Sistema TS — Italy's Health Card System — is mandatory for psychologists and psychotherapists who invoice healthcare services. Find out who is covered, which services count, and how to comply on time.
What Sistema TS is, and who it applies to
Sistema Tessera Sanitaria is a Ministry of Health platform that tracks healthcare spending. It feeds the pre-filled Italian tax return and tax deductions. It is mandatory for healthcare professionals with a VAT number.
Psychologists registered with the Ordine degli Psicologi, Italy's professional body, are required to submit. It applies to self-employed practitioners and to organisations working under public agreement alike. Those on the flat-rate tax scheme must comply too.
If you run online sessions, issue fee notes or invoice, Sistema TS concerns you. There is no exception for remote consultations or video appointments.
Which psychological services must be reported
Every service your practice provides must be sent to Sistema TS. There are no exemptions by type of work.
- Psychotherapy sessions: individual or group, in person or online.
- Psychological consultations: assessment, evaluation, follow-up.
- Psychodiagnostics: clinical assessment and diagnosis.
- Psychological testing: administering and interpreting diagnostic instruments.
- Advisory work: guidance, parental counselling, school counselling.
- Psychological assessments: forensic and expert assessments.
- Online sessions and video consultations: treated exactly like in-person sessions.
Every invoice, fee note or receipt must correspond to a submission to Sistema TS. Records must be detailed and filed on time.
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Deadlines and how to submit
The main deadline is the 10th of the month following the service. January sessions, for example, must be submitted by 10 February.
Submissions are cumulative: you can group several invoices into one transmission. The system accepts electronic files from authorised providers.
Each submission must contain the invoice number, date, patient (anonymised identifier), amount and service code. Records must be kept for three years.
How to register on the Sistema TS portal
Go to the Ministry of Health's official Sistema TS portal. Register with your SPID or CIE credentials.
Complete your professional profile: enter the practice details, your registration number with the professional body, and your VAT number. Check every field is correct.
Once activated, you can open the "Invio Dati" section to send your submissions. Keep the submission receipts.
Submitting data with BeebeeDoc
BeebeeDoc submits to Sistema TS automatically. You do not have to enter each service by hand.
Once BeebeeDoc is set up in your practice you can issue invoices directly, see a monthly summary, and submit to Sistema TS automatically before the deadline.
The software also handles online sessions and video consultations, treating them the same as in-person services automatically. You do not have to distinguish between them.
Data is encrypted and compliant with privacy law. You can download reports to check what has been submitted.
Penalties for failing to submit
Penalties are severe: a minimum of 100 euros for each document not submitted, with a minimum total fine of 500 euros.
The maximum penalty reaches 50,000 euros for serious or repeated failures. Agenzia delle Entrate, the Italian Revenue Agency, checks compliance periodically.
Partial omissions — incomplete data — are penalised too. That is why dependable tools like BeebeeDoc matter.
Frequently asked questions for psychologists
Do online sessions have to be sent to Sistema TS?
Yes, without exception. Video consultations and remote sessions must be reported exactly like in-person ones. There is no exemption.
How do I handle fee notes that have not been paid yet?
Sistema TS requires submission once the service has been delivered, regardless of payment. If the patient has not paid yet, you still report it.
If an invoice is cancelled later, you can correct the submission. Document that change carefully.
What if a patient objects to the submission?
A patient's objection does not release you from the obligation. Sistema TS is a legal requirement on the professional, not a choice for the patient.
You do have to tell the patient about the submission to the system. Include that clause in the informed consent form.
Is Sistema TS linked to the pre-filled tax return?
Yes. Sistema TS data feeds the patient's pre-filled Italian tax return. The expenses appear in their income tax declaration.
This lets the patient deduct 19% of what they spent. It works both ways: fiscal transparency for you, tax relief for them.
What does the Ordine degli Psicologi say?
The Ordine degli Psicologi, Italy's professional body for psychologists, states that Sistema TS is mandatory and that its members must comply. There are no exceptions for particular practitioners.
The professional body recommends using certified software such as BeebeeDoc to ensure compliance and reduce administrative errors.
Are FSE 2.0 and Sistema TS connected?
FSE 2.0 — Italy's Electronic Health Record — is the new system for digital clinical records. It complements Sistema TS; it does not replace it.
If you work under agreement with public healthcare organisations, you also have to populate FSE 2.0. BeebeeDoc supports that integration.
A compliance checklist for 2026
- Properly registered with the Ordine degli Psicologi.
- An active VAT number, up to date with Agenzia delle Entrate.
- Registered on the Ministry of Health's Sistema TS portal.
- Invoicing software (such as BeebeeDoc) configured and tested.
- A calendar with the monthly deadlines marked (submission by the 10th).
- An informed consent form that mentions Sistema TS and FSE 2.0.
- Data backups, with invoices archived for three years.
- Monthly review of the submission reports from your software.
In closing: stay compliant and make the work simpler
Sistema TS is not optional: it is a legal obligation for psychologists and psychotherapists. Meeting the deadlines protects you from penalties.
Tools like BeebeeDoc turn this administrative burden into an automatic process. You invoice, the software submits. No stress.
If you are not using it yet, start the free BeebeeDoc trial. Fifteen days to see how much simpler invoicing, Sistema TS and digital signatures become.
Keep up with regulatory changes and choose dependable platforms for your psychology practice.
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