Reimbursement

On April 1, 2025, the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) published its report on the utilization and development of digital health applications (DiGA) covering the period from September 1, 2020, to December 31, 2024. The report presents GKV’s key findings along with recommendations aimed at optimizing the current framework for DiGA reimbursement and regulation.

On April 9, 2025, the Ministry of Labor, Health, Solidarity and Families published the Order setting DRG tariffs and tariffs for other packages and supplements for 2025. New tariffs are applicable from March 1, 2025.

On April 8, 2025, the National Union of Health Insurance Funds issued an update to the Common Classification of Medical Procedures (CCAM), which serves as a reimbursement nomenclature for medical procedures in hospital and ambulatory settings. Changes include the introduction of new procedure codes, provisional registration of several procedure codes, and modification of existing services. Newly introduced procedure codes concern cardiovascular and peripheral vascular procedures, interventional radiology, ENT, and others. The update takes effect on July 1, 2025.

In March 2025, the entity managing the DRG system in Switzerland, SwissDRG, announced that they would be accepting applications for changes in the DRG system from June 2, 2025, until July 14, 2025. The results of the DRG applications made in 2025 will be reflected in the 2027 version of the SwissDRG.

On April 1, 2025, the revised EBM (German Uniform Evaluation Standard) catalog for the second quarter of 2025 came into force. The main changes introduced concern updates of the contents (services legends, preambles of several EBM subchapters) and the introduction of new EBM codes related to follow-up and evaluation of another reimbursable health app and second-opinion consultations.

The French National Authority for Health (HAS) has released new recommendations regarding add-on reimbursement for medical devices and medical aids following the March 2025 meetings of the National Commission for the Evaluation of Medical Devices and Health Technologies (CNEDiMTS). Six favorable opinions were published concerning the registration of new devices or modifying conditions/indications for existing ones in the List of Reimbursable Products and Services (LPPR). The recommendations relate to devices in the fields of cardiovascular, peripheral vascular, endocrine, neuromodulation, and medical aids.

In March 2025, two new versions of the Nomenclature of Medical Biology Procedures (NABM 95 and 96) were released. No new tests were added. The reimbursement tariffs for several existing tests were adjusted, and one test was removed.

On March 6, 2025, NHS England released an annual update of the HRG4+ Local Payment Grouper for 2025/26, to come into effect on April 1, 2025. No new HRGs were added; the total number of HRGs has not changed (2,900).

Between late February 2024 and early March 2025, seven 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, 59 health apps are currently available in the DiGA Directory, and ten health apps were delisted from the Directory.

On February 18, 2025, the Swiss Health Observatory (Obsan) published its 2023 report confirming the ongoing shift from inpatient to outpatient care in Switzerland. The number of procedures required to be performed in outpatient settings to be reimbursed expanded from six in 2019 to 18 in 2023, with outpatient costs two to eight times lower. Despite the shift, overall healthcare costs have risen due to an increase in treatment volumes.

The French National Authority for Health (HAS) has released new recommendations about add-on reimbursement of medical devices and medical aids from the February 2025 meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS). Sixteen favorable opinions were published concerning the registration or modification of registration conditions/extension of indications for the medical devices in the List of Reimbursable Products and Services (LPPR). They relate to cardiovascular and peripheral vascular, neurovascular, endocrinology, interventional radiology, nephrology and urology, orthopedic devices, and medical aids.

The French National Authority for Health (HAS) has released new recommendations about add-on reimbursement of medical devices and medical aids from the January 2025 meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS). Seventeen favorable opinions were published concerning the registration or modification of registration conditions/extension of indications for the medical devices in the List of Reimbursable Products and Services (LPPR). They relate to cardiovascular, endocrine, e-health, interventional radiology, neurology and neurosurgery, orthopedic devices, and medical aids.