Out of hospital care

Procedures carried out by doctors, midwives and biologists

Definition:

TThis refers to procedures carried out in private practices or at mutual health centres.

It includes the following services:

  • Consultations
  • Home visits
  • All diagnosis and treatment procedures:
            - Technical medical procedures (code: ATM) 
            - Imaging or x-ray procedures (code: ADI or ADE) 
            - Surgical procedures (code: ADC) 
            - Biological procedures (code: BMO or B)

Imaging and biological procedures require a prescription.

Conditions:

The treatment form completed by the practitioner must be sent to the SPME, accompanied by the relevant prescription where required.

Common treatment forms are now used by all social security schemes in Monaco (SPME, CCSS, CAMTI) and are distributed to contracted practitioners.

Please consider using the FSE procedure. All you need to do is present your SPME card to your practitioner. You no longer need to send your treatment forms to the SPME. The FSE is completed directly by your doctor, in secure electronic format, and then sent immediately to the SPME for processing and reimbursement.

See the Press Release .

Please note

Prescriptions are valid for six months.

Prior consent of Medical Advisor:

In accordance with current legislation, some procedures are subject to prior consent being granted by the SPME Medical Advisor. Your practitioner must submit a request for prior consent when required and wait to receive this consent before the procedures are carried out.

In all cases, prior consent from the Medical Advisor is valid for six months.

Dental care

Definition

This refers to procedures carried out in private practices or at mutual health centres.

It includes the following services:

  • Treatments:
       - Procedures listed under code D (for dental surgeons: dental procedures and treatments 
       - Procedures listed under code Z (for dental surgeons): radiography 
       - Procedures listed under code CCD (for dental surgeons): consultations 
       - Procedures listed under code K or KC (for oral medicine specialists): extractions, surgery 
       - Procedures listed under code CS (for oral medicine specialists): consultations

 

  • Dentures:
       - Procedures listed under code DPRL (fixed denture): bridge, crown (metallic, veneer, ceramic), pivot tooth, implant 
       - Procedures listed under code DPRL (removable denture): resin plate, metal frame, skeletal
       - Denture listed under code DIMP (fixed denture): dental prosthesis by implant procedure. Only implant prostheses are reimbursable; the costs incurred for fitting implants are not. Ensure that you request a detailed quote for all the work that will be billed to you (implants and implant prostheses).

 

  • Dentofacial orthopaedics or orthodontics:
       - Procedures listed under code CS: consultation 
       - Procedures listed under code DORS: dentofacial orthopaedic treatment 
       - Procedures listed under code Z: X-rays

Conditions

The treatment form completed by the practitioner must be sent to the SPME.

Common treatment forms are now used by all social security schemes in Monaco (SPME, CCSS, CAMTI) and are distributed to contracted practitioners.

Prior consent from the Dental Advisor

In accordance with current legislation, some procedures are subject to prior consent being granted by the SPME Dental Advisor. Your practitioner must submit a request for prior consent when required and wait to receive this consent before the procedures are carried out.

It is mandatory in the following cases:

  • Preparation or fitting of any prosthetic 
  • Any orthodontic treatment 
  • Any special treatment or multiple extraction (more than eight teeth)

 

In all cases, prior consent from the Dental Advisor is valid for six months.

Procedures carried out by paramedics

Definition

This refers to procedures carried out by the following health professionals, either in private practice or as an employee of another practitioner:

  • Midwives, when related to nursing care (code: AMI or AIS)
  • Speech therapists (code: AMO) 
  • Orthoptists (code: AMY)
  • Physiotherapists (code: AMS or AMK)
  • Pedicurists (code: POD)
  • Nurses (code: AMI or AIS)

 

All of these procedures require a prescription issued by a doctor.

Conditions

The treatment form completed by the practitioner carrying out the procedure must be sent to the SPME, together with the prescription and/or the request for prior consent showing the SPME Medical Advisor’s decision.

Common treatment forms are now used by all social security schemes in Monaco (SPME, CCSS, CAMTI) and are distributed to contracted practitioners.

Please note

Prescriptions are valid for six months.

Prior consent of Medical Advisor

Procedures carried out by nurses and allied health professionals may be reimbursed provided that, in the case of certain procedures, including functional rehabilitation, nursing care, speech therapy and orthoptics…, the SPME, on the advice of its Medical Advisor, has agreed in advance to cover them.

All requests for prior consent should be sent to the SPME Medical Advisor.

Requests should include the original prescription issued by the doctor specifying the nature of the procedures, where they are to be carried out and the number of sessions to be completed (the last of these is not mandatory in the case of functional rehabilitation).

Requests should specify the following information:

  • Full name and SPME registration number of the insured person
  • Full name of the person receiving treatment 
  • Details of the health professional who will be carrying out the procedure
  • Nature and code of procedures to be carried out and date of request

 

Treatment may not be provided until the SPME Medical Advisor has agreed to cover it, except in cases of medical emergency.

In all cases, prior consent from the Medical Advisor is valid for six months.

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