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Reimbursement strategy

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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 for the first quarter of 2024 published in Germany

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 for the first quarter of 2024 was published on December 21, 2023.

The most significant changes concern the update of Annex 2 of the catalog, the introduction of the new EBM codes for external electrical cardioversion in adult and pediatric patients, follow-up and evaluation of the health app companion patella, as well as companion diagnostics test for genotyping to determine CYP2C19 metabolism status.

As previously announced, Annex 2 of the updated EBM catalog was enriched with an additional 33 interventional procedures, including biopsies of the prostate and joints, incisions in the area of the eyes and male genitalia, and the revision of indwelling venous catheter systems.

Annex 2 “Assignment of the operative procedures according to §295 SGB V (OPS) to the services of chapters 31 and 36” of the EBM catalog, determines the allocation of the interventional procedures performed in day case settings and described using hospital (OPS) procedure codes to specific EBM categories. The Evaluation Committee annually adapts Annex 2 of the EBM catalog to the new OPS version and makes further changes if necessary.

The examples of newly introduced EBM codes are provided below:

EBM sub-chapter 1.4 “Visits, ward rounds, examination of home care, prescription of special treatment measures, administrative complex, telephone consultations, consultation flat rate, stay, consultation on organ donation and tissue donation”

  • 01477 “Additional flat rate for the follow-up and evaluation of the digital health application (DiGA) companion patella in line with the Directory for digital health applications according to §139e SGB V” with a tariff of €7.64.

EBM sub-chapter 4.4.1 “Fee order items for pediatric cardiology”

  • 04421 “External electrical cardioversion, including material costs” with a tariff of €223.76.

EBM sub-chapter 13.3.5 “Cardiology fee order items”

  • 13552 “External electrical cardioversion, including material costs” with a tariff of €223.76.

EBM sub-chapter 32.3.14 “Molecular genetic examinations”

  • 32869 “Genotyping to determine CYP2C19 metabolism status before administration of mavacamten in symptomatic hypertrophic obstructive cardiomyopathy (NYHA class II-III) according to the Summary of Product Characteristics (SmPC)” with a tariff of €82.

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 premium subscription service Market Access Monitor every week from more than 80 organizations. Access our paid service to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). Access is organized as an online Database and email alert formats. Contact us to get a free, three-month, no-obligation trial.