Frequently asked questions
Our FAQs explain how CSS checks the services that are billed under the TARMED 1.09 tariff structure.
A bill has been sent back. How can I find out why it has been rejected?
CSS checks all the quantitative and time limits as well as compliance with any bans on aggregating items.
Each time we reject a bill, you will find details of the items that cannot be aggregated or the items that exceed a quantitative limit. You can also see which bills have been taken into consideration in our calculations.
For details of aggregation or quantitative limits, please refer to the tariff items in the relevant chapter of the TARMED schedule.
The prescribed quantitative limit doesn’t allow me to reflect my treatment in full. What can I do?
TARMED does not permit quantitative limits to be exceeded. Consequently, any such action cannot be approved by CSS.
If patients require more time than is permitted by the set limit, this can be applied in exceptional cases (by indicating an increased need for treatment under benefit group LG-30).
You do not need a commitment to provide cover to bill this item. Keep a record of why your patient required more treatment, leading you to bill this item. We may ask you to confirm or explain the increased need for treatment.
How does CSS verify periods in relation to quantitative limits?
We take only a "rolling" approach as we consider this to be the correct way of checking that the rules on aggregation (GI-9) are being applied properly.
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).
How does CSS check compliance with quantitative limits and the ban on aggregation in group practices and hospitals?
CSS checks the majority of limits prescribed by TARMED 1.09 at doctor level.
Individual services for which multiple billing in a single day does not make sense are checked at ZSR level.
Accordingly, please do not use any administrative GLNs in the XML file. If you do, limits will be checked across departments/units.
Does CSS still accept TARMED items from the 1.08 version of the tariff structure?
For treatment provided on or after 1 January 2018, items must be billed in accordance with the 1.09 version of the tariffs.
Items from the 1.08 tariff structure can only be used for treatment provided before 1 January 2018.