General tariff system for outpatient services

Yes. Doctors, facilities and hospitals must join the tariff structure agreement in order to bill under TARDOC or outpatient flat rates. Please address any questions about the procedure for joining the agreement to the service provider associations (FMH and H+).

No. The TARMED tariff ended on 31 December 2025 and is no longer valid. We will reject such bills.

For correct billing you must allocate the service provided to the correct tariff item code or flat rate in the applicable tariff system (TARDOC or flat rates). The bill that is submitted must also comply with the current technical requirements (XML 5.0 standard). For specialist and technical questions relating to billing, please contact the competent professional associations and tariff organisations (OAAT, H+ and FMH).

CSS checks the following:

• Quantitative and time limits, i.e. if the permitted number and frequency of services have been exceeded.
• Bans on aggregation, i.e. whether certain services are not allowed to be billed simultaneously.
• Double payments, i.e. checking whether a service has been charged more than once.
• Whether the correct prices were charged for the billed items.
• Whether the service falls under UVG/IVG or is a non-mandatory benefit that is not covered by the insurance.
• Whether the diagnosis and medical department/speciality are stated correctly.
• Complete information about additional items, body side and the reference code required for the precise allocation of the service.

Every rejection comes with information about which item/s is/are affected. You can also see which bills have been taken into consideration in our calculations.

There can be various reasons. These include:

• Multiple items: More than one item was queried, but only one was amended.
• Incomplete correction: The corrections were incomplete or not entirely correct.
• Formal mistakes: There are other mistakes, e.g. wrong tariff code or missing details.
• System-based rejection: Bills are often rejected automatically when they do not exactly meet the requirements.

You will receive a rejection code with each rejection. If there are problems, please contact your software provider.

Under the tariff structure agreement, the medical department/specialty must be provided for each item on the bill. This applies to facilities which support outpatient healthcare provided by doctors (pursuant to Art. 35 para. 2n. KVG (Federal Health Insurance Act) and to hospitals (pursuant to Art. 35 para. 2h. KVG).

In XML, the "section_code" attribute must feature at the item level and must have a valid value. Your software provider can tell you how to capture the medical department/specialty correctly in your system. Please contact your association if you have any questions about the tariff structure agreement.

The regulations on the medical departments/specialties are available on the OAAT website, under Annex B.

The tariff structure agreement defines how the diagnosis should be indicated on the bill:

• For TARDOC: Diagnosis at the session level by way of the Ticino code or ICD-10-GM
• For outpatient flat rates: Diagnosis by way of ICD-10-GM

The diagnosis must be transmitted correctly in XML in accordance with the Forum Datenaustausch standards. In XML the attribute appears at the item level: "invoice: xtra_service" (enter token + value). Your software provider must take care of this.

The files relating to the systematic and alphabetic ICD-10-GM catalogues in German and the transition between two versions are prepared and published by Germany's Federal Institute for Drugs and Medical Devices (BfArM). The reference version is the German version of the systematic catalogue in PDF format. The different formats of ICD-10-GM are available on the internet.

This error occurs when an outpatient flat rate and TARDOC services have the same session number. Outpatient flat rates cannot be combined in any way with the TARDOC fee-for-service tariff and other outpatient medical tariffs for a single outpatient treatment.

According to the XML 5.0 standard, the group or session number for outpatient flat rates must always be unique across dates. TARDOC items with services that do not belong to the same outpatient treatment as the flat rates must be entered with a different session number than the outpatient flat rate.

Your software provider can help with technical questions, while your professional association can help with specialist questions regarding the session/group number.

For some tariff items it is necessary to indicate whether the service was provided to the right, left or both sides of the body. The instructions can be found in the tariff browser for the relevant items. In XML, the "body_location" attribute at the item level must have a valid value. This value must be provided for all items where the tariff so requires. Your software provider can help you with questions regarding the correct technical transmission.

TARDOC uses four service types:

• Main services: Independent services with self-contained content.
• Additional services "+": Must always be allocated to a specific main service by way of a reference code and may only be entered together with the main service.
• Free additional services "(+)": Must be allocated to the relevant main service by way of a reference code.
• Reference services: Must always refer to a main service (reference code).

In XML, the "ref_code" (reference code) attribute at the item level must have a valid value.

Your software provider can help with technical questions, while your professional association can help with specialist questions.

Quantitative limits may not be exceeded and any excess will not be reimbursed by CSS.

According to the General Interpretation GI-15, quantitative limits apply on a rolling basis.

Taking a billed item as our starting point, we look at the other services billed within the permitted time frame, both past and future (if there are further items on the same or other bills).

According to GI-15:

• Bans on aggregation and quantitative limits apply per session. Quantitative limits per time unit apply per service provider in an outpatient setting.