Table of contents
Table of contents
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Key Takeaways
Any reimbursable consultation or medical procedure must be codified according to an official nomenclature.
Two nomenclatures coexist in France: the NGAP for consultations and clinical procedures, and the CCAM for technical medical procedures.
A codification error can lead to a billing rejection, a recovery of overpayments, or an audit by Health Insurance (l'Assurance Maladie).
Combination rules, modifiers, and surcharges are responsible for a large portion of billing errors.
While codification rules change regularly, the year 2026 marks an important milestone in the rollout of the 2024-2029 medical agreement, with several tariff revaluations and new possibilities for combining certain NGAP and CCAM procedures.
Why is the coding of medical procedures important?
The coding of medical procedures forms the foundation of billing in private and hospital medicine.
Each consultation, technical procedure, home visit, or complementary examination must be associated with a precise code in order to be covered by Health Insurance.
This coding allows for:
calculating the practitioner's fees;
determining the patient's reimbursement;
applying any potential increases and modifiers;
checking billing compliance.
Whether you perform a follow-up consultation, an electrocardiogram, a joint injection, or a Pap smear, choosing the right code directly determines your payment.
1. What does the law say?
The coding of medical procedures is governed by Article L.162-1-7 of the Social Security Code.
Only procedures registered in the official nomenclatures can be covered by Health Insurance.
In concrete terms:
the billed code must correspond exactly to the procedure performed;
the procedure must be documented in the medical file;
the rules for combining procedures must be respected;
the conditions for coverage must be verified.
In the event of an audit, Health Insurance can compare the billed procedures with the elements present in the patient's file.
2. What is the difference between the CCAM and the NGAP?
A doctor can use several nomenclatures during a single consultation.
Let's take a concrete example.
A patient consults their general practitioner for palpitations.
The practitioner performs:
a consultation;
an electrocardiogram.
The consultation is coded according to the NGAP. The electrocardiogram is coded according to the CCAM.
The difference between the two nomenclatures therefore depends on the type of procedure performed and not on the professional who performs it.
Criterion | NGAP | CCAM |
|---|---|---|
Full name | Nomenclature Générale des Actes Professionnels (General Nomenclature of Professional Procedures) | Classification Commune des Actes Médicaux (Common Classification of Medical Procedures) |
Main use | Consultations, visits, and clinical procedures | Technical medical procedures |
Professionals concerned | Doctors, dental surgeons, midwives, nurses, physiotherapists, speech therapists, and other medical auxiliaries | Doctors and surgeons performing technical procedures |
Pricing type | Key letter and increases | Specific tariff for each procedure |
Code format | G, CS, VG, APC... | DEQP003, JKHD001, JLQE002... |
Example (general medicine) | Consultation G (or VG if home visit) | ECG DEQP003 |
Entry into force | 1960s | 2005 |
Why is the coding of medical procedures important?
The coding of medical procedures forms the foundation of billing in private and hospital medicine.
Each consultation, technical procedure, home visit, or complementary examination must be associated with a precise code in order to be covered by Health Insurance.
This coding allows for:
calculating the practitioner's fees;
determining the patient's reimbursement;
applying any potential increases and modifiers;
checking billing compliance.
Whether you perform a follow-up consultation, an electrocardiogram, a joint injection, or a Pap smear, choosing the right code directly determines your payment.
1. What does the law say?
The coding of medical procedures is governed by Article L.162-1-7 of the Social Security Code.
Only procedures registered in the official nomenclatures can be covered by Health Insurance.
In concrete terms:
the billed code must correspond exactly to the procedure performed;
the procedure must be documented in the medical file;
the rules for combining procedures must be respected;
the conditions for coverage must be verified.
In the event of an audit, Health Insurance can compare the billed procedures with the elements present in the patient's file.
2. What is the difference between the CCAM and the NGAP?
A doctor can use several nomenclatures during a single consultation.
Let's take a concrete example.
A patient consults their general practitioner for palpitations.
The practitioner performs:
a consultation;
an electrocardiogram.
The consultation is coded according to the NGAP. The electrocardiogram is coded according to the CCAM.
The difference between the two nomenclatures therefore depends on the type of procedure performed and not on the professional who performs it.
Criterion | NGAP | CCAM |
|---|---|---|
Full name | Nomenclature Générale des Actes Professionnels (General Nomenclature of Professional Procedures) | Classification Commune des Actes Médicaux (Common Classification of Medical Procedures) |
Main use | Consultations, visits, and clinical procedures | Technical medical procedures |
Professionals concerned | Doctors, dental surgeons, midwives, nurses, physiotherapists, speech therapists, and other medical auxiliaries | Doctors and surgeons performing technical procedures |
Pricing type | Key letter and increases | Specific tariff for each procedure |
Code format | G, CS, VG, APC... | DEQP003, JKHD001, JLQE002... |
Example (general medicine) | Consultation G (or VG if home visit) | ECG DEQP003 |
Entry into force | 1960s | 2005 |
For doctors, both nomenclatures are often used in conjunction. The same consultation can combine a NGAP code for the consultation and a CCAM code for a technical procedure performed during the session.
3. How is a CCAM code structured?
Each technical procedure has a unique code consisting of: 4 letters + 3 digits
Meaning | Element |
|---|---|
Major anatomical system concerned | 1st letter |
Organ or function | 2nd letter |
Action performed | 3rd letter |
Technique or approach | 4th letter |
Sequential number of the procedure | 3 digits |
Example
DEQP003 (Electrocardiogram):
D: Cardiovascular system
E: Cardiac function
Q: Investigation
P: Functional recording
003: Procedure identifier
JKHD001 (Cervical-vaginal smear):
J: Female genital tract
K: Cervix and vagina
H: Diagnosis
D: Cytological sampling
001: Procedure identifier
GLQP012 (Spirometry):
G: Respiratory system
L: Respiratory function
Q: Investigation
P: Functional recording
012: Procedure identifier
4. How is a NGAP code structured?
Unlike the CCAM, the NGAP does not describe a specific technical procedure, but rather a category of consultation or care management.
Key-letter | Meaning |
|---|---|
G | General practitioner consultation |
CS | Specialist consultation |
V | Home visit |
VS | Home visit by a specialist |
APC | One-off consultant opinion |
MCS | Coordination surcharge |
Example
A patient consults a general practitioner for chest pain.
The doctor performs:
a consultation;
an ECG.
The billing combines:
G (NGAP);
DEQP003 (CCAM).
For doctors, both nomenclatures are often used in conjunction. The same consultation can combine a NGAP code for the consultation and a CCAM code for a technical procedure performed during the session.
3. How is a CCAM code structured?
Each technical procedure has a unique code consisting of: 4 letters + 3 digits
Meaning | Element |
|---|---|
Major anatomical system concerned | 1st letter |
Organ or function | 2nd letter |
Action performed | 3rd letter |
Technique or approach | 4th letter |
Sequential number of the procedure | 3 digits |
Example
DEQP003 (Electrocardiogram):
D: Cardiovascular system
E: Cardiac function
Q: Investigation
P: Functional recording
003: Procedure identifier
JKHD001 (Cervical-vaginal smear):
J: Female genital tract
K: Cervix and vagina
H: Diagnosis
D: Cytological sampling
001: Procedure identifier
GLQP012 (Spirometry):
G: Respiratory system
L: Respiratory function
Q: Investigation
P: Functional recording
012: Procedure identifier
4. How is a NGAP code structured?
Unlike the CCAM, the NGAP does not describe a specific technical procedure, but rather a category of consultation or care management.
Key-letter | Meaning |
|---|---|
G | General practitioner consultation |
CS | Specialist consultation |
V | Home visit |
VS | Home visit by a specialist |
APC | One-off consultant opinion |
MCS | Coordination surcharge |
Example
A patient consults a general practitioner for chest pain.
The doctor performs:
a consultation;
an ECG.
The billing combines:
G (NGAP);
DEQP003 (CCAM).
5. How to find the code for a medical procedure?
The official bases
The primary source of reference remains the Assurance Maladie (French Health Insurance).
Doctors can search for a procedure:
by keyword;
by specialty;
by code;
by anatomical system.
Professional software
Most medical software includes:
the up-to-date CCAM;
the NGAP;
accumulation rules;
modifiers;
tariff updates.
Intelligent medical assistants
The new generation of medical assistants makes it possible to automate part of the codification process.
Based on the content of the consultation, these tools can:
suggest relevant NGAP and CCAM billing codes;
detect applicable surcharges;
verify accumulation rules;
At Aldebaran, this assistance is based on a combination of structured medical knowledge, conventional rules, and artificial intelligence to help doctors code their procedures more quickly and reliably.
6. Understanding surcharges
Surcharges make it possible to enhance the value of certain clinical or organizational situations.
They are added to the main billing code when the conditions are met.
Among the most frequent:
Surcharge | Situation |
|---|---|
MCS | Coordinated care pathway |
MPC | Specialist surcharge |
MHP | Outside care pathway |
U | Emergency |
F | Public holiday |
N | Night |
These surcharges are regularly forgotten even though they can represent a significant portion of the clinic's revenue.
5. How to find the code for a medical procedure?
The official bases
The primary source of reference remains the Assurance Maladie (French Health Insurance).
Doctors can search for a procedure:
by keyword;
by specialty;
by code;
by anatomical system.
Professional software
Most medical software includes:
the up-to-date CCAM;
the NGAP;
accumulation rules;
modifiers;
tariff updates.
Intelligent medical assistants
The new generation of medical assistants makes it possible to automate part of the codification process.
Based on the content of the consultation, these tools can:
suggest relevant NGAP and CCAM billing codes;
detect applicable surcharges;
verify accumulation rules;
At Aldebaran, this assistance is based on a combination of structured medical knowledge, conventional rules, and artificial intelligence to help doctors code their procedures more quickly and reliably.
6. Understanding surcharges
Surcharges make it possible to enhance the value of certain clinical or organizational situations.
They are added to the main billing code when the conditions are met.
Among the most frequent:
Surcharge | Situation |
|---|---|
MCS | Coordinated care pathway |
MPC | Specialist surcharge |
MHP | Outside care pathway |
U | Emergency |
F | Public holiday |
N | Night |
These surcharges are regularly forgotten even though they can represent a significant portion of the clinic's revenue.
7. Understanding the rules of combining medical procedures
Combination rules determine which procedures can be billed together during the same consultation.
They represent one of the most complex topics in medical billing.
The general principle is simple:
Not all procedures performed during the same session are necessarily billable in full.
Depending on the case:
some procedures can be combined at 100%;
some procedures can be combined with a discount;
some procedures cannot be combined;
certain exceptions exist.
Why are combination rules complex?
The rules depend on:
the specialty;
the type of procedure;
the nomenclature used;
modifiers;
conventional updates.
This is why many doctors prefer to rely on business software or intelligent medical assistants to secure their billing.
8. What mistakes should be avoided when coding medical procedures?
Forgetting a combinable procedure
Forgetting combinations and surcharges is among the most common causes of under-billing in private medical practice.
Although there are no consolidated national statistics on the number of forgotten procedures each year, medical unions and billing training organisations regularly report that these errors represent several thousand euros in annual lost earnings for some practices.
Forgetting a surcharge
Forgetting surcharges also represents a significant source of financial loss.
Using the wrong CCAM code
Two similar procedures may have different codes.
An error can lead to:
a rejection;
a recovery of overpayments;
an audit.
Failing to comply with regulatory conditions
Certain billings require:
a referral letter;
compliance with the coordinated care pathway;
certain age conditions;
a specific clinical indication.
7. Understanding the rules of combining medical procedures
Combination rules determine which procedures can be billed together during the same consultation.
They represent one of the most complex topics in medical billing.
The general principle is simple:
Not all procedures performed during the same session are necessarily billable in full.
Depending on the case:
some procedures can be combined at 100%;
some procedures can be combined with a discount;
some procedures cannot be combined;
certain exceptions exist.
Why are combination rules complex?
The rules depend on:
the specialty;
the type of procedure;
the nomenclature used;
modifiers;
conventional updates.
This is why many doctors prefer to rely on business software or intelligent medical assistants to secure their billing.
8. What mistakes should be avoided when coding medical procedures?
Forgetting a combinable procedure
Forgetting combinations and surcharges is among the most common causes of under-billing in private medical practice.
Although there are no consolidated national statistics on the number of forgotten procedures each year, medical unions and billing training organisations regularly report that these errors represent several thousand euros in annual lost earnings for some practices.
Forgetting a surcharge
Forgetting surcharges also represents a significant source of financial loss.
Using the wrong CCAM code
Two similar procedures may have different codes.
An error can lead to:
a rejection;
a recovery of overpayments;
an audit.
Failing to comply with regulatory conditions
Certain billings require:
a referral letter;
compliance with the coordinated care pathway;
certain age conditions;
a specific clinical indication.
9. What changes are in store for the codification of medical procedures in 2026?
The year 2026 marks a new stage in the roll-out of the 2024-2029 medical convention.
Revaluation of numerous CCAM procedures
The CCAM monetary conversion factor has been revalued.
New NGAP + CCAM combinations
Several technical procedures can now be combined more advantageously with a consultation:
certain infiltrations;
certain spirometries;
the insertion or removal of an IUD;
certain colposcopies.
Revaluation of certain modifiers
Modifiers K and T have been revalued for certain surgical, anaesthetic and obstetric procedures.
New consultations and new codings
The medical convention is also continuing to revalue:
complex consultations;
long consultations;
monitoring of elderly patients;
certain chronic care management.
Conclusion
Medical coding is no longer simply a matter of choosing between a G consultation and a CCAM procedure. It is based on a complex set of rules combining nomenclatures, surcharges, modifiers and combination rules.
Understanding the logic of the NGAP and CCAM is now essential to secure billing, avoid errors and correctly value the daily medical work carried out.
In a context where nomenclatures are regularly changing, coding assistance tools and intelligent medical assistants are becoming valuable allies in reducing the administrative burden and securing practice income.
9. What changes are in store for the codification of medical procedures in 2026?
The year 2026 marks a new stage in the roll-out of the 2024-2029 medical convention.
Revaluation of numerous CCAM procedures
The CCAM monetary conversion factor has been revalued.
New NGAP + CCAM combinations
Several technical procedures can now be combined more advantageously with a consultation:
certain infiltrations;
certain spirometries;
the insertion or removal of an IUD;
certain colposcopies.
Revaluation of certain modifiers
Modifiers K and T have been revalued for certain surgical, anaesthetic and obstetric procedures.
New consultations and new codings
The medical convention is also continuing to revalue:
complex consultations;
long consultations;
monitoring of elderly patients;
certain chronic care management.
Conclusion
Medical coding is no longer simply a matter of choosing between a G consultation and a CCAM procedure. It is based on a complex set of rules combining nomenclatures, surcharges, modifiers and combination rules.
Understanding the logic of the NGAP and CCAM is now essential to secure billing, avoid errors and correctly value the daily medical work carried out.
In a context where nomenclatures are regularly changing, coding assistance tools and intelligent medical assistants are becoming valuable allies in reducing the administrative burden and securing practice income.
French Health Insurance (Ameli)
Professional organisations
MG France Tariff brochures. 2023-2026
Additional references
Suhard V. History of medical conventions. IRDES, 2022.
Public Health Code – Relevant Article (Legifrance). Version in force on 1 January 2026.
