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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 October 2021

01 Nov 2021

The reimbursement of services in the public outpatient sector in Germany is regulated in the EBM catalog (Einheitlicher Bewertungsmaßstab), updated once in 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 Щсещиук 1, 2021.

The most significant introduced changes concern mainly IVD tests: extension of the newborns screening by the inclusion of the tests for sickle cell disease and 5q-associated spinal muscular atrophy, the introduction of microsatellite instability testing, amendments of Oncotype DX® test reimbursement, the introduction of screening for hepatitis B and C as part of health check-up, as well as changes in reimbursement of radiation therapy services.

The list of the most important changes in EBM for the fourth quarter of 2021 is presented below. The examples of the new codes introduced in the EBM catalog:

EBM sub-chapter 1.7.2 “Early detection of diseases in adults”

  • 01734 Surcharge for service 01732 (health check-up for people aged over 18) for screening for hepatitis B and/or hepatitis C with a tariff of €4.56;
  • 01744 Screening for hepatitis B and/or hepatitis C as part of the transitional arrangement with a tariff of €4.56;
  • 01865 Detection of HBs antigen and/or HCV antibodies with a tariff of €11.68;
  • 01866 Surcharge for service GOP 01865 for the determination of the hepatitis B virus DNA in the case of a reactive result of the examination for HBs antigen with a tariff of €89.55;
  • 01867 Surcharge for service 01865 for the nucleic acid detection of hepatitis C virus RNA in the case of the reactive result of the test for HCV antibodies with a tariff of €40.05;

EBM sub-chapter 19.4.4 “In-vitro diagnostics of tumor genetic changes to indicate pharmacological therapy”

  • 19464 “Microsatellite instability testing in the tumor material to indicate targeted drug treatment, if this is mandatory according to the specialist information, twice in the case of disease” with a tariff of €96.45;

EBM sub-chapter 25.3.4 “Radiation therapy planning”

  • 25345 “Computer-assisted radiation therapy planning for percutaneous radiation therapy with individual dose planning for soft radiation therapy or orthovoltage therapy” with a tariff of €117.25.

Also, the tariffs of multiple services (radiation therapy in benign and malignant diseases, radiation therapy planning) listed under the EBM chapter 25 “Radiotherapy fee order items” are decreased;. In contrast, the tariff for the service under the EBM code 25310 “Soft radiation therapy or orthovoltage therapy” is increased to €12.79 (the previous tariff amounted to €10.23).

The full details in German can be found here.

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