#SFHU2617273SFrance updates reimbursed medical and dental procedure rules
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This decision updates France’s official list of medical acts and services covered by health insurance. It changes billing rules for certain somatic genetic tests used in cancer treatment decisions, especially tests linked to reimbursed targeted therapies. It also adds new reimbursable dental procedures, including therapeutic sealing for premolars and molars, atraumatic restorative treatment using glass ionomer cement, and a therapeutic pulpotomy procedure. The practical impact is mainly for laboratories, dentists, healthcare billing teams, and insurers handling reimbursement claims.
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Key Changes
- Updates billing rules for somatic genetic tests used in cancer treatment decisions.
- Allows limited billing of two consecutive tests on different genes, with reduced payment for the second act.
- Adds new reimbursable dental procedures for tooth restoration and pulp treatment.
Obligations
What this law requires
For act code ZZQX042, only somatic genetic tests identifying biomarkers for targeted therapies covered under Articles L.162-17 and L.162-22-7 of the Social Security Code or Article L.5123-2 of the Public Health Code may be billed to health insurance.
For act code ZZQX042, the act may be billed together with itself only once where two consecutive tests each concern a different gene; no more than two identical acts may be associated, and the second act must be billed with a 15% tariff reduction.
For act code ZZQX042, the mutation detection must not have been performed as part of an NGS panel in order for the act to be billed.
For act code ZZQX484, only somatic genetic tests identifying biomarkers for targeted therapies covered under Articles L.162-17 and L.162-22-7 of the Social Security Code or Article L.5123-2 of the Public Health Code may be billed to health insurance.
For act code ZZQX484, the act may be billed together with itself only once where two consecutive tests each concern a different gene; no more than two identical acts may be associated, and the second act must be billed with a 45% tariff reduction.