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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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Early detection of cervical cancer: reimbursement set up in Germany

At the start of the organized program for the early detection of cervical cancer on January 1, 2020, several new services will be added to the EBM (Einheitlicher Bewertungsmaβstab, German Uniform Evaluation Standard).

The National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV) agreed on this in the Evaluation Committee. The amount of reimbursement is now also fixed. The new services cover primary screening and diagnostic tests for cervical cancer, which will be carried out from 2020 according to the Guideline for Organized Cancer Screening Programs (oKFE-RL), providing cytological diagnostics for women between 20 and 34 years of age.

Insured women older than 35 will be offered combined test (cytology + HPV test) every three years. From the beginning of 2020, this test can also be carried out by women who were examined in 2019 or 2018 according to the requirements of the previous directive. During the two years between the combined tests, only clinical examination (without cytology + HPV test) will be performed.

According to the decision of the Evaluation Committee, doctors will receive 19.67€ (179 points) for the gynecological examination and swab collection as part of the primary screening from January 2020. Reimbursement will be provided via the fee order item (GOP) 01761. As soon as the documentation for the program is approved with a separate decision, the rating will increase to 23.73€ (216 points).

There are two more new GOPs for examining the smears within primary screening: the GOP 01762 (81 points / 8.90€) for the cytological examination and the GOP 01763 (171 points / 18.79€) for the HPV test. The latter comprises the detection of the high-risk HPV types and, if the results are positive, the genotyping of the particularly carcinogenic types 16 and 18.

For gynecological examinations without smear, which doctors can carry out once a year between the three-year examination interval (according to the cancer screening guidelines and outside the program), the GOP 01760 (159 points / 17.47€) will be provided in the EBM. The previous GOP 01730 for cancer screening in women will no longer be available.

To clarify conspicuous findings from the primary screening, GOP 01764 (67 points / 7.36€), for clarification diagnostics with smear sampling, will be included in the EBM catalog. The collection materials will be provided to the gynecological practice by the cytological laboratory.

Clarification colposcopy, according to GOP 01765, may only be carried out by gynecologists with the appropriate qualifications and a billing approval. The examination will be reimbursed with 72.30€ (658 points). As soon as the documentation for the program is approved, the evaluations of the GOP 01764 and 01765 will also be adjusted.

In connection with the assessment diagnostics, GOP 01766 (288 points / 31.64€) will be used for the cytological examination, GOP 01767 (171 points / 18.79€) for the HPV test and GOP 01768 (248 points / 27.25€) for the histological examination will be included in the EBM.

All services for the early detection of cervical cancer and the clarification of abnormal findings will be reimbursed extrabudgetary.

The revised program for the early detection of cervical cancer is already the second program after colon cancer screening, which has been further developed into an organized screening based on cancer screening and registration law.

The health insurance companies will send invitations to eligible women from January 1st, 2020. These will only be used to remind of the examination. The invitation will not be required for the examination itself.

The full details in German can be found here.

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