Procedure coding
Procedure coding for endoscopic gastrointestinal procedures is well established in most European countries. The procedure codes differ for upper and lower gastrointestinal tract procedures, differentiating between diagnostic measures and therapeutic methods. The codes typically indicate the anatomical site of intervention (e.g., esophagus, stomach, etc.) and the intervention performed (e.g., coagulation, lesion destruction, mucosectomy, etc.).
For example, in France, there are specific CCAM codes for the endoscopic treatment of gastrointestinal bleeding: for the upper GI tract – esogastroduodenoscopy with hemostasis of lesion of the esophagus, stomach, and/or duodenum without laser (code HESE002) or with laser (code HESE001); for the lower GI tract – several codes for hemostasis of colonic lesions with or without laser by total colonoscopy (code HHSE003 and code HHSE002) and rectosigmoidoscopy or partial colonoscopy (code HHSE001 and code HHSE004).
New gastrointestinal endoscopic procedures can be a subject for a new procedure coding in country-specific procedural nomenclatures. For example, in Germany, seven new codes for gastrointestinal endoscopic procedures were introduced in 2025 within the German procedural classification (OPS). These include additional specific codes for single-use duodenoscopes (code 5-54a.20) and gastroscopes (code 5-54a.21), as well as codes for simple (code 1-313.10) and long-term (code 1-313.11) high-resolution esophageal manometry.
Payment mechanism
Since diagnostic and therapeutic endoscopic gastrointestinal procedures are usually performed in outpatient specialist and day case settings, the payment model depends on the payment system used in these settings: in England, France, the Netherlands, and countries of the Nordic region, the procedures are reimbursed solely via the diagnosis-related group (DRG) mechanism. In contrast, in Belgium, Germany, Italy, and Switzerland, a fee-for-service model via country-specific catalogs for specialist services is applied.
For example, in Germany, therapeutic colonoscopy with polypectomy is reimbursed via a fee-for-service model using the combination of the following codes from the EBM catalog: 13421 “Additional flat rate for colonoscopy” with a 2025 tariff of €198.29 or code 13422 “Additional flat rate for (partial) colonoscopy” with a 2025 tariff of €121.7, which are used with a code 13423 “Additional service(s) in connection with billing codes 13421 or 13422” with a 2025 tariff of €28.88.
Diagnostic gastrointestinal procedures have become a subject of novel approaches to reimbursement intended to improve patient access to medical care and reduce healthcare costs associated with inpatient care. In England, diagnostic and therapeutic gastrointestinal procedures have become a subject of activities in the Community Diagnostic Centres (CDCs), with reimbursement via HRG. For instance, transoral and transnasal upper gastrointestinal tract diagnostic endoscopic procedures are reimbursed via the same HRG FE22Z “Diagnostic Endoscopic Upper Gastrointestinal Tract Procedures, 19 years and over” with the same tariff £423 for day case, outpatient specialist settings, and CDCs.
In some countries (e.g., France and England), devices used in therapeutic endoscopic GI procedures attract additional reimbursement, which is paid on top of the DRG tariff. For example, in France, Medtronic's BARRX catheters used for endoscopic radiofrequency ablation of Barrett’s esophagus are subject to add-on reimbursement via the List of reimbursable products and devices via brand-specific categories (LPPR codes 5326545, 5357741, 5302734, and 5338933, respectively), with a reimbursement tariff of €1,326.
Policy considerations
Gastrointestinal endoscopy procedures are well-established technologies; they are unlikely to be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist.
Health technology assessment
Due to established reimbursement in European countries, diagnostic and therapeutic gastrointestinal endoscopy technologies have rarely been the subject of HTA in recent years.
New evidence for technologies can lead to the reassessment of technologies. For example, in England, in January 2025, NICE published a positive prioritization decision (of November 2024) regarding the evaluation of endoscopic submucosal dissection for lower gastrointestinal lesions. The Prioritization Board recognized the potential for improved outcomes resulting from the use of technologies for endoscopic submucosal dissection (ESD) of lower gastrointestinal lesions.
Future challenges
Gastrointestinal endoscopy procedures have established reimbursement and funding in most European countries. Novel gastrointestinal endoscopy procedures utilizing innovative devices with unique designs may necessitate the development of procedure codes, establishing reimbursement, funding, and obtaining HTA recommendations.
MTRC has experience with more than 12 projects related to gastrointestinal endoscopy in Europe.
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