How payment and reimbursement works

On seeing a sector 1 doctor, a patient with no special medical conditions or circumstances will usually pay the requested fee and be partially reimbursed later by their Cpam via direct payment into their bank to a set percentage of the basic state rate (the tarif de convention). Exceptions to upfront payment include people on low incomes and where a doctor has opted to offer this.

The doctor usually arranges the patient’s reimbursement automatically by swiping their carte Vitale, known as télétransmission (sending the reimbursement data at a distance). If you have a mutuelle and have provided details to your Cpam, the mutuelle automatically repays the top-up part to the level of your policy cover.

You may still come across some doctors who do not accept this and instead issue a paper feuille de soins that you need to send to your Cpam, but this is now rare.

This may be a sign that the doctor is sector 3 - also called déconventionné, meaning they have opted out of the state system and can set their own tariffs freely. In this case, you will get very minimal reimbursement from the state (reimbursement level by mutuelle depends on the contract).

For different types of visits, both the tariff and the percentage reimbursed can vary. Specialists usually cost more than GPs.

A standard visit to your médecin traitant has a fixed cost (tarif de convention) of €30. You are reimbursed 70% by the state (minus the €2 participation forfaitaire) = €19. The 30% non-reimbursed part is payable by you or your mutuelle.

Tariffs and rates are renegotiated from time to time but usually stay constant for several years. Some rises (eg. from €26.50 to €30 for a GP visit) were fixed for late 2024, with further ones planned in 2025. There has also been talk of possible cuts to reimbursement rates (eg. from 70% to 65% for a GP visit).

To give examples of specialists’ tariffs, a gynaecologist has a basic rate of €37 as of December 2024 and this will rise to €40 in July 2025. Paediatricians treating two to six-year-olds charge €35 as of December 2024, whereas those treating babies up to two-year-olds charge €39, which will rise to €40 from July 2025. Psychiatrists charge €55 and this is rising to €57.

Current tariffs and percentage rates for visits to the doctor can be found here. For convenience, and because tarifs and rates may evolve, here are some tips to understand this.

We will assume that in most cases you plan to follow the ‘parcours de soins’ (this includes where you have a médecin traitant but are not going via them, in the limited permitted situations mentioned on the previous page of this chapter). In which case, click on Les consultations dans le cadre du parcours de soins coordonnés.

As you scroll down, the first part relates to consulting your own médecin traitant (it allows for the possibility that this could be one of various specialists, but in most cases they will be a généraliste - GP).

 On the left you can see the type of doctor and their sector, then each column includes the tariff they will charge (or ‘honoraires libres’ - freely-fixed tariff), then the ‘base amount of the reimbursement’, then the percentage rate, and finally the montant remboursé - the amount reimbursed by the state. The last column factors in the €2 participation forfaitaire.

As you scroll further down you can see rates for various specialists your GP may refer you to. Note they can vary depending on whether you will see the specialist on an ongoing basis (suivi régulier) or for a one-off opinion (avis ponctuel).