The Dutch Healthcare Authority will implement new cardiac surgery DRGs and supplementary payments for remote monitoring in cardiovascular diseases in 2023

Neuromonitoring is increasingly used during carotid endarterectomy and aortic surgery for extensive aneurysms to identify life-threatening complications. On April 28, 2022, the NZa published the first release of the DRG package for 2023 (RZ23a). By 2023, nine new DRGs for carotid endarterectomy and aortic surgery for extensive aneurysms will split into DRGs with and without neuromonitoring.

The DRGs 979001259 “Open surgery on the major body artery – in the chest or abdominal cavity with monitoring of nervous system function in heart/lung disease” and 979001260 “Open surgery on the major body artery – in the chest or abdominal cavity in heart disease/lung disease” belong to the regulated segment of the DRG system with the tariffs of €52,492 and €42,395, respectively, determined by the NZa at the national level. Other seven DRGs have a tariff negotiated locally between providers and insurers.

In the Netherlands, medical procedures within medical specialist care can be reimbursed via DRG or via supplementary payments called "Other care products" (Overige zorgproducten, OZPs). The codes of the list of procedure codes (Zorgactiviteiten) within the DRG package are used for coding and billing these supplementary payments.

In 2019, a new type of OZP was established – the “optional service” (facultatieve prestatie). Optional service is a way for providers and insurers to innovate on the payment model for care, including creation of new payment categories or the replacement of existing payment categories. “Optional service” model is only applicable to well-established care, which is currently provided as part of the Basic Health Insurance. Innovations without proven benefits cannot utilize the “optional service” pathway.

On April 28, 2022, the NZa published the first release of the DRG package for 2023 (RZ23a), which includes four new “optional services” for remote monitoring of patients with cardiovascular diseases and one new “optional service” for remote heart rhythm measurement and assessment in atrial fibrillation:

• 198505 “Optional service – remote monitoring in cardiac arrhythmias”;
• 198506 “Optional service – remote monitoring in hypertension”;
• 198507 “Optional service – remote monitoring in heart failure”;
• 198510 “Optional service – remote monitoring for chest pain”;
• 198704 “Optional service – Telecheck for atrial fibrillation with remote heart rate measurement and assessment by cardiologist”.

The services have tariffs negotiated locally between providers and insurers.

The effective date of the release is January 1, 2023.

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).

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).