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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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Matrix-associated autologous chondrocyte implantation on the knee joint reimbursed in Germany

On February 17, 2022, the Federal Joint Committee (G-BA) has decided to include the method of matrix-associated autologous chondrocyte implantation (M-ACI) on the knee joint in the case of symptomatic cartilage damage in the lists of reimbursed procedures in the hospital and ambulatory settings.

M-ACI will be included in Annex I of the G-BA Directive on ambulatory care methods. Annex I lists all medical examination and treatment methods recognized by the G-BA. These methods are reimbursed at the expense of statutory health insurance. The M-ACI will only be reimbursed in patients with a symptomatic articular cartilage defect of the knee joint of severity III or IV according to the classification of the International Cartilage Repair Society.

Moreover, the G-BA Directive “Methods of examination and treatment in hospital settings” will be updated in the following way:

  • The method of collagen-covered and periosteum-covered autologous chondrocyte implantation on the knee joint will be introduced under the §4 of the Directive, which includes the methods that are excluded from reimbursement within the statutory health insurance;
  • Also, the method of M-ACI on the knee joint will be included in Annex I of the abovementioned Directive. Annex I lists methods that have been assessed by the G-BA were considered as necessary and therefore are reimbursed.

The outlined changes will come into force after the publication of the respective decisions in the Federal Gazette (Bundesanzeiger).

The full details in German can be found here and here.

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