# List of CPAM official prices for services, medicines?



## trigger08

My French is okay but I am having quite a time trying to find the list of official prices/tariffs that la Secu uses to calculate the amount they will actually reimburse (at whatever percentage applies based on the situation) for any given procedure, drug, etc. Searching online I find comments that this base tariff information is somewhere on the Ameli website, but I can't dig it up…can anyone provide a working link to the right part of the Ameli website?

We just received our temporary Social Security numbers and are shopping for a mutuelle plan, and it would be really helpful to know the "base tariff" for specific procedures in Euros - then we could compare that amount to the physician's listed price and see whether 100%, 125%, 200%, etc coverage is needed. Thanks for any help.


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## Bevdeforges

It may take a little bit of digging, but the "lists" for reimbursement purposes are here: Ce qui est remboursé | ameli.fr | Assuré
There are about a dozen categories (from Consultations to Spas and plenty in between). It takes a bit of slogging through it to start to get familiar with how to read it all. But it can be time well spent.


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## trigger08

Thank you, I have been digging around on that page for the last day or two but still cannot find the rates for various medical procedures/acts. I see the rates for "consultation" with specialists, but for example how do you know what amount CPAM uses for the base rate for ultrasound or radiology procedures? They must not just use the amount under "Consultations" that applies to the physician in general? 

Like if our primary doctor refers us to a specialist for an ultrasound, and the specialist is sector 1, that chart says the base for reimbursement for a referred specialist "consultation" is 30 Euro with 70% reimbursement. But at the consultation the specialist does a few scans, each with its own line on the feuille de soins under "actes effectues" with subtotal/cost in the 10s or 100s of Euros, those are the numbers I am trying to relate back to defined tariffs for reimbursement at Ameli.


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## Bevdeforges

There is also another graphic there under consulatations that indicates Des tarifs pour les consultations complexes - these fees may or may not include the various sorts of tests or treatments individually, and normally for things like ultrasounds, x-rays and other lab tests, you get a prescription to take to a lab that performs that sort of work. The doctors generally don't do those sorts of tests in office (other than highly specialized tests). 

Yes, the system here can seem pretty complex at times, but it does seem to work out OK. Doctolib and the Annuaire of medical practitioners on the Ameli site do publish information about which "sector" each doctor is a member of, and information about "average" charges.


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## trigger08

Thanks for your help, Bev. I didn't want to go into too many details but after we applied to enroll in the system, and before we received our temporary SS numbers, my wife started seeing a gynecologist who then referred her to a few specialists for scans, tests, etc. As you said, the gynecologist wrote prescriptions for those specialists and lab tests and we made separate appointments around town.

Now I am just trying to see how the real-world prices on our pile of feuilles compare to the CPAM "official" prices that would be used for the basis of reimbursement. That information would help me decide what level of mutuelle top-up coverage % to purchase, since we expect that she may have to repeat some of these scans and we would like to balance the need for enough top-up coverage with not paying too much per month (we are generally quite healthy and are not taking any prescriptions). I looked at the list of 30 or so "complex consultations" you mentioned and it seems that would not apply here (they are things like tuberculosis, brain injury, diabetes, cancer, etc).

Does CPAM set official prices for individual medical acts/procedures, specific lab tests, outpatient surgeries that do not require hospitalization, etc? Is that information available to the public online? Or is everything just lumped under "consultations" ? If all medical procedures are lumped under the "consultation" heading, in which case the base rates for specialists seem to be in the 25-50 Euro range and our charges for some of her scans came to over 150 Euros… if we wanted everything fully covered going forward we would need something like 300-400% mutuelle coverage?


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## trigger08

Aha, I think I found what I was looking for: Classification Commune des Actes Médicaux (CCAM)
I tried entering the 6-7 character codes for some of the medical acts on our feuilles and it returns the "official" tariff with possible modifying conditions.


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## Bevdeforges

OK - like I said, it takes some digging. And, the devil is in the details (or in this case, in the "modifying conditions"). Just don't base your ultimate decision on a mutuelle on just the percentage of the rate chart that they reimburse. There are things that mutuelles reimburse (or pay for) that CPAM doesn't touch - or other sorts of limits (particularly on things like eyeglasses and dental "appliances" - crowns, bridges and other reconstructive types of things). 

I know I was kind of regretting going for a top grade plan for my husband and myself, given that my husband is 100% covered by CPAM for a long-term condition - but I really wanted the best eyeglass cover we could afford. Turns out now that my husband needs surgery for something completely different - not an urgent or critical type of thing - but having the best policy we felt was reasonable at the time means that he could insist on having his surgery at the same private hospital that handled his original long-term condition. And we know that the mutuelle handles the somewhat higher fees with no problem. To borrow an old saying, it takes the worry out of being sick. <g>


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