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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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Dutch Healthcare Authority published the first release of the DRG package for 2022

03 Dec 2020

On November 3, 2020, the Dutch Healthcare Authority (NZa) published the critical features of the first release of the DRG package for the 2022 (RZ22a). The RZ22a is the policy release for the year 2022 that applies to specialist medical care. The effective date of the release is January 1, 2022.

The following new procedure codes will be implemented in 2022:

  • Mastoid, epitympanum and/or radical cavity obliteration (031824);
  • Placing the septum button at the perforation of the nasal septum (032066) to occlude a perforation of the nasal septum;
  • Surgical removal of large and complicated growth, excluding Mohs surgery (038916);
  • Treatment using a non-invasive respiratory support device (030001) and device for non-invasive respiratory support including accessories (190381);
  • Transperineal ultrasound of prostate (039471)
  • Seven new procedure code for immune effector cell therapy (CAR-T therapy);
  • Three new procedure codes for removal or revision of vaginal mesh (037272), non-vaginal pelvic mesh (037273), and mid-urethral sling (037274) due to complications

Brand name in procedure code Mitraclip (190666) will be replaced by "Device for percutaneous (transcatheter) mitral valve plastic".

The following new DRGs will be introduced:

  • New medical specialty code for Sports Medicine (8416) with the list of diagnoses and new DRG group 990003026;
  • New DRGs for the immune effector cell therapy (CAR-T therapy);
  • New diagnosis code for heart rhythm monitor implantation (2290) within medical specialty "Cardiopulmonary surgery" (0328) and "Pediatrics general" and four new DRGs within DRG group 990516 for placing or removing heart rhythm monitor.

A number of changes will be implemented for transplantation care, including new diagnoses for screening late effects of stem cell transplantation in non-malignant conditions, splitting DRGs for stem cell transplantation for phase 3 (aftercare), change of the DRG structure for aftercare after organ transplantation (excluding heart and lung transplant). Gynecological surgery (uterus removal) will be included in the DRG logic for preventive surgical treatment in cancer gene mutations. By 2022, the seven-day closing rule that is currently applied for chronic dialysis will be used for acute dialysis.

One new supplementary payment for additional costs for the use of a femtosecond laser on request of the patient (per eye) performed in the same session as cataract surgery (199875) will be introduced.

The full details in Dutch 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).

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