Reimbursement

The Swiss Services Ordinance (KLV/OPre) is the document that defines the health care services which are covered by the compulsory health insurance in Switzerland. It is updated annually (with more frequent updates possible); thus, the 2020 version is released. Changes concern autologous transplantation of chondrocytes, extracorporeal photopheresis, transcatheter aortic valve implantation, ultrasound therapy focused on the pallidum, thalamus and subthalamus, CAR-T cell therapies, tomography with positron emission (PET/CT), stereotactic radiation therapy (photons) of wet age-related macular degeneration.

The Clinical Coding and Schedule Development (CCSD) group develops and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern removal of pectus bar, open surgical correction of pectus deformity of the chest wall, intradermal injection into the scalp, nerve and neurolytic root block with or without image guidance, facet joint injection with or without image guidance and diagnostic code for gustatory testing. The codes are introduced with a recommended adoption date being the 1st of May 2020. The documents also contain a list of textual changes in codes, unacceptable combinations, and inactivated codes.

The French National Authority for Health (HAS) regularly publishes new decisions about add-on reimbursement for medical devices. The decisions made in December 2019 concern various types of devices, mostly for cardiovascular devices. A total of five decisions were made.

New material codes for implantable non-rechargeable neurostimulator, electrodes, and extensions for stimulation of the dorsal root nodes were added to the List of reimbursable devices of the Belgian National Institute for Health and Disability Insurance (INAMI-RIZIV) in December 2019.

In mid-December 2019, the Swiss Federal Department for Home Affairs (FDHA) has decided that two new autologous cell therapies (CAR-T therapies) for the treatment of leukemia and lymphoma will be reimbursed by compulsory health care insurance.

On November 7, 2019, the Nomenclature was updated. The update brought changes in chapter V of Nomenclature, regarding the creation of new codes and modification of existing codes.

In December 2019, the Swiss Medical Tariff Commission (MTK/CTM) has published their recommendations regarding the knee Autologous Chondrocyte Implantation (ACI). The CTM recommends covering the costs of the implant for knee ACI until the end of 2024.

At the end of November 2019, the company in charge of the development of the DRG system in Switzerland, SwissDRG SA, has announced the tariff versions (2020/2020) of the DRG and the add-on reimbursement catalog.

The French National Authority for Health (HAS) regularly publishes new decisions about add-on reimbursement for medical devices. The decisions made in November 2019 concern various types of devices, including orthopaedic, and cardiovascular devices. A total of twenty-four decisions were made.

The Clinical Coding and Schedule Development (CCSD) group develops and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern injection eustachian tuboplasty, extracorporeal shockwave therapy for carpal tunnel syndrome, robotic-assisted laparoscopic excision of recto-vaginal endometriosis, and diagnostic codes for alpha-melanocyte stimulating hormone, NK cell inhibition panel, XR whole spine, and others. The codes are introduced with a recommended adoption date being the 1st of February 2020. The documents also contain a list of textual changes in codes, unacceptable combinations, and inactivated codes.

On September 16, 2019, the Nomenclature was updated. The update brought changes in chapter V of Nomenclature, regarding the creation of new codes and modification of existing codes.

The French National Authority for Health (HAS) regularly publishes new decisions about add-on reimbursement for medical devices. The decisions made in October 2019 concern various types of devices, including orthopedic, cardiovascular devices, and hearing aids. A total of twenty-four decisions were made.