A new reimbursement scheme for outpatient pathology services is being gradually introduced in Norway starting in 2022. In this scheme, Pathology Activity Codes (APAT) of the Norwegian Pathology Code system (NORPAT) are used for reimbursement by Helfo (the Norwegian Health Economics Administration, an external agency of the Directorate of Health). Previously, NORPAT was not allocated to reimbursement, and tariffs from the Ministry of Health and Care Services were used for a limited number of pathology procedures.
NORPAT (and APAT) codes are updated annually and published by the Directorate of e-Health.
In the new scheme, Helfo annually publishes the list of reimbursable APAT codes (separately for public and private laboratories). Each code is allocated to a generic reimbursement category. Tariffs for reimbursement categories (separately for public and private laboratories) are published annually by the Ministry of Health and Care Services and on the Directorate of e-Health website.
There are two types of codes in APAT:
- T-codes for sampling materials, which are not allocated to reimbursement categories;
- P-codes (e.g., for the method of sampling, indications, method of testing). Some P-codes (additional) are allocated to reimbursement categories and therefore allow additional payment, while others are not.
There are also so-called “classified sample materials”, the specific combinations of T- and P-codes, which are allocated to the reimbursement categories.
In 2023, five new classified sample materials for cytology were included in the reimbursement scheme and allocated to the reimbursement category PATP1 (meaning that the reimbursement tariff in state laboratories is 112.31 NOK). The example of new codes are presented below:
- T0X000 Blood + P10850 Puncture and drainage;
- T04000 Breast + P31070 Imprint.
A total of 22 new additional P-codes for the method of testing were included in the reimbursement scheme. Some examples of new codes are presented below:
- P33544 Cell extraction and storage of cell-free DNA - allocated to reimbursement category PATA4 (meaning that the reimbursement tariff in state laboratories is 155.19 NOK);
- P34101 cfDNA droplet digital PCR - allocated to reimbursement category PATA7 (meaning that the reimbursement tariff in state laboratories is 816.8 NOK).
- P34104 cfDNA-next-generation sequencing (NGS) >400 genes - allocated to reimbursement category PATA12 (meaning that the reimbursement tariff in state laboratories is 18,209.54 NOK).
Furthermore, in 2023, multiple other changes were made in the scheme (e.g., change of reimbursement categories for existing codes, removing of codes).
See the full details in Norwegian here.
This news is just one of about 300 market access news collected by our team in the subscription services "HTA Alerts" and "Reimbursement Alerts" every two weeks from more than 80 organizations. Access our paid subscription services to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). First EU issues of both newsletters are available for download free-of-charge.
Not ready for a subscription service? Subscribe to our free-of-charge newsletter delivered every second week to get updates about key reimbursement developments in Europe (10-12 news every two weeks).