Amendment 7: setting up as a physiotherapist in France

If you are looking for what applies today to your setting up in practice or to your billing codes, one point needs making straight away: the pay increases expected on 1 July 2025 did not take place on that date. They were suspended, then postponed to 1 January 2026. Here is where things stand on amendment 7 (avenant 7, an amendment to the national agreement between physiotherapists and the Assurance Maladie, the French national health insurance): the conditions for setting up and the zoning, the grants, the pay increases, amendment 8 and the nomenclature.

Setting up in private practice: the conditions set by amendment 7

Amendment 7 changed access to the national agreement (conventionnement), that is, the right to practise in private practice at the agreement's rates. Two separate rules apply: a prior experience requirement for recently trained physiotherapists, and the regulation of agreement places in the areas best served by care provision.

The prior experience requirement

For physiotherapists whose training began in 2023 or later, setting up in private practice under the agreement requires meeting at least one of the following two conditions: showing two years of prior professional experience in a health or medico-social establishment in France, or committing to practise for at least the first two years of your agreement in a "very underserved" or "underserved" zone (article 4 of amendment 7).

According to the Assurance Maladie's circular CIR-13/2024 (updated on 17 December 2024), the two years can combine an establishment and an underserved zone, either successively or simultaneously. In an establishment, the required duration corresponds to 70% of a full-time equivalent, that is 2,240 hours over two years; in an underserved zone, you must show at least 6,000 acts over the two years. Clinical placements carried out during training, in an establishment or in an underserved or very underserved zone, are taken into account, except those completed abroad.

Regulation of agreement places in "non-priority" zones

The zoning distinguishes four categories, established from the localised potential accessibility indicator: very underserved, underserved, intermediate and "non-priority" zones, formerly known as overserved. Amendment 7 extends the latter to 30% of the French population, compared with 12.5% previously according to the circular.

In these zones, once the region's zoning order has been published, an agreement place is granted only to the successor designated by a colleague who permanently stops practising: this is the "one departure for one installation" principle. The colleague has two years at most to designate a successor, and their cessation opens a place only if their activity reached at least 1,200 acts in the previous year, subject to the departmental joint committee's assessment of particular situations. The successor must begin the setting-up formalities within six months of notification of the agreement decision. The regulation also applies to practice carried out exclusively at patients' homes, and the agreement provides for exemptions: your CPAM (local health insurance office) will tell you which ones apply to your situation.

Where the zoning of your municipality stands

In a given region, the regulation applies only from the publication of the zoning order of the ARS (regional health agency), and this date varies from one region to another, as REZONE Kiné, the Assurance Maladie's tool, explains. By way of example, the ARS of Hauts-de-France published its zoning on 21 January 2025, applicable from 22 January 2025, and the one for Normandy came into force on 1 February 2025. As the orders may be revised, check the classification of your municipality on REZONE Kiné, on your region's ARS website or with your CPAM before any decision to set up.

Setting-up grants in very underserved zones

Amendment 7 raised the amounts of the three demographic contracts, the CACCMK, the CAIMK and the CAMMK, reserved them for "very underserved" zones and removed the annex that still carried the former incentive contract (CIMK). A supplement is added for hosting a trainee.

Their amounts, the conditions for joining, the payment schedule and the rule for pro-rating by volume of acts are detailed in our dedicated article: setting-up grants for physiotherapists: amounts and conditions.

Why the July 2025 pay increases were postponed to January 2026

The alert committee on the development of health insurance spending issued its opinion on 18 June 2025 (recalled in the preamble to amendment 8), estimating a risk of the alert threshold being exceeded. This procedure automatically triggers the suspension of all pay increase measures planned during the year, under article L. 162-14-1-1 of the Social Security Code.

As a result, the tariff measures of amendment 7 expected on 1 July 2025 were postponed to 1 January 2026, as the preamble to amendment 8 and the ministry's reply published in the Journal officiel of 10 March 2026 recall. There is one exception, and it matters for your billing: the simplification of the flat-rate travel allowances did take effect on 1 July 2025.

The coefficients set by the 1 January 2026 schedule

The value of the key letter does not vary by act: €2.21 in mainland France, €2.43 in the overseas departments, for the AMK, the AMC and the AMS. It is not among the postponed measures. What changes are the coefficients. The euro amounts below are calculated for mainland France from the coefficients and rounded.

• Acts formerly coded AMS 7.5 (RAM, RAO, RSC, RSM, RIC, RIM, VIM, VIC, VSM, VSC, DRA, APM): a 0.9-point increase in two stages. The first, +0.6 point, raises the coefficient from 7.5 to 8.1, or about €17.90 instead of €16.58, calculated on the €2.21 key letter (about €1.33 more per act). The second, +0.3 point, is planned for 1 July 2027 and will bring the coefficient to 8.4.

• Balneotherapy supplements: +1.3 points of coefficient, or about +€2.87 on the pool supplement as on the bath supplement. The pool supplement thus goes to a coefficient of 3.5, or about €7.74.

• Rehabilitation of walking in older people: the act coded AMK/AMC 6 is removed and replaced by an RPE 8.5 act, or about €18.79 instead of €13.26.

• Neuromuscular diseases and frailty screening: amendment 7 provides, on 1 September 2026, for a one-point increase in the coefficient of the acts in article 4 of chapter II of title XIV whose coefficient is 10 or 11, and for the creation of an act to screen for frailty in people aged 70 or over (AMK 10, subject to the opinion of the Haute Autorité de santé, the French national health authority). These measures depend on the prior amendment of the list of acts: check their implementation on ameli.fr.

Keep the mechanism in mind rather than the amounts: what differentiates the pay for two acts is not the key letter, which is the same for all acts, but the coefficient attached to the act.

Amendment 8: a pay increase brought forward to 28 May 2026

Amendment 8 to the agreement was concluded on 28 November 2025 and published in the Journal officiel of 19 December 2025. Its scope is targeted, and it remains incomprehensible until it is tied to the amendment 7 schedule.

Amendment 7 provided for +0.3 point of coefficient on 1 July 2026 for acts formerly coded AMS 9.5, that is the key letters TER (multi-territory rehabilitation) and APM (amputations of several limbs). Amendment 8 brings this stage forward to 28 May 2026. The starting coefficients were TER 9.49, TER 9.51 and APM 9.50; the amendment raises them to TER 9.79 (without surgery), TER 9.81 (with surgery) and APM 9.80 (amputation of at least two limbs).

If your patient base includes multi-territory rehabilitation or post-amputation care, the check is worth the quarter of an hour it takes: the amendment provides for this increase on 28 May 2026, subject to the prior amendment of the list of acts. Check on the ameli amendments page and in your software that the new coefficient is actually applied: billing left on the old coefficient is a silent shortfall, act after act.

What did take effect on 1 July 2025: the IFS allowance

The specific flat-rate travel allowances were simplified, and this measure was not postponed. The codes IFO, IFR, IFN, IFP and IFV are removed, replaced by a single code, IFS, worth €4.

The IFS applies to a precise scope: rehabilitation of all or part of several limbs or of the trunk and one or more limbs, rehabilitation of the consequences of inflammatory rheumatic conditions, of the consequences of neurological and muscular conditions, rehabilitation of respiratory diseases, and the acts of article 9 of chapter II of title XIV. The IFD allowance remains in force for acts not covered.

The nomenclature: 80 acts, and about twenty key letters

This is the fundamental change in amendment 7, and it predates the pay increases. The nomenclature no longer groups acts by broad category of condition: it describes 80 acts, each with its own combination of key letter and coefficient. The wordings formerly coded AMS have been redescribed one by one.

Hence the twenty or so key letters that have replaced the AMS: APM for amputations, ARL for respiratory, maxillofacial and ENT conditions, DRA for spinal deviations, NMI for neuromuscular and inflammatory conditions, PLL for palliative care, RAB for abdominal and perineal-sphincter rehabilitation, RAM and RAO for the spine, RAV for vascular conditions, TER for multi-territory rehabilitation, and others.

The AMK has not disappeared, and this matters for three categories of acts that come up every week: assessments, including the physiotherapy diagnostic assessment, balneotherapy supplements, and podiatry acts.

On the timeline, a useful point: billing with the new codes has been mandatory since 1 June 2024, and the associated tariffs have been in force since 22 February 2024.

Where to check a coefficient, and why at the source

Agreement tariffs depend on where you practise, and coefficients circulate widely, often copied from one year to the next without being updated. The articles that display a full table of codes are precisely those that age the worst, and the July 2025 postponement is proof of this.

The references to keep bookmarked:

• the nomenclature of physiotherapy acts on ameli.fr, which provides the file of the 80 acts and their wordings;

• the agreement tariffs, which give the values applicable to your sector;

• the list of amendments to the agreement, for the dates of entry into force;

• the texts published in the Journal officiel, amendment 7 and amendment 8 on Légifrance, as well as the Assurance Maladie's circular CIR-13/2024, which details the implementation of amendment 7;

• REZONE Kiné, for the classification of your municipality in the zoning;

• the official booklet on amendment 7 published by the Ordre (the professional body), which details the coefficients and demographic contracts act by act, in its November 2024 edition, prior to the postponement and to amendment 8.

Other developments to anticipate concern digital tools: your obligations to feed the DMP (shared medical record) and the rollout of direct access in CPTS (local professional health communities).

What the nomenclature requires of your assessment

One consequence remains that reading an amendment rarely reveals. If each act now carries its own wording, then the precision of your assessment determines the accuracy of your coding. Coding multi-territory rehabilitation requires that the territories treated are described. Coding respiratory rehabilitation requires that the indication is in the record. Traceability of care is no longer only a safeguard in the event of an inspection: it becomes the raw material of your billing.

This is where the organisation of the practice meets the nomenclature. An assessment written in the evening, from memory, three patients later, describes less than one written from what was actually said and observed during the session. Markus transcribes the consultation and drafts the report in your template, from your words. You review, adjust and validate. Markus drafts, it does not decide: the coding remains your professional act, and the description you base it on simply becomes more faithful.

If you are currently comparing the tools on the market, we keep up to date a comparison of software for physiotherapists, and the Markus for physiotherapists page details what transcription changes over a day at the practice.

Try Markus free for 14 days, no credit card required.

The dates and amounts cited come from the texts of amendments 7 and 8 published in the Journal officiel, from the Assurance Maladie's circular CIR-13/2024, from Assurance Maladie pages, from the websites of the regional health agencies and from the official booklet on amendment 7 published by the Ordre, consulted on 15 October 2026. The euro amounts are calculated from the coefficients and rounded. Agreement tariffs depend on where you practise: check the value applicable to your sector on ameli.fr.