Changes in the reimbursement of outpatient surgeries in 2023 in Germany

In late December 2022, the National Association of Statutory Health Insurance Physicians (KBV) published a detailed overview of the changes in the reimbursement of outpatient surgeries to be introduced in Germany in 2023, which are aimed at expanding the utilization of these procedures by physicians.

Since January 1, 2023, the catalog for ambulatory operations in hospitals (AOP catalog) will be significantly expanded. More specifically, 208 interventional procedures will be included in the catalog.

In addition, as a part of the previously announced further development of the German Uniform Evaluation Standard (EBM) catalog, since January 1, 2023, additional funding of €60 million will be available to promote outpatient (day case) surgical services; so that the reimbursement of the affected procedures will increase by 16% up to 42%. Also, 196 OPS (procedure) codes will be included in Annex 2 of the EBM catalog, mainly for neuromodulation, rhythm surgery, as well as arthroscopic interventions, providing the possibility to perform these procedures on an outpatient (day case) basis.

Moreover, the AOP contract, which regulates the performing of hospital day surgery, was updated for the first time since 2014, when the initial version of the contract was published. The most significant changes include the following:

• The introduction of surcharges for the reoperations depending on the severity degree;
• The amendment of the conditions of the material costs reimbursement for selected groups of materials (implants, suturing material, diagnostic and interventional catheters, etc.). These will be reimbursed as pass-through costs when the price per item exceeds €6.25 (previously – €12.50);
• The introduction of the obligation for hospitals to justify if they carry out services under the AOP contract on an inpatient basis. For this purpose, so-called context factors were developed - a list of indications and other criteria to justify the necessity of inpatient treatment.

Also, it is planned to develop a system assessing the severity of outpatient (day case) interventional procedures by the end of 2023. In addition to intervention-related factors, patient-related factors that can affect the severity of an operation should also be considered.

The full details in German can be found here and here.

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