Procedure coding
Procedure coding for gynecological surgery is well-established in many European countries. The procedure codes distinguish the different types of gynecological procedures, from dilation and curettage to hysterectomy. In addition to procedure type, the code usually indicates a type of approach. For example, in Germany, there are several OPS codes for total hysterectomy, including codes for open (code 5-683.00), laparoscopic (code 5-683.03), vaginal (code 5-683.01) and laparoscopically assisted vaginal (code 5-683.02) approach.
New minimally invasive endoscopic gynecological surgery can be a subject for a new procedure code in the country-specific procedural nomenclatures. For example, in England, six new codes for gynecological surgery in pelvic prolapse were implemented in 2023, including interventions in prior mesh reconstruction (code P29.6 “Oversewing of mesh in vagina” and code P30.3 “Plication of mesh previously inserted for suspension of vaginal vault”, code Q57.3 “Plication of mesh previously inserted for suspension of uterus”).
Payment mechanism
The payment model for gynecological surgery varies by country and the type of procedure.
In most European countries (England, Germany, Italy, and countries of the Nordic region), gynecological surgery is reimbursed solely via the diagnosis-related group (DRG) mechanism. The DRGs might be different depending on the type of approach for the procedure. For example, in England open and vaginal hysterectomy are allocated to the HRG MA07G “Major Open Upper Genital Tract Procedures with CC Score 0-2” with a 2025/26 tariff of £4,202, laparoscopic procedure – to the HRG MA08B “Major, Laparoscopic or Endoscopic, Upper Genital Tract Procedures, with CC Score 0-1” with a lower 2025/26 tariff of £3,491.
Devices used for gynecological surgery rarely receive additional reimbursement beyond the DRG tariff. For example, in England, there is a specific category in the High Cost Devices List “Sonata system for diagnostic imaging and treatment of symptomatic uterine fibroids”. The device is specified in the NICE IPG689 “Transcervical ultrasound-guided radiofrequency ablation for symptomatic uterine fibroids” and approved for funding by NHS England as part of the Specialised Services Devices Programme in partnership with NICE.
Minimally invasive gynecological surgery can be performed in outpatient and day case settings, utilizing the specific reimbursement model (DRG or fee-for-service). For example, in Germany, magnetic resonance-guided highly focused ultrasound therapy for the treatment of uterine fibroids is reimbursed via combination of EBM code 61050 “Preliminary examination within the framework of the MRgFUS-TUF testing guideline including the necessary imaging procedures” with a 2025 fee of €210.69, code 61051 “Magnetic resonance imaging-guided highly focused ultrasound therapy for the treatment of uterine fibroids within the framework of the MRgFUS-TUF trial guideline” with a 2025 fee of €4,089.82 and code 61052 “Follow-up examination(s) within the framework of the MRgFUS-TUF testing guideline including the necessary imaging procedures” with a 2025 fee of €371.80.
Policy considerations
Many gynecological surgery procedures are well-established technologies; they are unlikely to be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist.
Health technology assessment
Innovative technologies in gynecological surgery are frequently subject to health technology assessments (HTAs). For example, in October 2023, the National Institute for Health and Care Excellence (NICE) developed interventional procedure guidance on vaginal transluminal endoscopic hysterectomy and adnexal surgery for benign gynecological conditions. NICE recommended the procedure to be used with special arrangements for clinical governance, consent, and audit or research.
In Spain, the Andalusian Agency for Health Technology Assessment released an HTA report in January 2023, aiming to evaluate the clinical effectiveness and safety of bipolar radiofrequency endometrial ablation in patients with heavy menstrual bleeding. It was concluded that bipolar radiofrequency is more effective than the rollerball, heat balloon, microwaves, and hydrothermal ablation towards increasing the amenorrhea rate and patient satisfaction ratio in 12 months after intervention.
Future challenges
Many gynecological surgical interventions currently benefit from established reimbursement and funding pathways across most European countries. However, the rapid emergence of innovative technologies, such as novel ablation techniques, use of robotic assistance, augmented reality-guided procedures, etc., will increasingly be subject to rigorous HTAs.
Novel devices and surgical techniques with distinctive features may require the development of dedicated procedure codes and adjustments to existing payment models to ensure appropriate reimbursement that reflects their technological complexity and cost profile.
MTRC has experience with more than 10 projects related to gynecology surgery in Europe.
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