, here are the only DSD acts that are included in the PID system (see Article 4 of the nomenclature: ‘invoice is equivalent to quotation’ (mémoire d'honoraires vaut devis)):
DP47, DS18, DS19, DS24, DS26, DS27, DS33, DS34, DS35, DS36, DS41, DS42, DS43, DS44, DS45, DS47, DS50, DS69, DS70, DN50, DP1, DP2, DP3, DP4, DP40, DP50, DS53.
Under the PID, how should I take personal conveniences (CP) into account?
Personal conveniences must be invoiced via your software, together with the other acts you have provided to your patients.
You must clearly indicate which personal convenience you are invoicing your patient for: CP1 to CP7 for doctors, CP1 to CP8 for dentists. It is not sufficient to indicate ‘CP’ without identifying the type of personal convenience. For more information, please consult our page ‘Personal conveniences’.
As a reminder, personal conveniences are not covered by health insurance and are entirely at the expense of the insured person.
Under the PID, how should I charge for DSD acts (excess charges on quotations (dépassement sur devis))?
For DSD acts, it is essential that you indicate the rate you are charging in your software.
The existing list of DSD acts included in the PID system (see Article 4 of the nomenclature) has been expanded (acts in italics) and is as follows since 1 February 2025:
- DP47, DS18, DS19, DS24, DS26, DS27, DS33, DS34, DS35, DS36, DS41, DS42, DS43, DS44, DS45, DS47, DS50, DS69, DS70, DN50, DP1, DP2, DP3, DP4, DP40, DP50, DS53.
OPHTHALMOLOGIST: Under the PID, how should I invoice bilateral operations?
Following questions received regarding the invoicing of bilateral operations via PID, particularly concerning IVT treatments and laser therapies, we would like to provide some clarification.
Under the PID, it is possible to invoice the same procedure for both eyes:
- For codes 4G74 and 4G75 (Treatment of retinal disorders (except detachment) by photocoagulation or laser), the doctor must enter OG4G74 and OG4G75 for the left eye and OD4G74 and OD4G75 for the right eye. The second act must be completed with the suffix R.
- For all other codes (except for examinations 4E11 to 4E18), the doctor may indicate that it is a bilateral procedure by adding the suffix B.
Both approaches result in a chargeable amount of 150% of the basic rate, as provided for in the nomenclature for a bilateral operation
Is it possible to reschedule the PID to another date?
Yes, it is possible to change the PID to an earlier date. The date chosen cannot be in the future.
Important: In order to apply the PID, you must have received payment from the patient or authorisation from the patient if there is no personal participation to be paid.
Which editors are certified by the Agence eSanté?
Below is a link to the list of editors certified by the Agence eSanté.
Do I have to pay for software updates provided by the editor?
After installation, your publisher will send a delivery note and a training certificate signed by the doctor directly to the Agency eSanté, without you receiving an invoice.
The costs of updating and maintaining your software are governed by the contract between you and your publisher and are independent of the €625 (including VAT) funding granted to your publisher for connecting you to the service (see below).
The Agency eSanté and the CNS contribute to the costs of installing and activating the RA service or, alternatively, the PID service with a flat fee of £625 per installation paid directly to the publisher if it complies with the conditions defined. Only one payment may be granted to the publisher by the connected doctor.
When using PID coverage, do I need to print a document on paper? What documents are given to my patient?
You only need to print out a receipt in accordance with the template provided. Under the PID, an invoice for the insured person does not need to be printed.
Following PID coverage, the insured person will receive the following from the CNS:
- either details of the immediate direct payment made after each consultation directly to their private eSpace on MyGuichet.lu, if the insured person has activated the eDelivery function there,
- or a statement of the services provided via PID direct coverage sent by post once a month, if the insured person has not activated the eDelivery function on MyGuichet.lu.
When is payment initiated by the CNS?t-il initié par la CNS ?
Despite the PID transaction being validated in my software, I have not yet received the PID transfer. What should I do?
In principle, if the simulation has been validated correctly, i.e. within 10 minutes of the simulation and without any error messages from the CNS, the transfer of the amount should be made instantly. However, for various reasons, the transfer may not be immediate. In this case, the amount is usually credited to your account within 48 hours. If, after this deadline, you still have not received the transfer, we will be able to carry out a thorough check to identify the cause of the problem.
How should you contact the CNS in this case?
Please send us:
- a copy of the relevant PID receipt,
- as well as the four XML files relating to the transaction:
- XML simulation file,
- XML simulation response file,
- XML validation file,
- XML validation response file.
Ask your editor if you do not know how to extract these XML files. These documents are essential for a detailed analysis of the situation.
What if the payment did not go through as expected?
If the validation return XML file indicates an anomaly or does not contain a payment ID, this means that the validation has not been carried out correctly.
What should you do?
It is now possible to change the PID to an earlier date (= the actual date of the consultation). The date chosen cannot be in the future.
However, if you receive a negative response from your software simulation (even though you have already collected your patient's share on the day of the consultation), the only solution is to send the invoice directly to your patient. They will have to pay the remaining amount and can then submit their claim for reimbursement to their health insurance fund.
How do I draw up the fee invoice? Date the invoice on the actual date of the service, enter the tariff code(s) for the service(s) provided and their official amounts according to the nomenclature. Under the heading ‘deposit to be deducted’, indicate the amount of the personal participation already paid by your patient. The total is then the amount remaining to be paid (= the portion covered by the health and maternity insurance).
A rare problem but handled with care
Rest assured, these situations are extremely rare given the large number of PID transactions carried out every day. The CNS and its partners make every effort to avoid this type of technical malfunction and to guarantee a reliable service.
My patient wanted to apply the PID and paid only his share. However, I later realised that I had not validated the simulation correctly in my software. What should I do?
It is now possible to change the PID to an earlier date (= actual date of the consultation). The date chosen cannot be in the future.
However, if you receive a negative response from your software simulation (even though you have already collected your patient's share on the day of the consultation), the only solution is to send the invoice directly to your patient. They will then have to pay the remaining amount and can submit their claim for reimbursement to their health insurance fund.
How do I draw up the invoice? Date the invoice on the actual date of the service, enter the tariff code(s) for the service(s) provided and their official amounts according to the nomenclature. Under the heading ‘deposit to be deducted’, indicate the amount of the personal contribution already paid by your patient. The total then corresponds to the amount remaining to be paid (= the portion covered by the health and maternity insurance).
At the PID level, what action(s) entitle the doctor to quarterly compensation for digital costs?
In order for the doctor to be entitled to compensation* under the PID, the entire PID process must be successfully completed, i.e. a simulation submitted by the doctor to the CNS rules engine and resulting in coverage by the CNS via the PID. Compensation is paid automatically; the doctor does not need to submit a specific claim.
Compensation is calculated on the basis of a rate currently set at EUR 0.1 (10 cents) per effective PID transaction.
* in accordance with Article 110 of the Agreement between the National Health Fund and the Association of Doctors and Dentists, for doctors; and in accordance with Article 111 of the Agreement between the National Health Fund and the Association of Doctors and Dentists, for dentists.
What conditions are necessary to ensure that payment is made as smoothly as possible and that the financial impact on the doctor is as low as possible?
- Thanks to the PID, the statutory share is paid directly to the doctor by the CNS. The CNS has also set up a system to make instant SEPA transfers in a matter of seconds, 24 hours a day, 7 days a week, with most local banks, such as BCEE, BGL, BIL, ING, etc., at no extra cost or effort to the doctor. Other banks will follow shortly.
- Use a publisher and a fiduciary with communication software that allows payment reconciliation.
- Make sure your fiduciary offers a flat-rate pricing model (or similar) rather than a per-line pricing model.
How do I activate MySecu.lu web services?
Your software publisher has updated your software to enable the PID to function.
You must also activate the web services on mySecu.lu (this only needs to be done once). Activation is a simple process involving just a few steps. Once completed, you will be able to access and use the PID.
Here is a quick tutorial (in french only). I click on the ‘enlarge’ icon at the bottom left, or I click on this link to open the presentation in a new tab in my browser.
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