Reimbursement

In February 2023, the Clinical Coding and Schedule Development (CCSD) working group, which develops and maintains procedural and diagnostics nomenclatures for private payers in England, published Bulletins 188 and 084 with changes to be implemented no later than March 23, 2023. Five new procedure codes (concerning interventional radiology, robotic surgery, and radiotherapy) and one new diagnostic code were introduced.

On January 27, 2023, the Swiss Federal Office for Public Health announced the update of Annex 3 of the Health Care Benefit Ordinance (KLV/OPre), which contains the list of reimbursed IVD tests (List of Analyses). Two new tests on Monkeypox virus check will be introduced in March 2023.

On January 31, 2023, the Order approving Addendum 11 to the National Convention for Laboratory Directors was published in the Official Journal of the French Republic. The Addendum implements financial measures provided for by the Social Security Financing Act – reduces the reimbursement tariffs for the tests registered in the main reimbursement catalog for IVD tests in France Nomenclature of Medical Biology Acts (NABM).

On January 23, 2023, 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 March 1, 2023. Twenty-four new codes were added, 179 codes were changed, and 23 codes were terminated.

The French National Authority for Health (HAS) released new recommendations about transitional coverage of medical devices from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in January 2023. Two opinions were published regarding devices from two technology groups.

The French National Authority for Health (HAS) 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 (CNEDiMTS) in January 2023. Twenty-four 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 (LPPR). Opinions concern cardiovascular and peripheral vascular, neurovascular, and orthopedic devices, in-vitro diagnostics, as well as medical aids.

On January 3, 2023, the Federal Joint Committee (G-BA) initiated the evaluation procedure concerning the method of renal denervation using ultrasound ablation in treatment-resistant hypertension (Paradise-System™ by ReCor Medical) within the framework of the early benefit assessment (in line with § 137h SGB V).

On January 09, 2023, the National Institute for Health and Disability Insurance (INAMI-RIZIV) published 2023 tariffs for the “low variability care” (APR-DRG) system. APR-DRG logic for 2023 is not published as of January 27, so no information about its changes or new DRGs is available.

The updated German Uniform Evaluation Standard (EBM) catalog came into force on January 1, 2023. The EBM catalog (Einheitlicher Bewertungsmaßstab) 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 "zanadio" health app for follow-up and evaluation was introduced in the catalog.

On December 31, 2022, the Decree defining the reimbursement of medical telemonitoring activities via the new framework was published in the Official Journal of the French Republic. The Decree determines the methods of evaluation of digital solutions, registration for reimbursement, modification of the registration conditions, removal and invoicing of medical telemonitoring activities, as well as the conditions for setting the reimbursement packages.

In December 2022, NHS England launched a consultation on the preliminary 2023/25 NHS Payment Scheme, which is set for two years and will replace the National Tariff Payment System from April 2023. Two new cardiovascular categories (antibacterial envelope, mitral valve repair and replacement devices) are proposed for inclusion in the 2023/24 High Cost Device List (will be updated and reissued for 2024/25). The deadline for comments submission is January 27, 2023.

On December 26, 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.