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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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New CCAM codes introduced in France

In the middle of July 2024, the new version of the classification of procedure codes (CCAM v.76) was published. Several changes were introduced, including the creation of 14 new codes and changes in subdivision. 

Under sub-chapter 04.01.07, "Scintigraphy of the circulatory system," the following codes were registered (examples):

  • DAQL479 "Positron emission tomoscintigraphy of myocardial perfusion with the pharmacological test, with quantitative analysis of myocardial perfusion rate" with a CCAM fee of €76.11;
  • DAQL743 " Positron emission tomoscintigraphy of myocardial perfusion at rest and with pharmacological testing, without quantitative analysis of the myocardial flow reserve" with a CCAM fee of €89.54;
  • DAQL213 Positron emission tomoscintigraphy of myocardial perfusion at rest and with pharmacological test, with quantitative analysis of the myocardial flow reserve" with a CCAM fee of €111.93.

Under sub-chapter 08.03.01.01, "Destruction of the prostate lesion, the new code JGFE631 "Resection of a benign prostatic hypertrophy by pulsed water jet, with robotic ultrasound programming with urethrocystoscopy guidance" with a CCAM fee of € 294.94 was registered.

The sub-chapter 01.05.01.06 was changed to "Therapeutic procedures on the hypoglossal nerve". Under this sub-chapter, the following new codes were registered (examples):

  • ADLA187 "Implantation of a hypoglossal nerve stimulation system" with a CCAM fee of €367.97;
  • ADGA724 "Removal of a hypoglossal nerve stimulation system" with a CCAM fee of €248.15;
  • ADGA144 "Removal or replacement of a respiratory detection electrode of a hypoglossal nerve stimulation system" with a CCAM fee of €106.35.

Under sub-chapter 04.03.01.02, "Intraluminal dilation and insertion of a thoracic aortic prosthesis," the following new codes were registered: 

  • DGLF332 "Insertion of a fenestrated or multi-branch endoprosthesis in the ascending thoracic aorta and the horizontal aorta by transcutaneous arterial route" with a CCAM fee of €2,144.02;
  • DGLF756 "Insertion of a fenestrated or multi-branch endoprosthesis in the distal part of the horizontal thoracic aorta by transcutaneous arterial route" with a CCAM fee of €471.49.

See the details in French 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.