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Percutaneous ablation of organs

An overview of market access challenges for percutaneous ablation of organs in European countries

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Procedure coding

In European countries, the situation with procedure coding for percutaneous ablation of organ lesions differs depending on the anatomical site of intervention: procedure coding for percutaneous ablation of liver, lung, and kidney tissue is well established in most countries, whereas for other anatomical sites, the availability of specific coding is limited. For example, in the Netherlands, there is specific procedure code 036089 “Percutaneous excision or coagulation disorder kidney” and 035240 “Radiofrequency ablation of pathological liver tissue”. For other anatomical sites nospecific procedure code for RF ablation of diseased tissue by a radiologist (code 080058) can be used.

In many countries, the type of energy used is specified in the procedure code description. The typical ones include radiofrequency and cryoablation. Other types of energy are either not specifically coded or can be described using supplementary codes. For example, percutaneous ablation of lesions using microwaves is specified in the procedure code descriptions in Germany. In contrast, supplementary codes are used for it in England and countries of the Nordic region.

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Payment mechanism

In most European countries, the payment model for percutaneous ablation of organ lesions is DRG.

The anatomical site of intervention typically drives the DRG allocation.  In some countries, the type of energy used may impact the DRG allocation. For example, in England, percutaneous cryoablation of kidney tissue is allocated to the DRG YL01Z “Complex Percutaneous Ablation of Lesion of Kidney” with a tariff of €6,419, radiofrequency and microwave ablation – to the DRG YL02Z “Standard Percutaneous Ablation of Lesion of Kidney” with a tariff of €5,706.

In most European countries, the devices for percutaneous ablation of organ lesions do not attract additional (top-up) reimbursement, which is paid in addition to the DRG tariff. One of the exceptions is England, where radiofrequency, cryotherapy, and microwave ablation probes and catheters are included in the High Cost Devices List and reimbursed in addition to the HRG tariff.

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Policy considerations

Percutaneous ablation of organ lesions can be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist. 

For example, in 2017, the Dutch Healthcare Institute (ZIN) published a Position on thermal ablation in colorectal liver metastases, which concluded that the procedure could be reimbursed under basic health insurance only in unresectable colorectal liver metastases in case of radical surgery for colorectal cancer.

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Health technology assessment

Due to the rapid development of technologies and extension of indications, devices for percutaneous ablation of organ lesions frequently become a subject of HTA. For example, In July 2022, the Austrian Institute for Health Technology Assessment (AIHTA) published a decision support document, “Microwave ablation for liver tumors,” which recommended the inclusion of the procedure in the catalog of benefits only for the treatment of early-stage hepatocellular carcinoma. Re-evaluation of microwave ablation for secondary liver cancer was recommended in 2025.

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Future challenges 

Percutaneous radiofrequency and cryoablation of liver, lung, and kidney lesions have established reimbursement and funding in most European countries. New health technology assessments are unlikely to be relevant. Procedures for ablation of other organs, devices for percutaneous ablation of organ lesions with unique designs, or alternative energy sources might require the development of procedure codes, establishing reimbursement, funding, and obtaining HTA recommendations.

MTRC has experience with more than 16 projects related to the percutaneous ablation of organs in Europe

News and insights

Med Tech-related health technology assessments from NIHR in December 2023

In December 2023, the National Institute for Health and Care Research (NIHR) in England released two MedTech-related assessments in its Health Technology Assessment (HTA) Journal, which concerned ablative and non-surgical therapies for hepatocellular carcinoma and hidradenitis suppurativa treatment. HTA Journal publishes research reports on the effectiveness, costs, and broader impact of health technologies for those who use, manage, and provide care in the NHS and informs National Institute for Health and Care Excellence (NICE) guidance.

The final version of the 2024 OPS procedure coding classification released in Germany

On October 26, 2023, the BfArM (Federal Institute for Drugs and Medical Devices) published the final version of the 2024 OPS procedure coding classification. The OPS, together with the ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification), forms the basis for the reimbursement systems in outpatient and inpatient care in Germany.

New procedure and diagnostic codes added to the private reimbursement schedule in England

In April 2023, the Clinical Coding and Schedule Development (CCSD) working group, which develops and maintains procedural and diagnostics nomenclatures for private payers in England, published Bulletins 189 and 085 with changes to be implemented no later than June 15, 2023. Eighteen new procedure codes (concerning cardiovascular, endocrine, endoscopy, gastrointestinal, interventional radiology, neuromodulation, peripheral vascular, robotic surgery, men's health, and general surgery fields) and eight new diagnostic codes were introduced.

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