In order to be entitled to coverage from the CNS or the competent public sector fund, all physiotherapy sessions must be prescribed by a doctor.
Medical prescription: content and number of sessions
In order to ask a treatment, a standardised prescription must be issued, which informs especially about the type of treatment, the number of sessions and their frequency as well as the treatment prescribed.
The number covered per prescription may vary depending on the type of treatment, that is 8 in case of a common pathology, 64 in case of a severe pathology and 32 in case of a post-surgery rehabilitation.
Severe pathologies are defined in annexe G of the CNS statutes and they are indicated on the back of the standardised prescription. All pathologies that are not on this list, except post-surgery rehabilitation, are considered being common pathologies.
Foreign prescriptions must contain the same indications as the standardised prescription and they must be written in French, German or English. Prescriptions in other languages are returned, as they cannot be processed by the CNS.
Validation of prescription
The prescription must be validated by the CNS. In general, the insured person gives the prescription to the physiotherapist during their first session, who will then take care of the necessary administrative formalities. If the administrative conditions are met, the CNS will validate the prescription. This validation must be requested within 31 days of the issue of the medical prescription.
Certificate of coverage
The validation takes the form of a certificate of coverage issued by the CNS.
The certificate of coverage states the maximum duration of the treatment, the number of sessions covered and the rate of coverage.
Treatment must begin at the latest within 30 days following the issue of the certificate of coverage.
Third-party payment system
In this case, the insured person pays the physiotherapist only the proportion payable by them, and the physiotherapist sends an invoice to the CNS at the end of the treatment to receive the part of the costs covered by the health insurance. The physiotherapist hands back the prescription to the insured person and issues a fee note which indicates clearly the proportion payable by the insured person and the one payable by the CNS.
The third-party payment system only applies if the request for validation is done directly by the physiotherapist and the physiotherapist treatments are provided in the Grand Duchy. When the request for validation comes from the insured person or the physiotherapy treatments are provided outside the Grand Duchy of Luxembourg, the treatments must be paid for in full. The proportion covered by the health insurance is then reimbursed upon request.
Please note that for cross-border workers, the local health fund is responsible for covering healthcare received in their country of residence.
Advance of costs by the insured person
In this case, the physiotherapist gives the insured person an invoice for the total amount to be paid at the end of the treatment, i.e. the proportion covered by the fund and any remaining proportion payable by them. After payment, the insured person applies to their relevant fund (the CNS or the public sector health fund) for a reimbursement of the proportion covered by the health insurance
To be eligible for a refund, the physiotherapy invoice must:
- indicate the matricule number, full name of the insured person and the number of the certificate of coverage,
- be paid in full,
- be accompanied by the medical prescription.
The physiotherapist can adapt frequency of sessions and techniques used (massage, electrotherapy, …) according to the patient’s and the evolution of their pathology.
There are certain quality standards that the physiotherapist must respect. These standards provide for criteria relating to the infrastructure (waiting room, minimum surface of the treatment rooms, mandatory display of certain information) and the criteria in relation to the treatment itself (it is not allowed to treat more than one patient at a time, definition of the content of the patient’s files, minimum duration of a session of 20 minutes, …).
The physiotherapist's travel costs may be covered at a fixed rate as long as:
- the doctor indicates on the prescription that it is medically necessary for the physiotherapist to provide the treatment at the insured person’s home.
- the journey takes place inside Luxembourg. Journeys beyond the border are not covered.
If these conditions are fulfilled, the fixed travel allowance is covered at the same rate as the physiotherapy treatment provided at home.