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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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Three new IVD tests will be reimbursed via the German Uniform Evaluation Standard (EBM) catalog

28 Jun 2023

On June 15, 2023, the National Association of Statutory Health Insurance Physicians (KBV) informed that new services for the detection of the adeno-associated virus (AAV) and cytomegalovirus (CMV) will be included in the German Uniform Evaluation Standard (EBM) catalog since July 1, 2023.

In this regard, in line with the corresponding decision of the Evaluation Committee, the following new codes will be introduced in the EBM catalog:

  • 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;
  • 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 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 it varies depending on the evidence. The upcoming EBM catalog update is expected to come into force on July 1, 2023.

The full details in German can be found here and here (Evaluation Committee decision).

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.