Contracted or non-contracted: what does it mean?

The national agreement (convention) for physiotherapy is essentially a trade-off: as a contracted (conventionné) physiotherapist, you apply the fixed fees set by RIZIV-INAMI, the Belgian health insurance institute, and in return you get benefits such as the social status allowance of up to €3,853.04 a year. If you opt out, you set your fees entirely as you see fit, but your regular insured patients get 25 percent less reimbursed. According to INAMI, 64.34 percent of physiotherapists have signed up to the current agreement M/25 for 2025 and 2026, so more than 1 in 3 work outside the agreement. Below you can read exactly what you commit to, what you get in return, and how and when you can opt out.

What exactly is the national agreement for physiotherapists?

The agreement (convention) is the national deal between physiotherapists and the insurers (the health insurance funds, or mutualités), negotiated in the Agreements Committee at INAMI. The current text, agreement M/25, was adopted by the Insurance Committee on 13 January 2025 and published in the Belgian Official Gazette on 21 February 2025. It covers 2025 and 2026 and is not tacitly renewable: a new agreement has to be negotiated for the period after that. You will find the details in the official M/25 agreement text from INAMI.

Each time, the Insurance Committee has to establish whether the quorum of 60 percent sign-ups has been reached; with 64.34 percent, that was the case for M/25. The agreement applies to those who signed up, regardless of the sign-up rate across the profession. Signing up therefore remains an individual choice: every physio decides for themselves, and that choice determines both your fees and your INAMI benefits.

Nollie makes software for physiotherapists itself. All amounts and rules in this article come straight from INAMI and were checked on 13 August 2026.

What do you commit to as a contracted physio, and what do you get back?

By signing up, you commit to respecting the official fees set in the agreement. So you charge the fixed agreement fees, without supplements: in 2026, for example, €31.64 for an individual session for common conditions at the practice. You will find all current amounts and patient co-payments (ticket modérateur) in our overview of physiotherapy fees for 2026.

In return you get the main benefit: the INAMI social status allowance, an annual premium that INAMI pays into a pension agreement or a contract for replacement income in case of disability. The conditions: you are contracted for the whole premium year (except in the year you receive your INAMI number) and you reach a minimum level of activity. If you bill more than 6,500 services or 156,000 M values, you lose the entitlement.

For 2025 there is also a one-off agreement bonus of €373.04 on top, for physios who signed up in time, reach an activity threshold and registered their bank account number in ProGezondheid.

Social status allowance for physiotherapists: amounts for premium year 2026

What does opting out mean for you and your patients?

Opting out means that, as a physiotherapist, you do not sign up to the agreement. You then set your fees entirely freely and may charge more than the agreement fee. That is the whole benefit in a nutshell: freedom to set your fees.

The downside lands with your patients. Since 1 May 2025, the insurance reimbursement for all services by a non-contracted physio has been 25 percent lower for regular insured patients; INAMI calls this the -25% rule. In practice: for a standard session at the practice, the reimbursement drops from €25.39 to €19.05. Your patient pays that difference themselves, on top of the co-payment and any supplement you charge. The reduction does not apply to patients entitled to increased reimbursement: their reimbursement stays the same.

Mind you: even as a non-contracted physio, you are required to charge the agreement fees to patients with increased reimbursement and whenever you apply the third-party payment scheme (tiers payant). In practice, your freedom to set fees therefore only applies to regular insured patients. And you lose the social status allowance and the agreement bonus.

How and when can you opt out?

1. When a new agreement comes in: after publication in the Belgian Official Gazette, INAMI sends the text to all physiotherapists. If you are already contracted and do not want to stay that way, you refuse within 30 days of that mailing via the secure online application ProGezondheid (ProSanté). If you do not respond, you are deemed to remain signed up; that is also how it went with M/25 in early 2025.
2. During the term: you can withdraw your sign-up every year before 15 December, again via ProGezondheid. A withdrawal never takes effect immediately: you only become non-contracted from the following 1 January.
3. Partial opt-out does not exist for physiotherapists: unlike doctors, you cannot sign up for only part of your activity. Agreement M/25 only allows full sign-up, for your entire practice.
4. Going back is possible: every new agreement is a new decision point. If you are non-contracted today, you can sign up again with the next agreement.

Contracted or non-contracted: the trade-off

How do you make the right choice for your practice?

In the end, the decision comes down to the numbers. First count how many of your patients receive increased reimbursement and how often you apply the third-party payment scheme: for those sessions, opting out gains you nothing, because the agreement fee remains mandatory there. Through MyCareNet and the other services on our page about eHealth for physiotherapists, you retrieve that insurance status automatically.

Weigh that against what you can realistically charge your regular insured patients on top, and what you give up: up to €3,853.04 in social status allowance a year plus the agreement bonus. A physio treating mostly common conditions in a region with lots of competition will do the maths differently from a specialised practice with a waiting list.

Your admin, by the way, does not change with your status: certifying and billing work exactly the same, and the difference between eAttest, eFact and eAgreement is also the same for both statuses. In a modern electronic patient record, you immediately see each patient's insurance status and the correct fee.

Read more

Physiotherapy fees 2026: the full overview

Since 1 January 2026, physiotherapy fees in Belgium have been indexed by 2.72%. A standard session costs €31.64 at the practice and €34.81 at home: here is the complete overview, including the patient co-payment.

Fees and agreement · 8 August 2026