Robotic surgery interventions

Series
Robotic surgery
Status
Published
Date
Number of report
015

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Report presents summary of reimbursement situation for procedures using robotic equipment in European countries.

Five the most common robotic surgical procedures are included into report:

  • Total prostatectomy for prostate cancer
  • Total nephrectomy for kidney cancer
  • Total hysterectomy for endometrial cancer
  • Anterior resection of rectum for rectal cancer
  • Nissen (total) fundoplication for gastro-esophageal reflux disease (GERD)

Three types of surgical access are considered in the report:

  • Open access
  • Laparoscopic access
  • Robot-assisted access

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

Report focuses solely on reimbursement of robotic-assisted procedures and does not provide information about procurement of robotic equipment.

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 robotic surgery systems include:

  • Auris Surgical Robotics 
  • Corindus Vascular Robotics (CorPath®)                     
  • Elmed medical systems (Avicenna Roboflex™)                
  • Hansen Medical (Magellan™)                                                             
  • Intuitive Surgical (da Vinci®)
  • KB Medical (AQrate™)                                     
  • Mazor Robotics (Renaissance®)                     
  • Medrobotics (Flex®)                               
  • OR Productivity (FreeHand)                                                          
  • Renishaw (neuromate®) 
  • Robocath                                        
  • Smith & Nephew (NAVIO)            
  • Stereotaxis (Epoch®)                                        
  • Stryker (Mako platform)
  • THINK Surgical (TSolution One®)                                  
  • Titan Medical (SPORT™)                                       
  • TransEnterix (SurgiBot™)                                  
  • Verb Surgical                                     
  • Virtual Incision

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 robotic surgery interventions
5.2.1.    Procedure coding
5.2.1.1.    Procedure coding for total prostatectomy
5.2.1.2.    Procedure coding for total nephrectomy
5.2.1.3.    Procedure coding for total hysterectomy
5.2.1.4.    Procedure coding for resection of rectum
5.2.1.5.    Procedure coding for total fundoplication
5.2.2.    Diagnosis coding
5.2.3.    Payment mechanism and reimbursement tariffs
5.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
5.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
5.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
5.2.3.4.    Reimbursement for resection of rectum in rectal cancer
5.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
5.2.4.    Health technology assessment by LBI-HTA
6.    Reimbursement analysis in Belgium
6.1.    Overview of the reimbursement system
6.2.    Reimbursement for robotic surgery interventions
6.2.1.    Procedure coding 
6.2.1.1.    Coding for total prostatectomy
6.2.1.2.    Coding for total nephrectomy
6.2.1.3.    Coding for total hysterectomy
6.2.1.4.    Coding for resection of rectum
6.2.2.    Payment mechanism and reimbursement tariffs
6.2.2.1.    Reimbursement for total prostatectomy in prostate cancer
6.2.2.2.    Reimbursement for total nephrectomy in kidney cancer
6.2.2.3.    Reimbursement for total hysterectomy in endometrial cancer
6.2.2.4.    Reimbursement for resection of rectum in rectal cancer
6.2.3.    Policy considerations for robotic-assisted total prostatectomy
6.2.3.1.    Health technology assessment by KCE
7.    Reimbursement analysis in Denmark
7.1.    Overview of the reimbursement system
7.2.    Reimbursement for robotic surgery interventions
7.2.1.    Procedure coding 
7.2.1.1.    Procedure coding for total prostatectomy
7.2.1.2.    Procedure coding for total nephrectomy
7.2.1.3.    Procedure coding for total hysterectomy
7.2.1.4.    Procedure coding for resection of rectum
7.2.1.5.    Procedure coding for total fundoplication
7.2.2.    Diagnosis coding
7.2.3.    Payment mechanism and reimbursement tariffs
7.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
7.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
7.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
7.2.3.4.    Reimbursement for resection of rectum in rectal cancer
7.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
8.    Reimbursement analysis in England
8.1.    Overview of the reimbursement system
8.2.    Reimbursement for robotic surgery interventions
8.2.1.    Procedure coding 
8.2.1.1.    Procedure coding for total prostatectomy
8.2.1.2.    Procedure coding for total nephrectomy
8.2.1.3.    Procedure coding for total hysterectomy
8.2.1.4.    Procedure coding for resection of rectum
8.2.1.5.    Procedure coding for total fundoplication
8.2.2.    Diagnosis coding
8.2.3.    Payment mechanism and reimbursement tariffs
8.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
8.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
8.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
8.2.3.4.    Reimbursement for resection of rectum in rectal cancer
8.2.4.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
8.2.5.    Policy considerations 
8.2.5.1.    National commissioning by NHS England
8.2.5.1.1.    Commissioning of robotic-assisted prostatectomy
8.2.5.1.2.    Commissioning of robotic-assisted total nephrectomy
8.2.5.1.3.    Commissioning of robotic-assisted total hysterectomy
8.2.5.1.4.    Commissioning of robotic-assisted resection of rectum with anastomosis
8.2.5.2.    Health technology assessment by NICE
9.    Reimbursement analysis in France
9.1.    Overview of the reimbursement system
9.2.    Reimbursement for robotic surgery interventions
9.2.1.    Procedure coding 
9.2.1.1.    Procedure coding for total prostatectomy
9.2.1.2.    Procedure coding for total nephrectomy
9.2.1.3.    Procedure coding for total hysterectomy
9.2.1.4.    Procedure coding for resection of rectum
9.2.2.    Diagnosis coding
9.2.3.    Payment mechanism and reimbursement tariffs
9.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
9.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
9.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
9.2.3.4.    Reimbursement for resection of rectum in rectal cancer
9.2.4.    Policy considerations
9.2.4.1.    Health technology assessment of total robot-assisted prostatectomy by HAS
9.2.4.2.    Coverage with evidence development
10.    Reimbursement analysis in Germany
10.1.    Overview of the reimbursement system
10.2.    Reimbursement for robotic surgery interventions
10.2.1.    Procedure coding 
10.2.1.1.    Procedure coding for total prostatectomy
10.2.1.2.    Procedure coding for total nephrectomy
10.2.1.3.    Procedure coding for total hysterectomy
10.2.1.4.    Procedure coding for resection of rectum
10.2.2.    Procedure coding for total fundoplication
10.2.3.    Diagnosis coding
10.2.4.    Payment mechanism and reimbursement tariffs
10.2.4.1.    Reimbursement for total prostatectomy in prostate cancer
10.2.4.2.    Reimbursement for total nephrectomy in kidney cancer
10.2.4.3.    Reimbursement for total hysterectomy in endometrial cancer
10.2.4.4.    Reimbursement for resection of rectum in rectal cancer
10.2.4.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
11.    Reimbursement analysis in Italy
11.1.    Overview of the reimbursement system
11.2.    Reimbursement for robotic surgery interventions
11.2.1.    Procedure coding 
11.2.1.1.    Procedure coding for total prostatectomy
11.2.1.2.    Procedure coding for total nephrectomy
11.2.1.3.    Procedure coding for total hysterectomy
11.2.1.4.    Procedure coding for resection of rectum
11.2.1.5.    Procedure coding for total fundoplication
11.2.2.    Diagnosis coding
11.2.3.    Payment mechanism and reimbursement tariffs at national level
11.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
11.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
11.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
11.2.3.4.    Reimbursement for resection of rectum in rectal cancer
11.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
12.    Reimbursement analysis in the Netherlands
12.1.    Overview of the reimbursement system
12.2.    Reimbursement for robotic surgery interventions
12.2.1.    Procedure coding 
12.2.1.1.    Procedure coding for total prostatectomy
12.2.1.2.    Procedure coding for total nephrectomy
12.2.1.3.    Procedure coding for total hysterectomy
12.2.1.4.    Procedure coding for resection of rectum
12.2.1.5.    Procedure coding for total fundoplication
12.2.2.    Diagnosis coding
12.2.3.    Payment mechanism and reimbursement tariffs
12.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
12.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
12.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
12.2.3.4.    Reimbursement for resection of rectum in rectal cancer
12.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
12.2.4.    Policy considerations
12.2.5.    Health technology assessment by National Healthcare Institute
13.    Reimbursement analysis in Norway
13.1.    Overview of the reimbursement system
13.2.    Reimbursement for mitral robotic surgery interventions
13.2.1.    Procedure coding
13.2.1.1.    Procedure coding for total prostatectomy
13.2.1.2.    Procedure coding for total nephrectomy
13.2.1.3.    Procedure coding for total hysterectomy
13.2.1.4.    Procedure coding for resection of rectum
13.2.1.5.    Procedure coding for total fundoplication 
13.2.2.    Diagnosis coding
13.2.3.    Payment mechanism and reimbursement tariffs
13.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
13.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
13.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
13.2.3.4.    Reimbursement for resection of rectum in rectal cancer
13.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
13.2.4.    Policy considerations 
13.2.4.1.    Review of evidence for robot-assisted prostatectomy by NOKC
14.    Reimbursement analysis in Sweden
14.1.    Overview of the reimbursement system
14.2.    Reimbursement for robotic surgery interventions
14.2.1.    Procedure coding 
14.2.1.1.    Procedure coding for total prostatectomy
14.2.1.2.    Procedure coding for total nephrectomy
14.2.1.3.    Procedure coding for total hysterectomy
14.2.1.4.    Procedure coding for resection of rectum
14.2.1.5.    Procedure coding for total fundoplication
14.2.2.    Diagnosis coding
14.2.3.    Payment mechanism and reimbursement tariffs
14.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
14.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
14.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
14.2.3.4.    Reimbursement for resection of rectum in rectal cancer
14.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
14.2.4.    Policy considerations 
14.2.4.1.    Recommendations for radical prostatectomy in the national clinical guidelines
14.2.4.2.    Recommendations for resection of rectum in the national clinical guidelines
15.    Reimbursement analysis in Switzerland
15.1.    Overview of the reimbursement system
15.2.    Reimbursement for robotic surgery interventions
15.2.1.    Procedure coding 
15.2.1.1.    Procedure coding for total prostatectomy
15.2.1.2.    Procedure coding for total nephrectomy
15.2.1.3.    Procedure coding for total hysterectomy
15.2.1.4.    Procedure coding for resection of rectum
15.2.1.5.    Procedure coding for total fundoplication
15.2.2.    Diagnosis coding
15.2.3.    Payment mechanism and reimbursement tariffs
15.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
15.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
15.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
15.2.3.4.    Reimbursement for resection of rectum in rectal cancer
15.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
15.2.4.    Policy considerations 
16.    Disclaimer

07

Oct 2019

In September 2019, the French High Authority for Health (HAS) has released an assessment report regarding the evaluation of total or partial robotic-assisted nephrectomy, compared to open surgery and conventional laparoscopic surgery. Due to the lack of any prospective comparative studies reporting robust results with relevant judgment criteria and collected with appropriate follow-up time, HAS could not comment on the expected service or the expected service improvement of robot-assisted nephrectomy compared to open surgery or conventional laparoscopic surgery.

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14

Jun 2019

In early May 2019, the Austrian HTA body, the Ludwig-Boltzmann Institute (LBI), has published a health technology assessment on robot-assisted surgery in thoracic and visceral indications as part of the EUnetHTA work.

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01

May 2019

In Sweden, the Centre for Assessment of Medical Technology (CAMTÖ) leads the development of HTA cooperation in healthcare region Uppsala-Örebro. Currently, CAMTÖ is working on several assessments related to the medical devices and technologies such as equipment for 3D Printing, robot Intuitive daVinci Xi etc. After the completion of assessment procedure, the reports will be published at the web-site of Örebro County Council.

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30

Apr 2019

The Clinical Coding and Schedule Development (CCSD) group develop and maintains procedural and diagnostics nomenclature for private payers in England. New diagnostic codes concern circulating tumor DNA profile for the different type of cancers, myriad Prolaris test, PET Scan with florbetapir, etc. and a procedure code for robotic-assisted radical hysterectomy and lymphadenectomy. The codes are introduced with a recommended adoption date being the 1st of May 2019. The documents also contain a list of textual changes in codes and an updated list of unacceptable combinations of codes.

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11

Apr 2019

On March 15, 2019, the Swiss Medical Board published two appraisal reports: “Robot-assisted laparoscopic surgery versus open surgery for radical prostatectomy” and “Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery for simple or radical hysterectomy.”

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29

Mar 2019

Norway established in 2013 a framework “New Method” for the introduction of innovations into the health care system through either a national or hospital-based health technology assessment. In this framework, all innovations should undergo HTA before being funded. Currently, 13 ongoing mini-HTA projects are conducted in Norway: robotic-assisted procedures, microwave ablation, and tonsillectomy devices, among others.

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08

Feb 2019

The Clinical Coding and Schedule Development (CCSD) group develop and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern robotic-assisted laparoscopic procedures, 2-dimensional radiotherapy, revision of anti-reflux operations, etc. The codes are introduced with a recommended adoption date being the 1st of May 2019. The document also contains a list of textual changes in codes and an updated list of unacceptable combinations of codes.

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29

Jan 2019

The Clinical Coding and Schedule Development (CCSD) group develops and maintains procedural and diagnostics nomenclature for private payers in England. In October/November 2018, five new procedure codes for laser correction of refractive error following non-refractive ophthalmic surgery, insertion of urethral catheterization device, injection of botulinum toxin for hyperhidrosis, laparoscopic and robotic-assisted pancreatoduodenectomy have been added to the CCSD Schedule.

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18

Jan 2019

Two mini-method assessments regarding intraepidermal nerve fiber density in skin biopsy and neurovascular structure-adjacent frozen-section (NeuroSAFE) during robot-assisted laparoscopic prostatectomy (RALP) were initiated by Oslo University Hospital in December of 2018. All finalized mini-method assessments are published in the National Database for Mini-HTA.

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26

Nov 2018

The Clinical Coding and Schedule Development Group develops and maintains procedural and diagnostics nomenclature for private payers in England. In October, eight new procedure codes for operations on joints, morcellation of uterine leiomyomas, transurethral water vapour and water jet ablation for lower urinary tract symptoms and transoral surgery have been added to the CCSD Schedule.

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09

Nov 2018

Two mini-method assessments regarding the magnetic technology (Magseed) for labeling non-palpable breast lesions and robotic-assisted minimally invasive harvesting of muscle patches for reconstructive surgery were initiated in Norway this October of 2018. All finalized mini-method assessments are published in the National Database for Mini-HTA.

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10

Oct 2018

EUnetHTA is a network of HTA bodies within Europe that promote the development of health technology assessment in all European countries by working together. This article will present the plans for the projects that will be published in the near future.

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18

May 2018

In the second half of April, the National Institute for Health and Care Excellence (NICE) published one diagnostic guidance on adjunctive colposcopy technologies for assessing suspected cervical abnormalities, four Interventional Procedure Guidance for robot-assisted kidney transplant, nerve transfer to partially restore upper limb function in tetraplegia, prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia and microinvasive subconjunctival insertion of a trans-scleral gelatin stent for primary open-angle glaucoma, and two new MedTech Innovation Briefings for sleep mask for diabetic retinopathy and diabetic macular oedema and disinfecting cap for needleless connectors.

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12

Feb 2018

The Clinical Coding and Schedule Development Group develops and maintains procedural and diagnostics nomenclature for private payers in England. In January new codes for robotic assisted laparoscopic pelvic lymphadenectomy, ligation of the intersphincteric fistula tract and eminectomy of temporomandibular joint were added to the CCSD Schedule.

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03

Aug 2017

The Clinical Coding and Schedule Development Group develops and maintains procedural and diagnostics nomenclature for private payers in England. Several codes were added to both procedural and diagnostic Schedules, including procedures for treatment of knee and hip osteoarthritis, robotic procedure, insertion of wireless pacemaker.

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27

Jun 2017

Assessments were directed by national HTA body AGENAS. They cover renal denervation for hypertension, next generation sequencing in oncology, robotic surgery, sling operation for urinary incontinence and vertebral disc replacement.

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06

Jun 2017

HAS published updated program that defines priority areas of work for 2017, including evidence review as part of developing new procedure codes for robotic surgery, endoscopic procedures, and technology assessments of remote monitoring, dialysis, coronary stents and others.

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23

May 2017

MTRC has completed reimbursement report for robotic surgery in 11 EU countries. Procedure codes are available only in number of geographies, including Belgium, Denmark, England, Germany, Norway, Sweden and Switzerland. Robotic-specific procedure codes are not available in Austria, France, Italy and the Netherlands.

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