The Referral Model for Psychotherapy: Process, Authorisation and Billing in Switzerland

The prescription model refers to the system in which a recognized psychologist-psychotherapist can practice and bill their services to the AOS, provided that they have been prescribed by a physician.

These foundations ensure a uniform framework across Switzerland, while leaving the cantons certain responsibilities regarding admission and pricing.

Until 2022, psychologist-psychotherapists worked under the so-called delegation model: they practiced under the responsibility of a psychiatrist, who handled the billing. With the prescription model, each authorized psychotherapist now bills independently, while collaborating with a prescribing physician.

Under the prescription model, an authorized physician prescribes psychotherapy, and the psychologist-psychotherapist then bills their sessions in their own name directly to the health insurer.

This marks a break from the former delegation model, in which billing had to go through a psychiatrist. Psychotherapists now practice and bill independently, provided that they meet the admission requirements for the AOS.

The main points to remember:

• Entry into force: July 1, 2022
• End of the delegation model: January 1, 2023
• Legal basis: OAMal and OPAS
• First prescription: up to 15 sessions
• Crisis intervention or short-term therapy: up to 10 sessions
• Prescription required: before the first session billable to the AOS
• Admission required: in particular registration in PsyReg, cantonal authorization and RCC number

The specific admission requirements for psychologist-psychotherapists and organizations of psychologist-psychotherapists are defined in the OAMal.

The prescription can be issued by:

• a specialist in psychiatry and psychotherapy
• a specialist in child and adolescent psychiatry and psychotherapy
• a primary care physician, e.g. a specialist in general internal medicine
• a pediatrician
• a physician holding the ASMPP certificate of advanced training, psychosomatic and psychosocial medicine
• other physicians according to the applicable provisions of the OAMal and OPAS

For crisis interventions and short-term therapies, physicians with other postgraduate titles or medical practitioners may also prescribe, in accordance with the OPAS.

To be able to bill psychotherapy sessions to the AOS, a psychologist-psychotherapist must meet the following conditions:

• Hold a master’s degree in psychology from a Swiss university or an equivalent recognized degree
• Have completed accredited postgraduate training in psychotherapy
• Hold a cantonal license to practice
• Be admitted to practice at the expense of the AOS
• Be registered in the federal register of psychology professions (PsyReg)
• Have an RCC number issued by SASIS SA
• Provide proof of the required clinical experience

The RCC number must appear on all invoices sent to patients or insurers.

During postgraduate training: independent billing is not possible. Services covered by the AOS remain possible within the framework of salaried employment, under qualified supervision, with a C number linked to the employer’s RCC number.

Before the first session billable to the AOS, an authorized physician issues a prescription. Without this prescription, coverage by basic insurance is not guaranteed.

The first prescription covers up to 15 sessions. Staggered prescriptions are possible, e.g. 3 sessions at first, followed by 10 additional sessions. For a crisis intervention or short-term therapy, the maximum is 10 sessions.

Around the 12th session, an exchange between the psychotherapist and the prescribing physician is recommended in order to assess the progress of the treatment. If the treatment is to continue, a second prescription for 15 additional sessions may be issued.

This exchange should be planned in advance to avoid any administrative interruption.

After 30 sessions, a request for extension must be submitted to the health insurer. The psychotherapist writes a report on the course of treatment, ideally from the 25th session onwards, and forwards it to the prescribing physician.

If the prescribing physician is not a specialist in psychiatry and psychotherapy, an assessment by a specialist is required. Physicians holding the ASMPP certificate may, depending on the case, carry out this assessment themselves.

The insurer then decides how many additional sessions will be covered. Once the guarantee has expired, a new request must be submitted. In the event of a change of insurer, the previous guarantee is not automatically transferred.

Interruptions such as holidays, hospitalization, a therapeutic break or a change of calendar year do not reset the counter. The prescription remains valid until the prescribed number of sessions has been used up.

In the event of a change of psychotherapist, it is recommended that the prescribing physician issue a new prescription, especially if the initial prescription names a specific therapist.

Psychotherapists bill their services in their own name and on their own account. The applicable tariff is the PsyTarif, with a provisional hourly rate set at CHF 154.80, subject to cantonal or contractual adjustments.

Certain services may also be covered by supplementary insurance under the LCA. However, it is not possible to combine AOS and LCA for the same course of treatment.

The prescription model does not define a single method. Recognized approaches are those that form the basis of accredited postgraduate training, in particular:

• cognitive behavioral therapy
• psychodynamic or psychoanalytically oriented psychotherapy
• systemic therapy
• person-centered psychotherapy

The choice of method depends on the indication, the clinical situation and the psychotherapist’s professional assessment.

The prescription model is based on active collaboration between the prescribing physician and the psychotherapist. The physician prescribes and is involved in extension procedures; the psychotherapist carries out the treatment, documents it and writes the necessary reports.

This collaboration is not limited to the start of care. It must be reactivated before the end of the first 15 sessions, and the extension report must document the therapeutic goals, the extent to which they have been achieved and the justification for continuing treatment. Patient data may only be transmitted with the patient’s explicit consent.

Digital referral tools and secure communication tools significantly reduce the administrative burden for both parties.