The reimbursement of services in the public outpatient sector in Germany is regulated in the EBM catalogue (Einheitlicher Bewertungsmaßstab), updated once a quarter (4 times a year). The adaption time frame of the EBM catalogue for a specific code is around five years but varies depending on the evidence. The latest EBM (German Uniform Evaluation Standard) catalog came into force on April 1, 2021.
The introduced changes are mainly minor and concern adjustment of reimbursement conditions for several services (e.g., sleep-related breathing disorders management, urethral pressure profile measurement, two IVD tests) and inclusion of two new IVD tests.
The list of the most important changes in EBM for the second quarter of 2021 is presented below. The following new codes were introduced in the EBM catalog:
- 19462 “Determination of the PIK3CA mutation status using circulating tumor DNA to indicate the targeted treatment of postmenopausal women and men with a hormone receptor (HR)-positive, human epidermal growth factor receptor-2 (HER2)-negative, locally advanced or metastatic breast cancer in disease progression after endocrine therapy as monotherapy, if this is mandatory according to the specialist information” with a tariff of €437.63;
- 19463 “Targeted determination of PIK3CA mutations using circulating tumor DNA for the indication of a targeted treatment of postmenopausal women and men with a hormone receptor (HR)-positive, human epidermal growth factor receptor-2 (HER2)-negative, locally advanced or metastatic breast cancer in the case of progression of the disease after endocrine therapy as monotherapy, if this is mandatory according to the specialist information” with a tariff of €233.61.
Furthermore, reimbursement conditions for the following EBM codes were revised:
- The conditions of the reimbursement of the EBM code 11601 for detection of the germline mutations of the BRCA1 and BRCA2 genes are now supplemented with the indications of adenocarcinoma of the pancreas and prostate cancer;
- EBM code 19456 for detecting the BRCA1 and BRCA2 gene mutations in the tumor tissue is now reimbursed also for the indication of prostate cancer.
The full details in German can be found here.
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