Question 17833 — maternity health insurance

Summary

Mr. Lionel Tivoli draws the attention of the Minister of Health, Families, Autonomy and People with Disabilities to the new rating rules applicable to the combination of several conventional radiology procedures. The decision of the National Union of Health Insurance Funds of October 14, 2025, which entered into force on November 5, 2025, now provides that conventional radiology procedures associated with each other fall under of the general rule provided for by the common classification of medical procedures (CCAM). This limits the number of procedures that can be priced during the same session to two, the procedure with the highest price being billed at full rate and the second at 50% of its value. This provision marks an evolution compared to the previous rule, which allowed the association of an unlimited number of conventional radiology procedures, following the first being then priced at 50%. However, several patients report concrete difficulties when their prescription includes x-rays of several anatomical regions, for example following a fall requiring the examination of a shoulder, an elbow and a hip. Some imaging centers then offer to spread these examinations over several appointments, or even over several days. If such practice results, even indirectly, rating rules, it raises a major difficulty in the coherence of health policy. It may require several trips for elderly, frail or patients with reduced mobility, delay the establishment of a complete diagnosis and, when these trips are the subject of a covered transport prescription, generate several trips by VSL or approved taxi. A measure intended to control Medical imaging expenses could thus, in certain situations, cause additional health insurance expenses and simultaneously degrade the patient's care pathway. Thus, he asks if an assessment has been carried out of the consequences of this new rating rule on the splitting of conventional radiology examinations and on the resulting medical transport expenses, what is the number of situations in which several procedures prescribed for the same clinical episode cannot be priced during a single session, and if the Government plans, in conjunction with health insurance, to adapt the rules of the CCAM in order to allow, when the same medical prescription justifies the exploration of several anatomical regions, the production and pricing of all the necessary x-rays during a single appointment, according to appropriate pricing terms, in order to prioritize the interests of the patient, the speed of diagnosis and the overall control of health expenses.

Machine translation from French. The official text remains authoritative.

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