Physiotherapy: serious conditions (E-pathology)
For the treatment of serious conditions, patients are reimbursed for more sessions and pay less co-payment.
The serious conditions are included in an exhaustive list . The approval of the consulting physician is required for reimbursement of the treatment . The benefits in kind are stated in art. 7, §1, 2° of the nomenclature. The application rules are in art. 7, §11 of the nomenclature and in the Royal Decree of 23-03-1982, art. 7, §3, 2nd paragraph, 3°.
First request
For a first application, send the following documents to the advising doctor:
- the diagnosis, confirmed by a medical specialist;
- the disorders, accurately described according to the WHO-ICF:
- extent of the disorder;
- reason for intensive and long-term physiotherapy or physiotherapy treatment;
- a documented link between the diagnosis and the disorders for which reimbursement is requested;
- a clarification of the treatment plan and the physiotherapy or physiotherapy techniques with which the intended functional result is intended to be achieved, on the basis of a functional balance;
- for the treatment of lymphedema: the results of perimetry, volumetry or lymphoscintigraphy in three steps;
- for the treatment of structural anomaly of the locomotor system: prevalence and recent publications demonstrating the need for intensive and long-term physiotherapy or physiotherapy treatment.
Except for the first document, all others can be drawn up by the specialist, the general practitioner or in consultation between the two with the possible cooperation of a physiotherapist.
Extension
If the agreement is to be extended, the patient's situation must be demonstrated again with a detailed medical justification from the general practitioner or specialist. This contains the same elements as a first application, except for confirmation of the diagnosis.
For lymphedema it must be demonstrated that the clinical reduction of the edema is only maintained by physiotherapy or physiotherapy services. No new lymphoscintigraphy is required.
Maximum number and nomenclature
An agreement or extension is possible for a maximum of three years . During the term, the number of sessions is not limited , except for the general rule of one session per day or even two under certain conditions, and except for the exceptions below.
Precedence of the serious condition agreement
During the period of the agreement, you must charge for all treatments using the dispensation codes for serious conditions, except for:
- treatment of palliative home patients ;
- perinatal physiotherapy ;
- session during day hospitalization;
- the second session per day described in art. 7, §12 of the nomenclature:
- attestable during the entire duration of certain stays in intensive care, local neonatal care, intensive neonatology;
- or attestable a maximum of fourteen times during thirty days after certain provisions for resuscitation or orthopedics in patients who are or have been admitted to a hospital.
Notifications F-acute or F-chronic , or agreements for additional sessions (current or F) have no effect during the term of an agreement for a serious condition.