Reimbursement

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.”

The French National Authority for Health (HAS) released new decisions about intra-DRG reimbursement of medical devices from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in July 2020. Decisions concern cardiac sutureless valve bioprostheses and implantable devices for the treatment of urinary incontinence.

From October 1, 2020, balneophototherapy can also be used for patients with moderate to severe neurodermatitis and billed via the EBM (German Uniform Evaluation Standard). So far, dermatologists have only been able to use the method for patients with psoriasis.

The French National Authority for Health (HAS) released new decisions about add-on and medical aid reimbursement of many medical devices from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in August 2020. Decisions concern cartilage implant, energy return prosthetic feet, and Yttrium-90 microspheres.

The French National Authority for Health (HAS) released new decisions about add-on and medical aid reimbursement of many medical devices from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in July 2020. Decisions concern drug-eluting coronary stents, TAVI, orthopedic appliances, wound dressing, stoma obturator, toric intraocular lens.

On the 28th of July 2020, in the Official Journal of French Republic (JORF), an Order for the inclusion of the web application MOOVCARE POUMON intended for the medical telemonitoring of relapses and complications in patients with non-progressive lung cancer in the French List of Products and Healthcare Services Qualifying for Reimbursement (LPPR) was published. The application is already included in the LPPR list in section 1, “Materials and treatments in the home, dietary products, items for dressings,” chapter 1, section 7, and a specific sub-section 7, which has been created for web applications and software for remote monitoring.

In July 2020, new material code and related conditions of reimbursement concerning the endoscopic treatment of primary or secondary vesicoureteral reflux were added to the List of reimbursable devices of the Belgian National Institute for Health and Disability Insurance (INAMI-RIZIV).

The Clinical Coding and Schedule Development (CCSD) group develops and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern planning, insertion, and removal of high/low dose rate radioactive treatment (brachytherapy) into a prostate tumor, open/laparoscopic repair of Spigelian hernia, and others. The codes are introduced with a recommended adoption date being the 1st of August 2020. The document also contains a list of textual changes in codes and unacceptable combinations. There were no changes to the CCSD Schedule of Diagnostic Tests.

In June 2020, santésuisse (the leading organization of Swiss health insurers) and the Swiss Society of Surgeons (FCMH) have submitted a proposal to the Federal Council for the acceptance of 67 lump-sum payment packages for out-patient services. In July 2020, eight more lump-sum payment packages were suggested to the Federal Council. More suggestions are expected in the near future.

The revised EBM (German Uniform Evaluation Standard) catalog came into force on July 1, 2020. MTRC has compiled the selection of the most significant changes.