Reimbursement

On October 18, 2025, the Decision of the National Union of Health Insurance Funds (UNCAM) on the update of the list of procedures and services covered by the Health Insurance, including the CCAM Classification, was published. The updates do not include new codes and concern adjustments of tariffs and billing rules for conventional radiology procedures. The Decision also implements the update of technical packages for CT scanners, MRIs, and PET scans set by the Medical Convention.

On October 8, 2025, the Federal Cabinet approved the draft of a law to adapt the hospital reform. The fundamental objectives of hospital reform remain preserved. Nevertheless, to ensure comprehensive healthcare coverage, additional exemptions and opportunities for cooperation will be introduced for hospitals, allowing the federal states greater flexibility in hospital planning.

The updated German Uniform Evaluation Standard (EBM) catalog came into force on October 1, 2025. The EBM catalog regulates the reimbursement of services in the public outpatient sector in Germany and is updated once a quarter (four times a year). Among other changes, a new code for the “ProHerz” health app was introduced.

The French National Authority for Health (HAS) released new recommendations on the registration of medical devices and medical aids in the List of Reimbursable Products and Services (LPPR) following the September 2025 meetings of the National Commission for the Evaluation of Medical Devices and Health Technologies (CNEDiMTS). Four favourable opinions were issued concerning add-on reimbursement for medical devices in the cardiovascular, peripheral vascular, interventional radiology, and spine fields.

On September 17, 2025, the National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) announced that they had reached an agreement in financing negotiations concerning outpatient care.

On September 10, 2025, the French National Authority for Health (HAS) published its evaluation principles for the reimbursement of digital medical devices via the list of medical telemonitoring activities (LATM) and advanced reimbursement for therapeutic and telemonitoring digital medical devices (PECAN). The HAS has also updated evaluation principles for reimbursement of medical devices for individual use via the List of Reimbursable Products and Services (LPPR), Intra-DRG (Intra-GHS) List, and transitional support (PECT).

In August 2025, the Dutch Healthcare Institute (ZIN) published the report called “Assessment Framework for Feasibility of Care”. It explains how ZIN determines and assesses the feasibility of interventions when deciding on coverage within the basic health insurance.

The French National Authority for Health (HAS) released new recommendations on the registration of medical devices and medical aids in the List of Reimbursable Products and Services (LPPR) following the August 2025 meetings of the National Commission for the Evaluation of Medical Devices and Health Technologies (CNEDiMTS). Four favourable opinions were issued concerning add-on reimbursement for medical devices in the cardiovascular, ENT, and neuromodulation fields.

Between early March 2025 and late August 2025, three more health apps were introduced in the Directory of digital health applications (DiGAs) at the Federal Office for Drugs and Medical Devices (BfArM) and thus became reimbursable. These apps can be prescribed by physicians and psychotherapists and will be reimbursed by health insurers. In total, 58 health apps are currently available in the DiGA Directory, and fourteen health apps were delisted from the Directory.

On July 29, 2025, the French National Authority for Health (HAS) issued positive opinions on including targeted next-generation sequencing-based panels in certain clinical indications for patients with aminoacidopathy and acute leukaemia in the NABM Nomenclature for regular reimbursement. Currently, these tests are temporarily reimbursed within the innovative payment scheme (RIHN). These HAS assessments are performed by HAS as a part of the RIHN reform and ‘cleaning up’ the List of temporary covered tests.

The French National Authority for Health (HAS) released new recommendations on the registration of medical devices and medical aids in the List of Reimbursable Products and Services (LPPR) following the July 2025 meetings of the National Commission for the Evaluation of Medical Devices and Health Technologies (CNEDiMTS). Four favourable opinions were issued concerning add-on reimbursement for medical devices in the orthopedics and ENT fields.

In July 2025, the Dutch Healthcare Institute (ZIN) announced a new policy framework “Reimbursement within Research” (Vergoeding in Onderzoek), which allows temporary reimbursement under basic health insurance during the evaluation period for specialist medical care and medical devices with limited evidence of effectiveness. ZIN is currently reviewing the framework to provide advice on implementation. The launch of the new framework is expected in November 2025.