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Evidence gap analysis

Strategic analysis of the sufficiency of evidence to obtain reimbursement and HTA approval in Europe and recommendations about evidence generation

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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 procedure and diagnostic codes added to the private reimbursement schedule in England

On April 15, 2024, the Clinical Coding and Schedule Development (CCSD) working group, which develops and maintains procedural and diagnostics nomenclatures for private payers in England, published Bulletins 195 and 091 with changes to be implemented no later than June 12, 2024.

Ninety new procedure codes and five new diagnostic codes were implemented in ENT, gastrointestinal, in-vitro diagnostics, nephrology and urology, neurology and neurosurgery, pulmonary and airways, orthopedics, robotic surgery, men's health, and general surgery fields. Some examples of newly added procedure codes are provided below:

  • F4307 Transoral robotic assisted vertical supra-glottic laryngectomy (as sole procedure);
  • E1921 Robotic assisted partial pharyngectomy;
  • E2331 Robotic assisted removal of lesion of para-pharyngeal space;
  • F3441 Robotic assisted tonsillectomy (and bilateral);
  • M6193 Robotic assisted radical prostatectomy using bilateral nerve-sparing technique, reconstruction of bladder neck including bilateral pelvic lymphadenectomy (including cystoscopy);
  • M6194 Robotic assisted radical prostatectomy through the rectovesical pouch, using a bilateral nerve- and ligamentsparing technique, reconstruction of bladder neck, including bilateral pelvic lymphadenectomy (including cystoscopy);
  • 0593B Plasma Guanidinoacetate (GUAP);
  • 3029G 72-Gene Multicancer Panel;
  • 0594B Aldosterone: Renin Ratio (ARR);
  • 0050G Pheochromocytoma and paraganglioma (NGS of 17 genes);
  • 0051G Urine Guanidinoacetate - (GUAN).

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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.