Reimbursement

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.

On January 28, 2025, the Federal Ministry of Health (BMG) provided updates on implementing the Hospital reform in Germany.

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices and medical aids from the December 2024 meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS). Three favorable opinions were published concerning the registration of new medical devices in the List of Reimbursable Products and Services (LPPR). They relate to breast reconstruction and medical aids.

On January 1, 2025, the revised EBM (German Uniform Evaluation Standard) catalog for the first quarter of 2025 came into force. The main changes introduced concern updates of the contents (services legends, preambles of several EBM subchapters), the introduction of new EBM codes related to dialysis services, CT coronary angiography, management of long COVID patients, different types of consultations and visits, and material costs flat rates related to shipping services.

On December 19, 2024, the Dutch Healthcare Institute (ZIN) published the updated list of medical procedures reimbursed under basic health insurance with restrictions or limitations. The procedures have the so-called "claim" codes (aanspraakcodes). The Dutch Healthcare Authority assigns the "claim" codes based on positions published by the ZIN. The changes included the introduction of one new procedure code.

On December 19, 2024, the Hybrid DRG reimbursement agreement for 2025 was published. It determines which interventions will be reimbursed via a hybrid DRG mechanism and the associated tariffs. The newly introduced DRGs mainly belong to the endoscopy, gastrointestinal, and men’s health fields.

On December 12, 2024, the entity managing the DRG system in Switzerland, SwissDRG, published the final (billing) version of the 2025 DRG system. In total, 23 new DRGs related to cardiovascular, gastrointestinal, nephrology and urology, neurology and neurosurgery, obstetrics and gynecology, orthopedics, pulmonary and airways, and some other areas were introduced. Also, 17 new add-on reimbursement categories were implemented.