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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 in January 2023

The reimbursement of services in the public outpatient sector in Germany is regulated in the EBM catalog (Einheitlicher Bewertungsmaßstab), updated once a quarter (four times a year). The adaption timeframe of the EBM catalog 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 January 1, 2023.

The most significant changes concern introducing the EBM codes for several IVD tests and further promoting outpatient (day case) surgical services.

As a part of the previously announced further development of the EBM catalog, since January 1, 2023, additional funding of €60 million is available to promote outpatient (day case) surgical services; so that the reimbursement of the affected procedures is increased by 16% up to 42%. Also, 196 OPS (procedure) codes were included in Annex 2 of the EBM catalog, mainly for neuromodulation, rhythm surgery, as well as arthroscopic interventions, providing the possibility to perform these procedures on an outpatient (day case) basis.

The examples of the new codes in the IVD field introduced in the EBM catalog are provided below:

  • 08315 “Cytological examination of one or more specially stained smears to diagnose hormonal function” with a tariff of €3.10;
  • 19327 “Cytological examination of one or more swabs from the ectocervix and/or from the cervical canal” with a tariff of €20.68 was introduced in the catalog. The code additionally covers further immunocytochemical examinations, using special staining to diagnose the hormonal function as optional services;
  • 19328 “DNA and/or mRNA detection exclusively for high-risk HPV types and genotyping for HPV type 16 and HPV type 18” with a tariff of €21.60;
  • 32810 “Nucleic acid detection of Orthopoxvirus spp. from maculo-/vesiculopapular skin or mucous membrane lesions (findings to be reported within 24 hours of receipt of material in the laboratory)” with a tariff of €19.90.

The full details in German can be found here.

This news is just one of about 300 market access news collected by our team in the subscription services "HTA Alerts" and "Reimbursement Alerts" every two weeks from more than 80 organizations. Access our paid subscription services to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). Contact us to get a free, three-month, no-obligation trial.