New procedure and IVD test reimbursement codes in Belgian Nomenclature to come into effect from August 1st of 2017

The Nomenclature of health benefits includes the benefits (with specific hospital and ambulatory codes) reimbursed by health care insurance, partially or totally. The Nomenclature and changes were published in the Belgian Official Gazette on July 14, 2017.

The changes of the following articles of the Nomenclature will come into force since August 1, 2017:

• Article 3 “Medical technical benefits”
• Article 14 (l) “Stomatology”
• Article 15 “Implementing rules for surgical services”
• Article 17 “Medical imaging: X-ray diagnostics”
• Article 17bis “Medical imaging: ultrasound”
• Article 18 “Radiotherapy and Nuclear Medicine”
• Article 19 “Radiotherapy and Nuclear Medicine: implementing rules”
• Article 24 “Clinical biology”
• Article 24bis “Clinical biology”
• Article 26 “Additional fees for urgent technical services performed overnight or on weekends or on public holidays”
• Article 33bis “Genetic testing”

Key changes in the Stomatology article

The following new cods has been introduced:

• Preparation and placement of a stabilization splint or repositioning splint of hard synthetic resin, which completely covers one of the two jaws and is in contact with all the elements of the antagonist jaw, within the framework of the pain and dysfunction of the maxillary system, 15 years and older (312491-312502).

There are the following conditions of reimbursement for the service 312491-312502:

• The intervention is reimbursed only in case of morning pain and persistent dysfunction, and only after a phase of motivation and local treatment;
• Service 312491-312502 includes impression making, determination of the occlusion ratio, manufacture of the hard synthetic resin overlay plate, placement, polishing and adjustment corrections, occlusion and follow-up to 30 days after placement;
• Service 312491-312502 can only be delivered once per period covering five calendar years.

Key changes in the article for Medical Imaging (X-ray diagnostics)

The following new codes have been implemented:

• Cone Beam CT without contrast of upper jaw and / or lower jaw (459933-459944)
• Cone Beam CT without contrast (459955-459966)

Cone Beam CT without contrast of upper jaw and / or lower jaw is reimbursed for the following indications:

• during the preoperative planning in case of autotransplantation and placement of dental implants (codes 308512-308523, 308534-308545);
• during a congenital dental abnormality;
• presumptions and / or follow-up of dentoalveolar trauma within the framework of interventions as they are described in service 312756-312760;
• where there is a presumption of an interrelation between the mandibular joint and a wisdom tooth for extraction of wisdom tooth;
• in case of a problem of eruption with implication of definitive, supernumerary or additional elements;
• in the case of bone-related jaw joint problems;
• in the case of diagnosis and / or therapeutic approach to tumors and benign jaw bone cysts;
• during preparation to the refillable maxillofacial surgery.

The indication for CBCT examination should be assigned in the medical record and available to the medical officer. The service is reimbursed only at the prescription of certified specialist in stomatology, pediatric specialist, specialist in emergency medicine, specialist in acute medicine, physician with the acute medicine certificate and dental practitioner with a specific professional title.

The following conditions of reimbursement have been added for the Cone Beam CT without contrast:

• the service is reimbursed only at the prescription of the specialist in otorhinolaryngology, neurosurgery specialist, neurology specialist, pediatric specialist, emergency medicine specialist, acute medicine specialist and physician holding the patent for acute medicine;
• a computer-aided tomography (CT) delivery cannot be certified as a computer-aided beam tomography (CBCT) and be reversed.

Key changes in the article for Medical Imaging (Ultrasound)

New reimbursement value of value of €94,19 has been implemented for the following services:

• Complete transthoracic ultrasound scan of the heart, comprising the acquisition of two-dimensional images in at least three different cutting planes and color and spectral mode Doppler signals at least three valvular orifices. The recording and archiving of the examination on magnetic tape or digital support and the detailed protocol are required (460456- 460460);
• Repetition in the calendar year of the benefit 460456 - 460460 or 469814 - 469825 for any of the indications given below (461215-461226).

Key changes in the article for Radiotherapy and Nuclear Medicine

New codes have been implemented for CT of location performed during the performance of codes 444356-444360 (1st simulation) and / or performance 444371-444382 (2nd simulation).

Reimbursement values for the following services have been updated:

• Lump-sum fees for exclusive brachytherapy in a patient who meets the criteria or pathology included in category 8 (444253-444264);
• Lump sum fees for preparations with simulation of external irradiation or brachytherapy treatment, by irradiation series for a category 1, 2, 3, 4, 5, 6, 7 or 8, the first simulation, except category 8 patients with treatment for prostate cancer by permanent implantation of radioactive iodine grains (444356-444360);
• Lump sum fees for preparations with simulation of external irradiation or brachytherapy treatment, by irradiation series for a category 2, 3, 4, 5, 6 or 8, second simulation (444371-444382).

Key changes in the articles for Clinical biology

New codes for the following IVD-tests have been implemented:

• Microscopic search for Acid-Resistant Bacilli in a Clinical Sample (549592-549603);
• Determination of the sensitivity of Mycobacterium tuberculosis complex to the 3 first-line antibiotics: Isoniazid, Rifampicin, Ethambutol (549614-549625);
• Determination of the sensitivity of Mycobacterium tuberculosis complex to Pyrazinamide (549636-549640);
• Complex mycobacterium tuberculosis nucleic acid search in clinical samples (556872-556883).

Reimbursement values for the following IVD tests have been updated:

• Identification of Mycobacterium tuberculosis (550476-550480);
• Identification of mycobacteria other than Mycobacterium Tuberculosis (550491-550502).

The following conditions of reimbursement have been implemented for complex mycobacterium tuberculosis nucleic acid search in clinical samples:

• direct examination shows the presence of acid-alcohol bacilli resistance;
• or if there is a strong clinical and radiological suspicion of tuberculosis;
• or if the respiratory specimen was taken by an invasive technique (bronchoscopy, puncture, biopsy).

Key changes in the articles for Genetic testing

New codes have been implemented for the screening for EGFR mutation (589831-589842).

Reimbursement values for the following tests have been updated:

• Screening of an amplification of the HER2 gene using a hybridization technique in situ in the context of the therapeutic choice for breast carcinoma (588556-588560);
• Investigation of the mutation of Leiden-like factor V by molecular biology technique (587016-587020);
• Investigation of the mutation of factor II (G20210A) by a molecular biology technique (587031-587042).

The following rules of application have been implemented:

• Service 588556-588560 can only be considered in the context of the therapeutic choice for mammary carcinoma or for gastric carcinoma;

Service 589831-589842 can only be considered in the context of the therapeutic choice for non-small cell and non-squamous pulmonary carcinoma.

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