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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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KBV, GKV, and DKG agreed on the further extension of the Hybrid DRGs catalog in 2025 in Germany

On March 28, 2024, it was announced that the National Association of Statutory Health Insurance Physicians (KBV), the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), and the German Hospital Federation (DKG) agreed to extend the Hybrid DRGs catalog with about 100 more procedures to be reimbursed via the Hybrid DRGs mechanism starting in 2025.

The procedures planned to be covered in the catalog include interventions on the clavicle, surgical treatment of anal fistulas, some breast-conserving operations, interventions on the testicles and epididymis, as well as endoscopic examinations or interventions on the pancreas, liver, and gallbladder. Also, further OPS codes for hernia surgery and pilonidal sinus surgery (already included in the catalog) will be introduced.

The tariffs for the respective Hybrid DRGs have yet to be determined; they are planned to be agreed upon jointly by the Evaluation Committee and the Institute for the Hospital Remuneration System (InEK) by September 30, 2024 (the latest - by December 31, 2024).

From now on, KBV, GKV, and DKG are obliged to review the Hybrid DRGs catalog every 2 years and update it if necessary.

The full details in German can be found here.

This news is just one of about 300 market access news collected by our team in the premium subscription service Market Access Monitor every week from more than 80 organizations. Access our paid service to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). Access is organized as an online Database and email alert formats. Contact us to get a free, three-month, no-obligation trial.