Coronary imaging and diagnostic procedures

Series
Coronary interventions
Status
Published
Date
Number of report
020

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The report presents a summary of reimbursement situation for a number of coronary imaging methods. Procedures, covered in the report include:

  • Intravascular ultrasound (IVUS)
  • Coronary fractional flow reserve measurement (FFR)
  • Instantaneous wave-free ratio (iFR)
  • Cardiac computed tomography
  • Optical coherence tomography (OCT)

An analysis is provided for three indications: stable angina, unstable angina, and acute myocardial infarction.

Reimbursement analysis is provided only for admitted care settings for stand-alone imaging procedures and for imaging procedures performed in adjunction to percutaneous coronary intervention with and without stenting.

The report includes essential information about reimbursement and national funding, including:

  • Brief overview of reimbursement system for medical devices
  • Procedure coding for technology
  • Diagnosis coding
  • Payment mechanism for technology
  • Reimbursement tariffs for technology
  • Restrictions in indications or scenarios for use of technology
  • Policy considerations by payers and policy-makers about technology

Reimbursement information is provided for the following geographies:

  • Austria
  • Belgium
  • Denmark
  • England (UK)
  • France
  • Germany
  • Italy
  • Netherlands
  • Norway
  • Sweden
  • Switzerland

It is also possible to add analysis in Czech Republic, Finland, Hungary, Romania, Russia and Turkey.

Manufacturers of devices for coronary imaging system include:

  • Abbott (OPTIS™)
  • Acist (RXi Rapid Exchange FFR)
  • Arineta 
  • Asahi Intecc
  • Avinger (WildCat)
  • Axsun Technologies
  • Boston Scientific (OPTICROSS™, iLab™, Ultra ICE™, Polaris, COMET™)
  • Canon (Aquilion)
  • CathWorks
  • FUJIFILM (Speedia)
  • GE (Innova®, Revolution FrontierTM, Discovery™)
  • Hitachi (SCENARIA)
  • InfraReDx (LipiScan IVUS, Makoto™ Intravascular Imaging System)
  • Opsens Inc. (OptoWire and OptoMonitor FFR)
  • Philips/ Volcano (Eagle Eye Platinum, Verrata)
  • Samsung/NeuroLogica (BodyTom®)
  • Shimadzu (NeuViz)
  • Siemens (IVUSmap)
  • Silicon Valley Medical Instruments (HD IVUS)
  • SinoVision Technologies (Insitum)
  • St. Jude Medical (PRESSUREWIRE™ X GUIDEWIRE)
  • Terumo (Lunawave)

Table of content

1.    Introduction and summary
2.    Executive summary table
3.    Contents
4.    Methodology
5.    Reimbursement analysis in Austria

5.1.    Overview of the reimbursement system
5.2.    Reimbursement for coronary imaging and diagnostic procedures
5.2.1.    Procedure coding
5.2.2.    Diagnosis coding
5.2.3.    Payment mechanism and reimbursement tariffs
5.2.4.    Health technology assessments by LBI-HTA
6.    Reimbursement analysis in Belgium
6.1.    Overview of the reimbursement system
6.2.    Reimbursement for coronary imaging and diagnostic procedures
6.2.1.    Procedure coding
6.2.2.    Diagnosis coding
6.2.3.    Payment mechanism and reimbursement tariffs
6.2.4.    Policy considerations by the INAMI/RIZIV
6.2.5.    Health technology assessments by KCE
7.    Reimbursement analysis in Denmark
7.1.    Overview of the reimbursement system
7.2.    Reimbursement for coronary imaging and diagnostic procedures
7.2.1.    Procedure coding 
7.2.2.    Diagnosis coding
7.2.3.    Payment mechanism and reimbursement tariffs
7.2.4.    Policy considerations
8.    Reimbursement analysis in England
8.1.    Overview of the reimbursement system
8.2.    Reimbursement for coronary imaging and diagnostic procedures
8.2.1.    Procedure coding 
8.2.2.    Diagnosis coding
8.2.3.    Payment mechanism and reimbursement tariffs
8.2.4.    Policy considerations 
8.2.4.1.    Specifics of commissioning of the procedure
8.2.4.2.    Health technology assessments by NICE
9.    Reimbursement analysis in France
9.1.    Overview of the reimbursement system
9.2.    Reimbursement for coronary imaging and diagnostic procedures
9.2.1.    Procedure coding 
9.2.2.    Diagnosis coding
9.2.3.    Payment mechanism and reimbursement tariffs
9.2.4.    Policy considerations by HAS
10.    Reimbursement analysis in Germany
10.1.    Overview of the reimbursement system
10.2.    Reimbursement for coronary imaging and diagnostic procedures
10.2.1.    Procedure coding 
10.2.2.    Diagnosis coding
10.2.3.    Payment mechanism and reimbursement tariffs
10.2.4.    Policy considerations by G-BA
11.    Reimbursement analysis in Italy
11.1.    Overview of the reimbursement system
11.2.    Reimbursement for coronary imaging and diagnostic procedures
11.2.1.    Procedure coding at national level
11.2.2.    Procedure coding at regional level (Emilia-Romagna, Lombardy, Veneto regions)
11.2.3.    Diagnosis coding
11.2.4.    Payment mechanism and reimbursement tariffs at national level
11.2.5.    Payment mechanism and reimbursement tariffs at regional level
11.2.6.    Policy considerations
12.    Reimbursement analysis in the Netherlands
12.1.    Overview of the reimbursement system
12.2.    Reimbursement for coronary imaging and diagnostic procedures
12.2.1.    Procedure coding 
12.2.2.    Diagnosis coding
12.2.3.    Payment mechanism and reimbursement tariffs
13.    Reimbursement analysis in Norway
13.1.    Overview of the reimbursement system
13.2.    Reimbursement for coronary imaging and diagnostic procedures
13.2.1.    Procedure coding 
13.2.2.    Diagnosis coding
13.2.3.    Payment mechanism and reimbursement tariffs
13.2.4.    Policy considerations 
14.    Reimbursement analysis in Sweden
14.1.    Overview of the reimbursement system
14.2.    Reimbursement for coronary imaging and diagnostic procedures
14.2.1.    Procedure coding 
14.2.2.    Diagnosis coding
14.2.3.    Payment mechanism and reimbursement tariffs
14.2.4.    Policy considerations
15.    Reimbursement analysis in Switzerland
15.1.    Overview of the reimbursement system
15.2.    Reimbursement for coronary imaging and diagnostic procedures
15.2.1.    Procedure coding 
15.2.2.    Diagnosis coding
15.2.3.    Payment mechanism and reimbursement tariffs
15.2.4.    Policy considerations
16.    Disclaimer

16

Apr 2021

In March 2021, the National Institute for Health and Care Excellence (NICE) published four new Interventional Procedure Guidance (transcervical ultrasound-guided radiofrequency ablation for symptomatic uterine fibroids, extracorporeal whole liver perfusion, free-functioning gracilis transfer to restore upper limb function, cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy), two Medical Technologies Guidance (Danis stent for acute oesophageal variceal bleeding, Alpha-Stim AID for anxiety disorders), two Medtech Innovation Briefings (Sonata system for symptomatic uterine fibroids, Butterfly iQ+ for diagnostic ultrasound), and one Diagnostic Guidance (QAngio XA 3D QFR and CAAS vFFR imaging software for assessing coronary stenosis). Also, five clinical guidelines were updated.

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17

Mar 2021

On February 18, 2021, the updated List of Reimbursable Products and Services (LPPR) was published. It contains new devices included in the LPPR list in January-February 2021, as well as other modifications made during this period. The newly-included devices belong to the cardiovascular (TAVI), ENT (cochlear and brainstem implants), and diagnostic imaging (FFR) technology groups.

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09

Feb 2021

On January 26, 2021, NHS Accelerated Access Collaborative published the MedTech Funding Mandate policy for 2021/22, which will come into force in April 2021. According to the NHS Long Term Plan, introducing a MedTech Funding Mandate will support getting innovative medical devices, diagnostics, and digital products to patients faster. Four technologies will be supported in 2021/22 - HeartFlow FFRCT, gammaCore, SecurAcath, and PIGF-based testing.

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22

Dec 2020

In November 2020, the National Institute for Health and Care Excellence (NICE) published one new interventional procedure guidance (for swallowable gastric balloon capsule for weight loss), five Medtech innovation briefings (for QuickChange Incontinence Wrap for urinary incontinence in men, Magseed for locating breast cancer lesions, Dexcom G6 for continuous glucose monitoring, and others). Also, one clinical guidance (for acute coronary syndromes) was updated.

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27

Nov 2020

On October 30, 2020, the Swiss Federal Statistics Office (UFS) published the 2021 version of the procedure code (CHOP) nomenclature in French and Italian. The version in the German language was published in July 2020. The most important changes regard cardiovascular and peripheral vascular interventions.

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