Reimbursement

In late October 2020, the BfArM (Federal Institute for Drugs and Medical Devices) has published the final version of the OPS 2021 (Operation and Procedure Keys) system. The OPS, together with the ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification), forms the basis for the reimbursement systems in outpatient and inpatient care.

The Austrian Institute for Health Technology Assessment (AIHTA) is conducting a research project “Framework for reimbursement decisions of digital health technologies (mHealth) and its (retrospective) application on selected examples”. The project started in May 2020, with expected completion in November 2020.

In late October 2020, the Swedish prospective cost-weights for NordDRG 2021 were released by the National Board of Health and Welfare (Socialstyrelsen).

In late October 2020, three more reimbursable health apps were introduced on the Directory of digital health applications (DiGAs) at the Federal Office for Drugs and Medical Devices (BfArM). These applications can be prescribed by physicians and psychotherapists and will be reimbursed by health insurers.

NHS England has opened a consultation on the proposed approach to updating the National Genomic Test Directory set out in the consultation document. The deadline for comments submission is November 17, 2020.

MTRC maintains two subscription services with a focus on all published, initiated or ongoing HTA and reimbursement reports and decisions for medical devices, procedures and IVD tests. HTA Alerts is a global service and covers 56 organizations from 24 countries. Reimbursement Alerts is focused on 14 key European countries. All alerts are tailed to the technologies of interest for each client. First EU issues of both newsletters are available for download free-of-charge.

In mid-October 2020, the Federal Joint Committee (G-BA) has decided that three more biomarker-based tests in breast cancer will be covered by the statutory health insurance. Since January 2020, the "Oncotype DX Breast Recurrence Score" test is already reimbursed in Germany with a tariff of €3,296.50.

At the information meeting on October 13, 2020, Norwegian Directorate for e-Health presented planned changes in the coding system (NCSP-NCMP-NCRP) for 2021. Two new surgical procedure codes for laparoscopy, two new radiology procedure codes, and nine new medical procedure codes are proposed.

The revised EBM (German Uniform Evaluation Standard) catalog for ambulatory reimbursement in Germany came into force on October 1, 2020. MTRC has compiled the selection of the most significant changes, concerning In-vitro diagnostics, telemedicine and vacuum wounds therapy.

On October 13, 2020, the Norwegian Directorate of Health published a preliminary version of the DRG system (ISF) for 2021. Four new DRGs were introduced.

In early October 2020, the first reimbursable health apps were introduced on the Directory of digital health applications (DiGAs) at the Federal Office for Drugs and Medical Devices (BfArM). These applications can be prescribed by physicians and psychotherapists and will be reimbursed by health insurers.

In late September 2020, the Austrian version of the DRG system (LKF) 2021 model with the relevant supplementary documents was published in Austria. For 2021, the main changes include the addition of sixteen new procedure codes and the introduction of two new procedure codes for billing in the day-case settings, update of cases flat rates, and adjustments of the cases daily component calculation.