Ambulante Pauschalen explained: when the flat rate applies — and when TARDOC does

Ambulante Pauschalen (outpatient flat rates) pay a defined outpatient treatment as one fixed amount instead of a list of single services. They were introduced together with TARDOC on 1 January 2026 and cover standardised, well-delimited interventions — typically day surgery and other planned outpatient procedures.

How a flat rate works

• One case, one rate. The flat rate covers the defined treatment including the services bundled into it — often including anaesthesia and follow-up components that used to be billed separately.
• Trigger by case criteria. Whether a case falls under a flat rate depends on the intervention and defined case characteristics, not on how the practice prefers to bill.
• Precedence over TARDOC. If a flat rate applies, the case must be billed as a flat rate. Billing the bundled services additionally as TARDOC single positions is a rule violation.

Where practices get caught

The most common mistake in the new system is double billing: coding TARDOC positions for services that are already inside the flat rate — anaesthesia positions bundled into a surgical flat rate are the classic case. The second most common: missing that a case qualifies for a flat rate at all and sending single positions the insurer will reject.

The safe workflow

1. 1Check whether the case matches an outpatient flat rate.
2. 2If yes, bill the flat rate and nothing bundled inside it.
3. 3If no, code TARDOC single positions and validate limitations and cumulation rules.

Viali TARDOC runs this check automatically: it detects positions already covered by a flat rate and validates the rest against the official tariff rules before the invoice goes out.

Frequently asked questions

What are Ambulante Pauschalen?

Swiss outpatient flat rates introduced on 1 January 2026 alongside TARDOC. They pay a defined outpatient treatment as one fixed amount instead of single-service positions.

When does a flat rate apply instead of TARDOC?

When the intervention and case characteristics match a defined flat rate. The flat rate then takes precedence and must be used.

Can I bill anaesthesia separately next to a surgical flat rate?

Not if the anaesthesia is bundled into the flat rate. Billing bundled services additionally as TARDOC positions is double billing and gets rejected.

What is the most common flat-rate billing mistake?

Double billing services already contained in the flat rate, followed by missing that a case qualifies for a flat rate and sending single positions instead.