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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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Continuous Passive Motion (CPM) remains covered by statutory health insurance in Germany

15 Aug 2019

Domestic use of motor-driven moving splints (continuous passive motion, CPM) after interventions at the knee or shoulder joint remains covered by statutory health insurance. This has been determined by the G-BA (the Federal Joint Committee).

Motor-driven motion rails are used for passive movement of the knee and shoulder joint after its injury or damage. The described devices are presented in the list of aids of the GKV-Spitzenverband under the number 32 "Therapeutic exercise devices."

The use of the CPM can be carried out within the scope of conservative treatment as well as after surgical interventions. The prerequisite is the presence of a significant functional impairment of a knee or shoulder joint, in which a distinctive improvement in the daily range of motion - despite regular physical therapy measures - can only be achieved by the additional application of a CPM. The application must be integrated into a corresponding treatment concept.

According to the law, the G-BA can examine whether certain contractual medical services should still be financed at the expense of the statutory health insurance (SHI). At the request of the GKV-Spitzenverband, the G-BA had now carried out such an examination for the use of CPM after interventions on knee and shoulder joints. As a result, the G-BA decided on June 20, 2019, that CPM after interventions on the knee and shoulder joint will remain covered by SHI. The CPM splints are correspondingly included in Annex I "Recognized examination or treatment methods" of the Directive on Contract Medical Care.

The Federal Ministry of Health is now examining the decision of the G-BA (in term of up to two months). In case of no objection, the resolution will come into effect the next day after publication in the Federal Gazette.

The full details in German can be found here.

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