Procedure coding
Typically, procedure coding is well-established for the ablation of heart tissue in European countries.
In many countries, there are multiple procedure codes for the ablation of heart tissue, which differ depending on the type of energy used (radiofrequency, cryoablation, etc.), anatomical site of intervention (right atrium, pulmonary vein isolation, etc.), the type of approach (open, thoracoscopic or percutaneous endovascular) or access to the site of intervention for percutaneous ablation (transvenous, transseptal, etc.).
For example, in Austria, procedure codes for percutaneous cardiac ablation include code DE060 “Catheter ablation of the cardiac conduction system in the pulmonary vein” and code DE050 “Catheter ablation of the cardiac conduction system”.
Payment mechanism
The payment model for ablation of heart tissue is DRG in most European countries.
In some countries, the DRG allocation depends on the anatomical site (e.g., Germany, the Netherlands or Switzerland). In other countries, the type of energy used impacts the DRG allocation. For example, in Switzerland percutaneous cryoablation of heart tissue is reimbursed via DRG F50B “Ablative measures for tachyarrhythmia with complex surgery, age > 15 years” with higher tariff of €12,990 compared to radiofrequency ablation, which is allocated to the DRG F50C “Ablative measures for tachyarrhythmia with certain ablation, age> 15 years” with a tariff of €10,956.
In most European countries, the devices for cardiac ablation do not attract additional (top-up) reimbursement, which is paid in addition to the DRG tariff. One of the exceptions is England, where radiofrequency, cryotherapy, and microwave ablation probes and catheters are included in the High Cost Devices List and reimbursed in addition to the HRG tariff.
Policy considerations
Due to the high prevalence of cardiac arrhythmias, ablation of heart tissue can be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist.
For example, in December 2022, NHS England, a national payer, published a Clinical Commissioning Policy on catheter ablation for adult patients with paroxysmal and persistent atrial fibrillation. NHS England will routinely commission catheter ablation as a treatment option for paroxysmal and persistent atrial fibrillation within the criteria set out in the policy.
Health technology assessment
Due to established reimbursement in European countries, devices for ablation of heart tissue rarely become a subject of HTA. However, there can be exceptions related to novel types of ablative technologies. For example, in England, NICE is awaiting the development of the HTA for pulsed-field ablation in atrial fibrillation.
Future challenges
Ablation of heart tissue using standard techniques and energy sources has established reimbursement and funding in most European countries. New health technology assessments are unlikely to be relevant. It is unlikely to benefit from the innovative payment schemes.
Novel devices for cardiac ablation with unique designs or alternative energy sources might need to develop specific procedure codes and adjust payment mechanisms to leverage their unique technology or cost profile fully.
How can MTRC help?
Development of reimbursement analysis (procedure coding, payment mechanism, reimbursement tariffs, and policy considerations)
Development of reimbursement strategy
Development of the value dossier
Performing evidence gap analysis for novel technologies
Development of reimbursement and HTA submission dossiers
Adaptation of the global health economic model to EU settings
MTRC has experience with more than 6 projects related to the ablation of heart tissue in Europe
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