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Cost-efficient European adaptations of global health economic models

Experience with model adaptations in Austria, Belgium, France, Germany, Italy, Norway, Netherlands, Spain, Sweden, the UK

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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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The 2024 DRG model announced in Austria

On July 3, 2023, the document "Changes and innovations in the 2024 LKF model" (Änderungen und Neuerungen in den LKF-Modellen 2024) was published. The document summarizes the most significant changes and innovations in the LKF model for inpatient and outpatient care. The newly added procedure codes mainly concern endoscopic procedures, orthopedics, peripheral vascular, and pulmonary and airways fields.

For 2024, the main changes will include the addition of 28 new procedure codes, the introduction of two procedure codes for billing in the day-case settings, the addition of three new DRGs, update of cases flat rates, adjustments of the cases daily component calculation and re-evaluation of the length of stay indicators. No new provisional codes (NUB) will be introduced. The 2024 model will enter into force on January 1, 2024. Some examples of the introduced procedure codes are listed below:

  • AA180 Transcranial tissue ablation using magnetic resonance-guided high-intensity focused ultrasound application (LE=per session);
  • ED032 Percutaneous transluminal recanalization with implantation of a stent graft – visceral vessels (LE=per session);
  • ED062 Percutaneous transluminal recanalization with implantation of a stent graft – iliac arteries (LE=per side);
  • EF042 Percutaneous transluminal recanalization with implantation of a stent graft - lower extremity (LE=per side);
  • GE012 Bronchoscopy – diagnostic with endobronchial ultrasound (EBUS) (LE=per session);
  • MZ515 Fixation forearm, finger (LE=per application/prosthesis/stent);
  • PZ555 Reduction/work on a fixation (LE=per application/prosthesis/stent).

The newly introduced DRGs are provided below:

  • APG12.55 Special tissue markings;
  • MEL01.20 Transcranial interventions;
  • MEL22.31 Locoregional hyperthermia.

The full details in German can be found 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). Contact us to get a free, three-month, no-obligation trial.