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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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The revised EBM catalog came into force in Germany on since April 2020

04 May 2020

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

The reimbursement of services in the public outpatient sector in Germany is regulated in the EBM catalogue (Einheitlicher Bewertungsmaßstab), updated once in a quarter (4 times a year). The adaption time frame of the EBM catalogue for a specific code is around 5 years but varies depending on the evidence.

The list of the most important changes in EBM for the second quarter of 2020 is presented below:

  • Counseling for pregnant women:
    • The fee order item (GOP) 01799 “Advice from a specialist in pediatric and adolescent medicine in accordance with Appendix 1c II.2 of the Maternity Guidelines in conjunction with Section 2a Paragraph 1 Pregnancy Conflict Act (SchKG)” with a tariff of €7.14 was added
    • The GOP 01770 “Care for a pregnant woman according to the guidelines of the Federal Joint Committee on medical care during pregnancy and after childbirth (Maternity Guidelines)” tariff was increased (€128.77 in the second quarter edition of the EBM compared to €120.09 in the first quarter edition of the EBM)
  • COVID-19:
    • The GOP 32816 “Nucleic acid detection of the novel coronavirus (2019-nCoV) using RT-PCR including a confirmation test for reactivity in the search test (report of findings within 24 hours after submission of material)” with a tariff of €59.00 included in EBM
  • Genetic testing:
    • The GOP 32866 “Genotyping to determine the CYP2C9 metabolism status before administration of siponimod in secondary progressive multiple sclerosis according to the summary of product characteristics (information for healthcare professionals)” with a tariff of €82,00. This examination is necessary because the patient's CYP2C9 metabolic status must be known before the administration of the Mayzent (brand name of siponimod)
  • HIV resistance testing:
    • The GOP 32821 with a tariff of €260,00 will now cover genotypic HIV resistance testing in HIV-infected persons before specific antiretroviral therapy or if therapy failure is suspected with integrase inhibitors or coreceptor antagonists or fusion inhibitors according to a summary of the characteristics of a drug (specialist information)
    • The GOP 32828 with a tariff of €260,00 will cover genotypic HIV resistance testing in HIV-infected persons before specific antiretroviral therapy or if therapy failure is suspected with protease inhibitors and/or reverse transcriptase inhibitors
  • Measurement of fractionated exhaled nitrogen monoxide (FeNO test):
    • The GOP 04538 (for pediatricians) and GOP 13678 (for pulmonologists) “FeNO measurement for the indication of therapy with dupilumab” with a tariff of €9,67 was added
  • The framework of the early detection of cervical cancer:
    • The GOP 01760 “Examination for the early detection of cancer in women in accordance with section B. II. §§ 6 and 8 of the cancer screening guideline” and the GOP 01764 “Assessment diagnostics in accordance with Part III. C. § 7 of the Guideline for Organized Cancer Screening Programs (oKFE-RL)” can be calculated on the same day of treatment
    • The genotyping of human papillomavirus (HPV) types 16, and 18 in the case of positive HPV detection within the scope of cervical cancer screening will no longer be a mandatory service within GOPs 01763 “Detection of human papillomaviruses according to Part III. C. § 6 of the Guideline for Organized Cancer Screening Programs (oKFERL)” and 01767 “Detection of human papillomaviruses according to Part III. C. § 7 of the Guideline for Organized Cancer Screening Programs (oKFERL)”. The HPV genotyping service will now be provided via a new GOP 01769 “Surcharge for fee order items 01763, and 01767 for genotyping of HPV type 16 and HPV type 18 with positive evidence of high-risk HPV types” with a tariff of €16,81 paid extrabudgetary.

The latest version of EBM can be accessed here.

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