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Cost-efficient European adaptations of global health economic models

Experience with model adaptations in Austria, Belgium, France, Germany, Italy, Norway, Netherlands, Spain, Sweden, the UK

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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 2023

12 Oct 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 October 1, 2023.

The most significant changes concern the introduction of the new EBM codes for several IVD tests, prostate-specific membrane antigen (PSMA) positron emission tomography, as well as for stereotactic radiosurgery (SRS) in vestibular schwannomas.

The examples of newly introduced EBM codes are provided below:

EBM sub-chapter 25.3.2 “High-voltage therapy (at least 1 MeV)”

  • 25322 “Single-stage SRS for the first target volume; once in the case of disease” with a tariff of €1,252;
  • 25323 “Surcharge for code 25322 for the SRS of more than one target volume; per each additional target volume” with a tariff of €312.91;
  • 25348 “Radiation planning for SRS; once in the case of disease” with a tariff of €3,651.

EBM sub-chapter 32.3.7 “Infection immunological examinations”

  • 32572 “Qualitative detection and/or quantitative determination of Toxoplasma antibodies of the immunoglobulin class IgM and/or IgG, also for monitoring purposes” with a tariff of €11.75;
  • 32573 “Surcharge for code 32572 for determining the avidity of Toxoplasma IgG antibodies as a clarification test after positive IgM antibody determination, in several batches, in total” with a tariff of €25.90.

EBM sub-chapter 34.7 “Diagnostic positron emission tomography (PET), diagnostic positron emission tomography with computed tomography (PET/CT)”

  • 34720 “Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) of the trunk with technical image fusion of a diagnostic computed tomography (CT) for the indication of therapy with (177Lu) lutetium vipivotide tetraxetan, if diagnostic CT examinations are available” with a tariff of €512.06;
  • 34721 “PSMA positron emission tomography (PET) of the trunk with technical image fusion of a diagnostic computed tomography (CT) for the indication of therapy with (177Lu) lutetium vipivotide tetraxetan, with diagnostic CT” with a tariff of €649.61.

In connection with the procedures under the EBM codes 34720 and 34721, the code 40585 “Flat rate for material costs in connection with the performance of the services under the codes 34720 and 34721 when using a Ga-68-PSMA ligand” under the EBM sub-chapter 40.10 “Performance-related flat rates for radionuclides” with a tariff €1,100 was introduced.

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.