Reimbursement

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.

New material codes and related conditions of reimbursement for anchoring and fixation implants for soft tissue were added to the List of reimbursable devices of the Belgian National Institute for Health and Disability Insurance (INAMI-RIZIV) in August 2020.

In late September 2020, the Swedish version of NordDRG for 2021 was issued by the National Board of Health and Welfare (Socialstyrelsen). Four (4) new DRGs were added, and few minor changes in DRG names and logic were made.

On September 30, 2020, the Dutch Healthcare Institute (Zorginstituut Nederland, ZIN) published the position that transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis and a high risk of surgery is eligible for reimbursement under basic health insurance package.

New material codes and related conditions of reimbursement for middle ear implants were added to the List of reimbursable devices of the Belgian National Institute for Health and Disability Insurance (INAMI-RIZIV) in August 2020.

On August 6, 2020, the Ministry of Solidarity and Health published an Order (of August 4, 2020) listing the rotational atherectomy systems ROTAPRO and ROTALINK PLUS of the company Boston Scientific under Title V of the list of reimbursable products and services provided for in Article L. 165-1 of the Social Security Code (LPPR List).

NHS England announced that the specialized High-Cost Tariff-Excluded Devices (HCTED) program is restarted working with NHS providers and NHS Supply Chain colleagues, throughout July and August 2020.

In mid-August 2020, the German Federal Institute for Drugs and Medical Devices (BfArM) published the preliminary 2021 version of OPS procedure coding nomenclature. Numerous content updates and new procedure codes inclusion concern the chapters 1 “Diagnostic measures,” 5 “Operations,” and 8 “Non-operative therapeutic measures.” The list of new endoscopy-related procedure codes added under the respective OPS sub-chapters of chapters 1 and 5 is provided below:

Earlier in September 2020, the Austrian Institute for Health Technology Assessment (AIHTA) released a synopsis of the ongoing research project “Reimbursement decisions for medical procedures in Austria: An analysis of factors – besides clinical evidence – influencing reimbursement decisions for the hospital benefit catalog 2010-2020.”