Pathological situations in physiotherapy: common, Fa list, Fb list

The situations of article 7

Four groups of article 7 cover most treatments at the practice and at home:

• Common pathology (courante, § 10): 18 sessions per situation per calendar year, and up to three situations a year.
• The Fa list (§ 14, 5°, A): a closed list of situations, those of annexe 05a. 60 sessions in the year after the first session.
• The Fb list (§ 14, 5°, B): another closed list, that of annexe 05b. 60 sessions per calendar year, then 20 more.
• The E list, heavy pathologies (§ 11): situations a) to l) as published by RIZIV, with a higher reimbursement, for the period the advisory physician's agreement sets. No yearly cap on the standard session.

Three other groups have rules of their own: perinatal physiotherapy (9 sessions per pregnancy, § 13), the palliative patient at home (§ 14bis) and the patient admitted to a day hospital (§ 14ter). The text of each list is in the official documents listed at the bottom of this page. Each session's code and its tariff: RIZIV tariffs.

Common pathology: 18 sessions per situation

• Per pathological situation and calendar year, 18 sessions at most: 9 with the first code (567011 at the practice), then 9 with the second (560011) once the first 9 are attested (§ 10).
• The patient intake (567033 at the practice) is attested once per patient per calendar year, at the first session, whatever the number of situations, and not a second time when the same treatment carries on into the next year. It needs no prescription and exists only for common pathology (§ 2, 3° and § 10).
• The year's first situation needs no agreement. For a second or third new situation in the same year, you ask the advisory physician for 18 additional services, by a letter addressed to them personally, with a report from the treating doctor or your own report and copies of the prescriptions. That agreement is given twice per calendar year at most: three situations in all (§ 10).
• The advisory physician is deemed to agree if, within 14 days of sending, they have neither notified a refusal nor asked for more information; the postmark is the proof. The additional sessions may not be attested before that agreement (§ 10).
• Past 18 sessions, the session is attested with a separate code for sessions past the cap (560055 at the practice). Those codes are limited to 54 per patient per calendar year, whatever the number of situations (§ 10).

Fa list: 60 sessions in one year

• 60 sessions per pathological situation, within one year from the first session: 20 with the first code (567276 at the practice), then 40 with the second (563010) (§ 14, 2°).
• That year does not follow the calendar: the count runs across 31 December without starting again. After that year, the situation is no longer an Fa-list situation (§ 14).
• For rubric j) of annexe 05a (polytraumatisms), the second band is 100 sessions instead of 40 (§ 14, 2°).
• Beyond that, the session is attested with the code for sessions past the cap (563054 at the practice).
• The treatment is notified with annexe 05a. It has no renewal box, unlike annexe 05b.

Fb list: 60 sessions per calendar year, then 20

• Per calendar year, 60 sessions with the first code (563614 at the practice), then 20 with the second (564270) once the 60 are attested (§ 14, 2°). Fb-list manual lymphatic drainage sessions count towards the 60.
• Past those 80 sessions, the session is attested with the code for sessions past the cap (563651 at the practice).
• The notification runs from the first session to 31 December of the second calendar year after it, and the count of 60 starts again every 1 January within that period (§ 14, 2° and 4°).
• Annexe 05b is used for the notification, then for its renewal.

The notification to the advisory physician

For an Fa or Fb situation, you notify the treatment to the advisory physician of the patient's health insurance fund on the official form: annexe 05a for the Fa list, annexe 05b for the Fb list. On it you declare that you are starting or have started the treatment on a given date, you tick one situation, and you keep in the record a copy of the prescription and the evidence that the patient is in that situation.

The form is invalid if its text is altered, if comments are added or if it is incomplete. Software may produce it, provided it reproduces the ticked situation's rubric in full.

If a new Fa or Fb situation arises while a notification is running, its additional sessions need the advisory physician's agreement: a letter addressed to them personally, with the notification for the new situation and one of the same two reports, and the same 14 days. Once agreed, the period of the earlier notification closes on the day before the new one's start date (§ 14, 4°).

From 1 January 2027, these notifications and requests go through eAgreement: your software sends them to the fund, which answers electronically. According to the NIC, eAgreement also covers the year's first common-pathology situation, which had no form. The background: MyCareNet in 2027.

Calendar year or rolling year

• Common pathology: everything counts from 1 January to 31 December: the 18 sessions per situation, the three situations, the 54 sessions past the cap and the intake.
• Fa list: one year from the first session, across two calendar years if need be.
• Fb list: 60 then 20 sessions per calendar year, within a notification that runs to 31 December of the second year after the first session.
• E list: no yearly count on the standard session; the period is that of the advisory physician's agreement.

In Praxio

Praxio ties each session to the pathological situation you opened for the patient. It counts the sessions, including those given elsewhere that you record, picks the code of the band, switches to the code past the cap and follows each list's own period. It also keeps count of the 54 sessions past the cap and of the year's intake.

It produces annexe 05a or 05b with the official text, and the letter to the advisory physician for a second or third common-pathology situation or for a new Fa or Fb situation. It tracks the 14 days and refuses to attest those sessions until the agreement is in.

You choose the situation: Praxio neither suggests nor assesses one. eAgreement is built; until the NIC accredits Praxio, the answers come from a simulation labelled as such, and the paper form stays the official route. See the eHealth roadmap.