Health Ticket Exemptions for Chronic Illness, Pregnancy, and Disability in Rome
Diabetes, cancer, a rare disease, disability, or pregnancy? If you have a confirmed diagnosis, many specialist visits and tests may be free. A guide to exemption codes and how to apply at your local ASL.
In a nutshell
If you have a chronic illness, cancer, a rare disease, a recognised civil disability, or are pregnant, you may not have to pay the co-payment (called the ticket) for medical visits and tests related to your condition. The exemption is free, is issued by the district office of your ASL (Azienda Sanitaria Locale — your local public-health authority), and in most cases is ready the same day. You need a certificate from a specialist working within the SSN (Servizio Sanitario Nazionale — Italy's national health service).
At a glance
| Cost | Always free |
| Timeline | Same day for chronic conditions and pregnancy; 5–15 days for rare diseases |
| Where in Rome | Health district of your residential ASL; Regional Reference Centres for rare diseases |
| Documents needed | Photo ID, Tessera Sanitaria (Italian health-insurance card), SSN specialist certificate, ASL exemption form |
What it covers — and what it doesn't
A condition-based exemption covers only treatments linked to your specific diagnosis: the visits, tests, and medicines needed to manage or monitor that particular condition. For everything else you continue to pay the standard ticket, unless you also hold an income-based exemption (codes E01–E04).
This is the key difference from income-based exemptions, which cover all specialist care regardless of reason. Condition-based exemptions are more targeted but have no income limit: they apply to anyone with the relevant diagnosis, regardless of wealth.
The five types of exemption
Chronic and disabling diseases (three-digit codes)
Ministerial decree DM 329/1999, updated by DPCM 12/01/2017, lists 64 chronic conditions that carry an exemption right. Each condition has a three-digit numeric code. Some of the most common:
| Code | Condition |
|---|---|
| 013 | Diabetes mellitus |
| 019 | Epilepsy |
| 021 | Hypothyroidism |
| 024 | Chronic kidney failure |
| 031 | Arterial hypertension (stages II and III) |
| 052 | Asthma |
| 056 | Multiple sclerosis |
The full list is available on the Ministry of Health portal, annex 8 of DPCM 12/01/2017.
Cancer — code 048
If you have a diagnosis of malignant neoplasm — whether in active treatment or in follow-up — you are entitled to code 048. It covers oncology visits, chemotherapy, radiotherapy, hormone therapy, related medicines, and all monitoring and relapse-prevention appointments. Validity is permanent: it never needs renewing.
Rare diseases — RR codes
DM 279/2001 and the 2017 DPCM recognise around 600 rare diseases with codes in the format RR0010. To obtain this exemption, your GP alone is not enough: you need certification from a Regional Reference Centre specialised in your condition. Once granted, close family members may also be exempt for genetic diagnostic testing. Validity is permanent.
Civil disability — codes 01–09
People with a civil-disability recognition issued by the INPS (Italy's social-security agency — pensions, unemployment, family benefits) medical commission are entitled to an exemption using a code between 01 and 09, depending on the category. Code 04 applies to people with 100% civil disability without a carer's allowance, or with a disability above 67%; code 05 applies to those with 100% disability and a carer's allowance; code 06 covers total blindness and pre-lingual deafness. To obtain these codes, bring your INPS assessment report to the ASL desk.
Pregnancy — codes M00–M50
If you are pregnant, you are entitled to an exemption for the full obstetric pathway set out by DM 10/09/1998: gynaecological visits, three trimester ultrasounds, blood and urine tests, prenatal screening (bi-test, tri-test, NIPT where included in the essential care package, amniocentesis or chorionic villus sampling when clinically indicated), and antenatal classes.
The codes change depending on the stage:
| Code | When |
|---|---|
| M00 | Pre-conception (tests for those trying to conceive) |
| M10 | First trimester (weeks 1–13) |
| M20 | Second trimester (weeks 14–26) |
| M30 | Third trimester (weeks 27–40) |
| M40 | High-risk pregnancy (on specialist prescription) |
| M50 | Post-partum and tests after miscarriage |
The exemption is valid until 6 weeks after delivery.
How to apply
For a chronic condition (e.g. diabetes, hypertension, asthma):
- See a hospital or SSN specialist, who issues a certificate with your condition code.
- Take the certificate to the ASL district office with your photo ID and Tessera Sanitaria.
- Fill in the request form at the counter.
- Receive your exemption card the same day.
For cancer (code 048):
- Have your histological report or discharge letter showing a diagnosis of malignant neoplasm.
- Go to the ASL district office with the report and your Tessera Sanitaria.
- Receive your card the same day; validity is permanent.
For a rare disease:
- Your doctor refers you to a Regional Reference Centre specialised in your condition.
- The Centre makes the diagnosis and issues a certificate with the RR code.
- The certificate is entered in the Regional Rare Diseases Register.
- Go to the ASL district office with the certificate: you will receive your card within 5–15 days.
For disability:
- Apply for civil disability through INPS (online with SPID (Italy's digital identity for accessing online public services) or through a Patronato (free union-run office helping with social-security and immigration paperwork)).
- Attend the INPS–USL medical commission and wait for the assessment report.
- If the report recognises disability above 67%, go to the ASL district office with the report and receive your card.
For pregnancy:
- See an SSN gynaecologist, your GP, or visit a consultorio familiare (public family health clinic).
- They issue a pregnancy certificate with the estimated due date.
- Go to the ASL district office (or the consultorio): you receive an M card with the progressive trimester codes. In many Rome ASL offices, your GP can add the M code directly to the electronic prescription so you don't need to visit the desk at all.
Where to go in Rome
To collect your exemption card, go to the health district of your residential ASL (see ASL Roma 1–3 addresses in the income-based exemption guide).
For rare diseases, the main Regional Reference Centres in Lazio are:
- IRCCS Bambino Gesù — paediatric rare diseases · Piazza S. Onofrio 4, 00165 Roma · 06 68591
- Policlinico Umberto I — Sapienza — adult rare diseases · Viale del Policlinico 155, 00161 Roma · 06 49971
- Policlinico Tor Vergata — rare haematological and metabolic conditions · Viale Oxford 81, 00133 Roma · 06 20901
- IRCCS Spallanzani — rare infectious diseases · Via Portuense 292, 00149 Roma · 06 55171
- Ospedale S. Andrea — rare neurological conditions · Via di Grottarossa 1035, 00189 Roma · 06 33771
- IFO (Regina Elena + S. Gallicano) — oncological and dermatological conditions · Via Elio Chianesi 53, 00144 Roma · 06 52661
To find your local consultorio familiare, search on salutelazio.it under "Consultori familiari", or contact your ASL's URP (public-relations office).
Mistakes to avoid
- Don't use the exemption for treatments unrelated to your diagnosis. The code only covers care linked to your specific condition. Using it for anything else is fraud against the SSN and is a criminal offence.
- The certificate must come from an SSN specialist. A certificate from a private doctor is not enough to obtain the exemption card.
- Don't use a relative's exemption card. The exemption is strictly personal. Presenting someone else's card is a criminal offence.
- If your disability assessment is reviewed, update your exemption. A change in your disability percentage could mean losing the right to it or switching codes — go back to the ASL with the new report.
- The M exemption expires after delivery. Six weeks post-partum, you return to the normal ticket regime. For newborn care, code E01 (children under 6) may apply if the family income falls within the threshold.
Special cases
You have more than one condition? You are entitled to more than one exemption card. The specialist applies the appropriate code on each prescription depending on what is being requested.
Your disease is not in the DM 329/1999 list? Check whether it qualifies as a rare disease, or consider applying to INPS for civil disability recognition if the condition is severe.
High-risk pregnancy? Code M40 also covers non-strictly obstetric care during the risk period (gestational diabetes, hypertension, placenta praevia, twin pregnancy). It must be prescribed by an obstetric specialist.
You had a miscarriage or a voluntary termination of pregnancy (IVG)? You are entitled to the M50 exemption for post-abortion tests. IVG (voluntary termination) carried out in public facilities is always free of charge (Legge 194/1978).
You are an undocumented pregnant woman? With an STP card (Straniero Temporaneamente Presente — temporary-presence card for undocumented migrants), you pay no ticket for urgent and essential care. For pregnancy, maternity protection, IVG, and vaccinations you have full and free entitlement with no reporting to the authorities (DLgs 286/1998 art. 35).
You hold both a condition-based exemption and an income-based exemption? They stack. The Sistema Tessera Sanitaria automatically chooses the most favourable one for each individual service.
Official sources
- Salute Lazio — Ticket and exemptions
- Ministry of Health — Chronic condition exemptions
- Ministry of Health — Rare disease exemptions
- Ministry of Health — General exemption list
- Rete Malattie Rare Lazio
- IRCCS Bambino Gesù
- Policlinico Umberto I
- IFO Regina Elena – San Gallicano
- INPS — Civil disability
- Lazio Region — Health
Legal references: DM 28/05/1999 n. 329; DM 18/05/2001 n. 279; DPCM 12/01/2017 annexes 7–8; DM 10/09/1998; Legge 388/2000 art. 85; Legge 118/1971; DLgs 286/1998 art. 35; Legge 194/1978; DGR Lazio 257/2007; DCA Lazio U00079/2014.