Health insurance and physiotherapy in Switzerland: everything you need to know

As a physiotherapist or practitioner in Switzerland, it is essential to have a good understanding of the reimbursement system. This not only helps you with correct administration, but also allows you to properly inform your patients about their reimbursement options. In this article, we share everything you need to know about health insurance and physical therapy in Switzerland.

Basic insurance and physical therapy

In the Swiss healthcare system, physiotherapy is covered by compulsory basic insurance. (Grundversicherung/Assurance de base) if the patient has a valid referral. This has various consequences for your practice:

• Mandatory referral: Only treatments performed on the basis of a medical referral can be declared via the basic insurance.
• Standardised rates: The rates for physiotherapy are based on a points system and vary by canton.
• Direct billing: Invoices can be sent directly to the health insurer or accident insurance.

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Referrals and their period of validity

A physical therapy referral (also known as a prescription or prescription) is a crucial document in your daily practice. It forms the basis for reimbursing treatments through the basic insurance and determines the treatment room you have. Here are the most important things you need to know:

• 9 treatments per referral: Each referral covers a maximum of 9 treatments. If the doctor does not specify a specific number, the standard maximum of 9 applies. These treatments can be spread over a longer period of time, there is no time limit for completing the treatments.
•  Validity period before starting: A referral is valid for 5 weeks from the date of issue before starting treatment. The first treatment must therefore take place within these 5 weeks, otherwise the validity of the referral expires and the patient would have to request a new one from the doctor.
• Frequency of treatments: The referring doctor can determine a recommended frequency (e.g. 1-2 times per week). If this is not specified, as a physiotherapist, you can decide this yourself in consultation with the patient, taking into account the medical need and practical considerations.
• Referral authority: In Switzerland, any doctor, regardless of specialty, can issue a physical therapy referral. This applies to general practitioners, specialists, and even dentists. Physical therapists themselves are not (yet) allowed to write out referrals.

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The limit of 36 treatments

It's important to keep track of how many treatments a patient has received for a specific diagnosis:

• 36 treatments per diagnosis: The basic insurance reimburses 36 treatments per diagnosis, divided into a maximum of 4 referrals.
• Different diagnoses: For each new diagnosis, a new maximum of 36 treatments applies.
• Cost commitment (Kostengutsprache): For treatments over 36, a cost commitment is required, requested by the doctor.

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The Swiss Fee System for Physical Therapy

The Swiss Physical Therapy System uses a few simple rate codes that you need to know:

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7301: General physiotherapy (80% of all treatments)

• For standard complaints such as back pain or sports injuries
• Reimbursement: 47-53 CHF per treatment, depending on your canton

7311: Comprehensive physical therapy

• For more complex cases such as neurological disorders or children up to 6 years
• Reimbursement: 75-85 CHF per treatment

7350: First treatment allowance

• For anamnesis, examination and treatment plan at first appointment
• Extra fee: 23-27 CHF (always combined with 7301 or 7311)

7354: Travel time allowance

• For home treatments
• Fee: 32-38 CHF per home visit

For all details and specific rate codes, please refer to our in-depth article on physiotherapy rate positions in Switzerland.

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Physical therapy without a referral (outside the insurance)

As a physiotherapist, you can also offer treatments without a referral or to patients who have exhausted their reimbursed treatments. This gives you the opportunity to broaden your care offerings and offer patients more flexibility. This can help patients who want to be helped quickly without first visiting a doctor, want to continue their treatment process after 36 reimbursed treatments, or seek preventive care.

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Transparency is essential for this uninsured care. Provide a clear pricing structure that suits your practice, location and specialization. Always inform patients fully about the costs in advance and consider package prices for patients who require multiple treatments. Also, communicate clearly about possible reimbursements through additional insurances. Pricing varies by region, specialization and type of practice, so determine a rate that is appropriate for your specific situation.

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Do you have more questions?

At takeoff, we have extensive knowledge of the Swiss healthcare system and work closely with practices and clinics across Switzerland. We understand the challenges that healthcare professionals face every day. Do you have questions about the reimbursement system or would you like more information about our services for Swiss practices? Feel free to take contact us for an informal conversation.

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