A complete, sourced guide to the value of the key letter, the fee codes by condition in the redrafted NGAP, the physiotherapy assessment, the ARL respiratory codes, the uplifts and travel allowances, and the framework for direct access. Every amount links back to the official text in force.
📝 In brief
- Since 28 May 2026, amendment 8 has raised by 0.3 point the procedures coded TER 9,49, TER 9,51 and APM 9,50, which become TER 9,79, TER 9,81 and APM 9,80 [JO].
- The value of the key letter remains set at 2.21 € in mainland France since 22 February 2024 [ameli].
- The former key letters AMS and AMC no longer appear in the NGAP in force (version of 21/06/2026): procedures are now described by condition, with dedicated key letters (RAM, RAO, TER, ARL, APM, VSM…) [NGAP].
- The uplifts originally due on 1 July 2025 were postponed and have applied since 1 January 2026 [ameli].
📜 Official sources used
- NGAP, version in force from 21/06/2026 (title XIV and General provisions): ameli.fr (PDF)
- Agreed fees for physiotherapists: ameli.fr
- Amendment 8 to the national agreement (concluded 28 November 2025, notice published in Official Journal no. 0297 of 19 December 2025): Légifrance
- Postponement of the uplifts following the alert committee’s opinion: ameli.fr
- Direct access: CNAM circular CIR-13/2024 of 09/04/2024 (updated 17/12/2024): circulaires.ameli.fr (PDF)
Contents
- Key letter and coefficient: how a fee is worked out
- What changed in 2026
- The table of common fee codes
- Physiotherapy assessment (BDK) and supplements
- Respiratory physiotherapy: the ARL codes
- Uplifts and travel allowances
- Direct access: invoicing without a referral
- FAQ: physiotherapy fees and schedule 2026
🧮 Key letter and coefficient: how an NGAP fee is worked out
Every NGAP procedure is identified by a key letter (which carries the monetary value) and a coefficient (which adjusts that value according to the procedure). The fee is worked out as follows:
Fee for the procedure = coefficient × value of the key letter.
In mainland France, the AMK key letter and the key letters of the redrafted schedule (TER, APM, ARL, RAM, RAO, VSM, etc.) are worth 2.21 € since 22 February 2024, the date the 3 % rise provided for by amendment 7 came into force [ameli].
An important point if you have recently qualified: the key letters AMS and AMC have gone. They no longer appear in the NGAP in force (version of 21/06/2026) [NGAP]. The former generic bands (« AMS 7,5 », « AMS 9,5 ») have been replaced by a descriptive schedule : around 80 procedure descriptions classified by condition, each with its key letter (RAM/RAO for the spine, RIM/RIC/VIM/VIC for the lower limb, RSM/RSC/VSM/VSC for the upper limb, TER for multiple regions, APM for amputations, ARL for respiratory and ENT…) and a two-decimal coefficient that identifies the procedure. The AMK key letter survives for « miscellaneous procedures »: the physiotherapy assessment and hydrotherapy supplements in particular [NGAP].
This guide covers mainland France. The ameli page on agreed fees also gives the value of the key letters in the overseas départements (2.43 €) and the TMK letter for remote care (2.15 €) [ameli].
📅 What changed in 2026
Two dates shape the year for your invoicing:
- 1 January 2026: the uplifts provided for on 1 July 2025 by the national agreement, postponed following the alert committee’s opinion on the national health spending target, came into effect [ameli].
- 28 May 2026: amendment 8 (concluded 28 November 2025, notice published in Official Journal no. 0297 of 19 December 2025) applies an uplift of 0.3 point to the procedures coded TER 9,49, TER 9,51 and APM 9,50, which become respectively TER 9,79, TER 9,81 and APM 9,80 [JO].
In practice, for the rehabilitation of at least 2 affected regions and rehabilitation after amputation of at least 2 limbs, this corresponds, by calculation (coefficient × 2.21 €, an amount not published in euros in the texts), to roughly 21.64 € (TER 9,79), 21.68 € (TER 9,81) and 21.66 € (APM 9,80) per session.
Note: amendment 8 removes annex 12 « Nomenclature redécrite et calendrier des revalorisations » [JO]. No uplift after 28 May 2026 is scheduled in the official texts consulted at the date this guide was checked.
📋 The table of common fee codes (mainland France, NGAP of 21/06/2026)
| Clinical situation | Fee code | Reference standard / conditions | ≈ € (calculated) |
|---|---|---|---|
| Non-specific low back pain | RAM 8,09 | 1 to 15 sessions in standard treatment; prior approval from the 16th session, or from the 31st if 30 sessions were funded in the preceding 12 months | 17.88 |
| Non-specific neck pain (reference standard) | RAM 8,07 | 1 to 15 sessions | 17.83 |
| Lumbosacral spine, outside the reference standard | RAM 8,11 (without surgery) / RAO 8,09 (with surgery) | — | 17.92 / 17.88 |
| Cervical spine, outside the reference standard | RAM 8,12 / RAO 8,10 | — | 17.95 / 17.90 |
| At least two spinal segments | RAM 8,13 / RAO 8,11 (surgery on at least one segment) | — | 17.97 / 17.92 |
| Recent lateral ankle and foot sprain | RIC 8,11 (operated) / RIM 8,10 (not operated) | 1 to 10 sessions in standard treatment | 17.92 / 17.90 |
| Knee arthroplasty (total or unicompartmental replacement) | RIC 8,12 | 1 to 25 sessions | 17.95 |
| Anterior cruciate ligament | RIC 8,08 | 1 to 40 sessions | 17.86 |
| Shoulder or arm, outside the reference standard, not operated | VSM 8,08 | — | 17.86 |
| At least 2 segments of the same upper limb | VSM 8,11 / VSC 8,12 | — | 17.92 / 17.95 |
| At least 2 affected regions (other than the same limb or the spine alone) | TER 9,79 (without surgery) / TER 9,81 (with surgery on at least one region) | Coefficients in force since 28 May 2026 | 21.64 / 21.68 |
| Amputation of an upper limb | APM 8,11 | — | 17.92 |
| Amputation of a lower limb | APM 8,10 | — | 17.90 |
| Amputation of at least 2 limbs | APM 9,80 | Coefficient in force since 28 May 2026 | 21.66 |
The former « AMS 7,5 » procedures are therefore found in redrafted procedures with coefficients of roughly 8,07 to 8,13, and the former « AMS 9,5 » in the TER 9,79 / TER 9,81 procedures [NGAP]. For any clinical situation missing from this table, refer directly to title XIV of the NGAP in force: it is the exact wording of the procedure, and that alone, which determines the fee code.
🩺 Physiotherapy assessment (BDK) and supplements
The assessment is coded at a flat rate, in AMK [NGAP] :
| Procedure | Fee code | Invoicing rhythm | ≈ € (calculated) |
|---|---|---|---|
| BDK: general case | AMK 10,7 | For a number of sessions between 1 and 10, then at the 30th session, then every 20 sessions | 23.65 |
| BDK: neurological and muscular conditions (excluding peripheral radicular or truncal involvement) | AMK 10,8 | Then at the 60th session, then every 50 sessions | 23.87 |
| Hydrotherapy supplement in a tank (min. 2 m × 1.80 m × 0.60 m) | AMK 2,5 | Chapter II procedures | 5.53 |
| Hydrotherapy supplement in a pool (min. 2 m × 3 m × 1.10 m) | AMK 3,5 | Chapter II procedures | 7.74 |
Remember: the condition attached to the BDK
Do not forget the condition attached to the BDK: a summary sheet of the initial assessment must be sent at the very start of treatment to the referring doctor [NGAP].
🫁 Respiratory physiotherapy: the ARL codes
| Procedure | Fee code | Conditions | ≈ € (calculated) |
|---|---|---|---|
| Urgent airway clearance (bronchiolitis in infants, acute flare of a chronic respiratory condition) | ARL 8,49 | — | 18.76 |
| Obstructive, restrictive or mixed respiratory disease (non-urgent) | ARL 8,5 | — | 18.79 |
| Pre- or post-operative respiratory rehabilitation | ARL 8,51 | — | 18.81 |
| Cystic fibrosis | ARL 10 | — | 22.10 |
| Pulmonary rehabilitation, individual care | ARL 28 | COPD with long-term illness status; sessions of around 1 h 30; a sequence of 20 sessions depending on clinical progress | 61.88 |
| Pulmonary rehabilitation in a group of 2 to 4 people (with individual respiratory rehabilitation) | ARL 20 | Same conditions: COPD with long-term illness status, ~1 h 30, a sequence of 20 sessions | 44.20 |
Remember: do not swap them round
Take care not to swap them round: ARL 28 = individual, ARL 20 = group of 2 to 4 [NGAP]: several unofficial sources have them the wrong way round.
🚗 Uplifts and travel allowances
| Item | Amount | Worth knowing |
|---|---|---|
| IFD: flat-rate travel allowance | 2.50 € | Cannot be combined with the night or Sunday uplifts (NGAP, art. 13 A) |
| IFS: specific flat-rate travel allowance | 4.00 € | A restrictive list of chapter II procedures under title XIV (NGAP, art. 13 E): see below |
| IK: mileage allowance on the flat | 0.38 € | Per kilometre |
| IK: mileage allowance in mountain areas | 0.61 € | Per kilometre |
| IK, on foot or on skis | 3.35 € | Per kilometre |
| Sunday and public holiday uplift | 7.62 € | Where urgency is justified by the patient’s condition (NGAP, art. 14) |
| Night uplift | 9.15 € | Procedures carried out between 8 pm and 8 am, where the practitioner was called between 7 pm and 7 am (NGAP, art. 14) |
IFD or IFS: which one do you invoice?
The IFS at 4.00 € [JO] applies only to a restrictive list of chapter II procedures under title XIV (art. 13 E of the General provisions): notably multi-region procedures (art. 1 D) and care after orthopaedic surgery, but in that last case only from discharge from hospital to the 35th day after that discharge [NGAP]. Beyond that, or for other procedures at the patient’s home, it is the IFD at 2.50 € [ameli]. Also note: ameli reports that on 1 July 2025 the codes IFO, IFR, IFN, IFP and IFV were removed and replaced by the IFS code.
🔓 Direct access: invoicing without a referral, within what framework?
Since article 9 of amendment 7, clarified by CNAM circular CIR-13/2024 [CNAM], you can carry out procedures without a prior medical referral if you work in a health institution, in a social or medico-social institution or service, or in a coordinated practice setting (primary or specialist care team, health centre or practice):
- Without a prior medical diagnosis : a maximum of 8 sessions per patient and per episode of care (acute episode, maximum duration of 3 months) [CNAM].
- With a prior medical diagnosis : no cap on the number of sessions, in line with the national health authority’s reference standards and good practice guidelines.
- Invoicing : enter your own health professional number in the « Prescriber » field of the invoice. An initial assessment and a report on the treatment given are sent to the patient’s GP and to the patient.
Remember: the reference timescales to memorise
- Non-specific low back pain (RAM 8,09) : 1 to 15 sessions in standard treatment; prior approval from the 16th session, or from the 31st if 30 sessions have already been funded in the preceding 12 months.
- Direct access without a prior medical diagnosis : 8 sessions maximum per episode of care, over a maximum of 3 months.
- IFS after orthopaedic surgery : from discharge from hospital to the 35th day after that discharge; beyond that, it is the IFD.
❓ FAQ: physiotherapy fees and schedule 2026
What is the value of the physiotherapist’s key letter in 2026?
In mainland France, the AMK key letter and the key letters of the redrafted schedule (TER, RAM, RAO, ARL, APM, VSM…) are worth 2.21 € since 22 February 2024 (amendment 7, +3 %) [ameli]. The fee for a procedure is worked out by multiplying its coefficient by that value.
What became of the AMS 7,5 and AMS 9,5 fee codes?
The AMS and AMC key letters no longer appear in the NGAP in force (version of 21/06/2026) [NGAP]. Procedures have been redrafted by condition: the former AMS 9,5 (at least 2 affected regions) has corresponded since 28 May 2026 to the procedures TER 9,79 (without surgery) and TER 9,81 (with surgery) [JO] ; the former 7,5 are redrafted as procedures with coefficients of roughly 8,07 to 8,13 (RAM, RIM, RIC, VSM…).
Which fee code for non-specific low back pain, and how many sessions?
RAM 8,09, i.e. ≈ 17.88 € by calculation (8,09 × 2.21 €) [NGAP]. A procedure subject to a reference standard: 1 to 15 sessions in standard treatment; prior approval from the 16th session, or from the 31st session if 30 sessions for non-specific low back pain have already been funded in the preceding 12 months.
IFD or IFS: which travel allowance do you invoice for a home visit?
The IFD (2.50 €) is the general case [ameli]. The IFS (4.00 €) is reserved for a restrictive list of chapter II procedures under title XIV (NGAP, art. 13 E): multi-region procedures, and care after orthopaedic surgery only from discharge from hospital to the 35th day after that discharge [JO]. The IFD cannot be combined with the night or Sunday uplifts.
Can I see a patient without a medical referral in 2026?
Yes, through direct access, but only if you work in a health institution, in a social or medico-social setting, or in coordinated practice (ESP, ESS, health centre or practice) [CNAM]. Without a prior medical diagnosis: 8 sessions maximum per episode of care (3 months maximum). Invoice using your own number in the « Prescriber » field, and send the initial assessment and the report on treatment to the patient’s GP.
Is there a « child » uplift for physiotherapists?
No: no uplift of that kind appears in title XIV of the NGAP in force (21/06/2026) [NGAP]. The uplifts that do exist are the night uplift (9.15 €) and the Sunday and public holiday uplift (7.62 €), subject to conditions [ameli]. The NGAP does, however, provide for specific paediatric procedures, such as rehabilitation for children with cerebral palsy or multiple disabilities.
Further reading in the review
Coding well above all means treating well: reference standards for low back pain, ankle, knee, COPD… Physio Learning offers DPC courses for physiotherapists and fully online physiotherapy courses, fundable depending on your situation (DPC, FIFPL or self-funded).
