The reimbursement of services in the public outpatient sector in Germany is regulated in the EBM catalog (Einheitlicher Bewertungsmaßstab), updated once a quarter (4 times a year). The adaption time frame 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 July 1, 2022.
The most significant changes concern introducing and updating multiple EBM codes for IVD tests and adjusting tariffs and content of radiotherapy services.
The examples of the new codes in the IVD field introduced in the EBM catalog:
- 01870 "Prenatal analysis of fetal DNA from maternal blood for the presence of trisomy 13, 18 or 21 in line with the guidelines of the Federal Joint Committee on medical care during pregnancy and after childbirth (Maternity Directive)" with a tariff of €184.99;
- 32701 "Detection of Clostridioides difficile in the stool" (bacteriological examination) with a tariff of €23.80;
- 32702 "Surcharge for the code 32701 for the nucleic acid detection of Clostridioides difficile in the case of discordant immunoassay results" with a tariff of €19.90;
- 32777 "Semi-quantitative European Committee on Antimicrobial Susceptibility Testing (EUCAST) or Clinical and Laboratory Standards Institute (CLSI) selected susceptibility testing of clinically relevant bacteria grown in pure culture from a material with atypical Gram staining characteristics or for which EUCAST or CLSI has defined service content other than code 32772 or 32773" with a tariff of €6.93;
- 32851 "Nucleic acid detection of one or more of the pathogens for acute respiratory infections (reporting of findings within 24 hours of receipt of material in the laboratory)" with a tariff of €19.90. The considered pathogens include viral pathogens: influenza A and B, parainfluenza viruses, bocavirus, respiratory syncytial virus, adenoviruses, human metapneumovirus, rhinoviruses, enteroviruses, and coronaviruses (except beta-coronavirus SARS-CoV-2); bacterial pathogens: Bordetella pertussis and B. parapertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophilia, Streptococcus pneumoniae, Haemophilus influenzae;
- 32852 "Nucleic acid detection of one or more of the pathogens of sexually transmitted infections (findings to be reported within 24 hours of receipt of material in the laboratory) with a tariff of €19.90. The considered pathogens include Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Herpes simplex virus types 1 and 2;
- 32853 "Nucleic acid detection of one or more of the pathogens of acute gastrointestinal infections (findings to be reported within 24 hours of receipt of material in the laboratory)" with a tariff of €19.90. The considered pathogens include viral pathogens: noroviruses, enteroviruses, rotaviruses, adenoviruses, astroviruses, sapoviruses; bacterial pathogens: campylobacter, salmonella, shigella, Yersinia enterocolitica, Yersinia pseudotuberculosis, Enterohemorrhagic Escherichia coli (EHEC)/Enteropathogenic Escherichia coli (EPEC); Cryptosporidium spp., Entamoeba histolytica, Giardia duodenalis, Strongyloides spp.
The full details in German can be found here.
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