Reimbursement

On December 17, 2022, the Ministry of Health and Prevention published an Order in the Official Journal of the French Republic on the transitional coverage for the renal denervation catheter SYMPLICITY SPYRAL.

In December 2022, the Clinical Coding and Schedule Development (CCSD) working group, which develops and maintains procedural and diagnostics nomenclatures for private payers in England, published Bulletin 187 with changes to be implemented in procedural classification no later than February 8, 2023. Five new procedure codes were introduced concerning orthopedic, surgical procedures, and men’s health. No changes were made to the diagnostic schedule.

On December 19, 2022, NHS Digital released HRG4+ Consultation Grouper for 2023/24 to support NHS England’s consultation process for the 2023/25 NHS Payment Scheme. There are no new HRGs or other significant changes in the 2023/24 Consultation Grouper. Local Payment Grouper will supersede Consultation Grouper in March 2023 for use from April 1, 2023.

On December 19, 2022, the Dutch Healthcare Institute (ZIN) published the updated list of medical procedures reimbursed under basic health insurance with restrictions or limitations. The procedures that were newly introduced to the list concern gynecological and surgical procedures, as well as interventional radiology.

In late December 2022, the National Association of Statutory Health Insurance Physicians (KBV) published a detailed overview of the changes in the reimbursement of outpatient surgeries to be introduced in Germany in 2023, which are aimed at expanding the utilization of these procedures by physicians.

In December 2022, the Norwegian Directorate of Health published the final version of the DRG system (Innsatsstyrt finansiering, ISF) for 2023. Eight new DRGs concerning endocrinology, surgical procedures, infection diseases, genetics, and the general area will be added in 2023.

On November 30, 2022, the entity managing the DRG system in Switzerland, SwissDRG, has published the final version of the 2023 DRG system. In total, 21 new DRGs were introduced, and they concern cardiovascular, ENT, gastrointestinal, gynecology, neurovascular, pulmonary, and some other technology groups. Also, three new add-on reimbursement categories were introduced.

On November 24, 2022, the INeK (Institute for the Hospital Remuneration System) published the DRG catalog (Fallpauschalen-Katalog) with the list of DRGs and add-on reimbursement categories (ZEs) for 2023. Seven new DRGs and seven ZE categories (for drugs only, none for medical technologies) were added to the catalog in 2023.

In November 2022, the Danish Health Data Agency (Sundhedsdatastyrelsen) published the DRG tariffs, as well as psychiatric and rehabilitation rates for 2023. Later, on December 1, 2022, the DRG tariff system (Takstsystem) guide for 2023 was also published. Among other changes, nine new DRGs, specifically in ENT, e-health, neurology and neurosurgery, ophthalmology, intensive care and OR, cardiovascular, and IVD fields, were introduced.

On November 23, 2022, the Norwegian Directorate of e-Health released an updated version of the National Laboratory code (NLK) system and associated tariffs for state and private laboratories to be implemented no later than January 1, 2023. Eighty-six new codes were added, 207 codes were changed, and 27 codes were terminated.

In late November – early December 2022, the application period for 2024 ICD-10-GM (German modification of ICD-10 diagnosis codes), OPS (procedure codes), and DRG changes was opened by the Federal Institute for Drugs and Medical Devices (BfArM) and the Institute for Hospital Remuneration Systems (INeK) respectively.

The French National Authority for Health released new recommendations about add-on reimbursement of medical devices from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies in November 2022. Twenty recommendations were published in relation to the registration, modification of registration conditions, and renewal of registration for devices in the List of reimbursable products and services. Opinions concern cardiovascular, neurovascular and neuromodulation, endocrine, ENT, endoscopic and dermatological devices, as well as devices for men’s health and medical aids.