Reimbursement

On November 15, 2022, a new body called “Organization for Outpatient Physician Tariffs AG (OAAT)” was founded under the leadership of the Bernese government councillor. It involves all tariff partners (associations of health insurers curafutura and santésuisse, as well as the association of hospitals H+, the association of physicians FMH, and medical tariff commission MTK/CTM), who have joined forces in order to reach the goal of improving the outpatient reimbursement system.

In November 2022, the National Board of Health and Welfare released the Swedish version of the NordDRG system to come into force in January 2023, including the list of DRG codes, names, and cost-weights. A total of 77 new DRGs will be implemented. Key new DRGs were introduced in cardiovascular, gastrointestinal, and endoscopy fields, also for breast reconstruction and bone-anchored hearing implants.

The new version of the classification of procedure codes (CCAM v.71), applicable from December 03, 2022, was published in France. Several changes were introduced, including the creation of four new codes related to ENT, pulmonary and airways, and interventional radiology areas. Also, the modification of tariffs for 50 dental procedure codes will enter into force on January 01, 2023.

In November 2022, NHS Digital published a final summary of core changes from OPCS-4.9 to OPCS-4.10 to be introduced from April 01, 2023. OPCS-4 is a statistical classification for clinical coding of interventions and procedures undertaken within the NHS. It is updated every three years. A total of 236 new four-character codes will be implemented in OPCS-4.10. Key changes concern cardiovascular, gastrointestinal, endoscopy, ENT, nephrology and urology, neurology and neurosurgery, obstetrics and gynecology, orthopedic, and breast surgery fields.

In November 2022, NHS England defined a deadline for applications to the High Cost Device List (HCDL) changes to be implemented in the 2024/25 National Tariff Payment System. The completed application form should be submitted via email by May 31, 2023.

In November 2022, an annual update of the Swedish procedure coding system (Classification of Health Care Measures, KVÅ) was released to come into force from January 2023. A total of 119 new surgical procedure codes and 98 new medical procedure codes will be introduced concerning cardiovascular, diagnostic imaging, eHealth, endocrinology, endoscopy, ENT, gastrointestinal, IVD, nephrology and urology, peripheral vascular, and others.

On November 3, 2022, the decision of the National Union of Health Insurance Funds relating to the update of the CCAM Nomenclature of procedure codes was published in the Official Journal of the French Republic. Four new procedure codes were introduced. The codes relate to the procedures of implantation and removal of the bone conduction hearing aid and destruction of bronchopulmonary tumors by radiofrequency.

On November 9, 2022, the Danish Health Data Agency (Sundhedsdatastyrelsen) published the DRG tariffs, as well as psychiatric and rehabilitation rates for 2023.

The French National Authority for Health released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies in October 2022. Fourteen 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, orthopedic, and ENT devices, as well as medical aids.

In October 2022, the Norwegian Directorate of Health published a preliminary version of the DRG system (Innsatsstyrt finansiering, ISF) for 2023. Eight new DRGs will be added in 2023.

In late September – early October 2022, 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 sickness funds.

On September 22, 2022, the Dutch Healthcare Authority (NZa) published the second release of the DRG package for 2023 (RZ23b). Nineteen new procedure codes, eight new supplementary payments, and seven new DRGs will be implemented. These changes concern remote monitoring, molecular diagnostics, surgical procedures, gynecology and dermatology technology groups.