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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 July 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 adaptation 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 July 1, 2023.

The most significant changes concern introducing the new EBM codes for several IVD tests, as well as for the cryopreservation of the ovarian tissue.

The examples of newly introduced EBM codes are provided below:

EBM sub-chapter 8.6 “Cryopreservation of egg or sperm cells or germ cell tissue as well as corresponding medical measures due to therapy that damages germ cells”

  • 08642 “Preparation and examination of ovarian tissue after removal for cryopreservation” with a tariff of €139.05;
  • 08643 “Preparation and freezing of ovarian tissue” with a tariff of €141.81;
  • 08649 “Thawing and processing of ovarian tissue to restore the ability to conceive” with a tariff of €100.67.

EBM sub-chapter 32.3.7 “Infection immunological examinations”

  • 32674 “Qualitative detection and/or quantitative determination of antibodies against adeno-associated viruses (AAV) to indicate targeted drug treatment, if this is obligatory according to the product information, once on the day of treatment” with a tariff of €40.

EBM sub-chapter 32.3.12 “Molecular biological examinations”

  • 32818 “Quantitative determination of CMV DNA for the diagnosis of CMV reactivation in organ transplanted patients or immunodeficient patients or before, during, at the end of or after discontinuation of specific antiviral therapy” with a tariff of €44.50;
  • 32820 “Genotypic CMV resistance testing in case of suspected therapy failure under a specific antiviral therapy, once in the case of treatment” with a tariff of €260.

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.