Surgical and endovascular treatment of brain aneurysm

Cerebral endovascular and surgical interventions
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Report presents summary of reimbursement situation for surgical and endovascular brain aneurysm treatments in European countries. Day case admissions are not considered in the report.  

The report includes the following procedures:

  • Surgical clipping
  • Endovascular placement of a flow diversion device
  • Intra-saccular flow diversion
  • Endovascular coiling
  • Stent-assisted coiling

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.

The only reimbursement within public / statutory health insurance systems is considered.

Manufacturers of devices for brain aneurysm treatment include:

Flow diversion device

  • Acandis GmbH (DERIVO Embolisation Device)
  • Balt Extrusion (The SILK flow diverter)
  • Medtronic (Pipeline Flex Embolization Device)
  • MicroPort NeuroTech (Tubridge Vascular Reconstruction Device)
  • MicroVention (Flow-Redirection Endoluminal Device)
  • MINT Technologies (Sphere)
  • Phenox GmbH (p64 Flow Modulation Device)
  • Stryker Neurovascular (Surpass Streamline Flow Diverter)

Coils for intracranial aneurysms

  • Cerenovus (Galaxy g3 MINI Coil)
  • Codman Neuro (Orbit galaxy, Micrusphere, Cashmere, Deltamaxx)
  • Penumbra Inc (Penumbra SMART COIL, Penumbra Coil 400)
  • Stryker (Target 360, Target Ultrasoft)
  • Taewoong Medical Co. (K3 Platinum Coil)
  • Terumo (Hydrogel coating embolization coil azur cx)

Stent-assisted coiling

  • Acandis GmbH (ACCLINO flex plus Stent)
  • Medtronic (Axium Detachable Coils, Solitaire Platinum Revascularization Device)
  • Microvention (LVIS, LVIS Jr. devices)
  • Stryker (Intracranial stent / nitinol / self-expanding / embolization coil support Neuroform EZ)
  • Taewoong Medical Co. (Barricade Coil System

Table of content
1.    Introduction and summary
2.    Contents
3.    Executive summary table
4.    Methodology
5.    What’s new
6.    Reimbursement analysis in Austria

6.1.    Overview of the reimbursement system
6.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm
6.2.1.    Procedure coding
6.2.2.    Diagnosis coding
6.2.3.    Payment mechanism and reimbursement tariffs
6.2.4.    Policy considerations
7.    Reimbursement analysis in Belgium
7.1.    Overview of the reimbursement system
7.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm
7.2.1.    Procedure coding
7.2.2.    Material coding
7.2.3.    Payment mechanism and reimbursement tariffs
7.2.4.    Policy considerations
7.2.5.    Procedure volume information
8.    Reimbursement analysis in Denmark
8.1.    Overview of the reimbursement system
8.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm
8.2.1.    Procedure coding 
8.2.2.    Diagnosis coding
8.2.3.    Payment mechanism and reimbursement tariffs
8.2.4.    Policy considerations
8.2.5.    Procedure volume information
9.    Reimbursement analysis in England
9.1.    Overview of the reimbursement system
9.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm
9.2.1.    Procedure coding 
9.2.2.    Diagnosis coding
9.2.3.    Payment mechanism and reimbursement tariffs
9.2.4.    Policy considerations    Specifics of commissioning of the procedure    Health technology assessments by NICE
9.2.5.    Procedure volume information
10.    Reimbursement analysis in France
10.1.    Overview of the reimbursement system
10.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm
10.2.1.    Procedure coding 
10.2.2.    Diagnosis coding
10.2.3.    Payment mechanism and reimbursement tariffs
10.2.4.    Policy considerations by HAS
10.2.5.    Procedure volume information
11.    Reimbursement analysis in Germany
11.1.    Overview of the reimbursement system
11.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm
11.2.1.    Procedure coding 
11.2.2.    Diagnosis coding
11.2.3.    Payment mechanism and reimbursement tariffs
11.2.4.    Policy considerations by G-BA
11.2.5.    Procedure volume information
12.    Reimbursement analysis in Italy
12.1.    Overview of the reimbursement system
12.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm
12.2.1.    Procedure coding
12.2.2.    Diagnosis coding
12.2.3.    Payment mechanism and reimbursement tariffs
12.2.4.    Policy considerations
12.2.5.    Procedure volume information
13.    Reimbursement analysis in the Netherlands
13.1.    Overview of the reimbursement system
13.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm
13.2.1.    Procedure coding 
13.2.2.    Material codes
13.2.3.    Diagnosis coding
13.2.4.    Payment mechanism and reimbursement tariffs
13.2.5.    Policy considerations
13.2.6.    Procedure volume information
14.    Reimbursement analysis in Norway
14.1.    Overview of the reimbursement system
14.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm
14.2.1.    Procedure coding 
14.2.2.    Diagnosis coding
14.2.3.    Payment mechanism and reimbursement tariffs
14.2.4.    Policy considerations 
14.2.5.    Procedure volume information
15.    Reimbursement analysis in Sweden
15.1.    Overview of the reimbursement system
15.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm 
15.2.1.    Procedure coding 
15.2.2.    Diagnosis coding
15.2.3.    Payment mechanism and reimbursement tariffs
15.2.4.    Policy considerations 
15.2.5.    Procedure volume information
16.    Reimbursement analysis in Switzerland
16.1.    Overview of the reimbursement system
16.2.    Reimbursement for surgical and endovascular treatment of brain aneurysm
16.2.1.    Procedure coding 
16.2.2.    Diagnosis coding
16.2.3.    Payment mechanism and reimbursement tariffs
16.2.4.    Policy considerations
16.2.5.    Procedure volume information
17.    Disclaimer


Aug 2021

On July 30, 2021, the Swiss Federal Statistics Office (UFS) published the 2022 version of the procedure code (CHOP) nomenclature in the German language. The newly introduced codes concern various technology groups, such as cardiovascular, gastrointestinal, neurology, interventional radiology, orthopedics, gynecology, and others.

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Jun 2021

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in May 2021. Recommendations concern orthopedic devices, cardiovascular, peripheral vascular, and neurovascular devices, medical aids, and pulmonary artery pressure sensor.

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Feb 2021

On January 29, 2021, the Institute for the Hospital Remuneration System (InEK) has published the List of the requests for innovation funding (NUB) that were submitted by the hospitals in 2020. The medical technologies belonging to the cardiovascular, ENT, eHealth, gastrointestinal, neuromodulation, neurovascular, orthopedic, and other technology groups obtained positive status 1.

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Jan 2021

In early January 2021, the new reimbursable health app was introduced on the Directory of digital health applications (DiGAs) at the Federal Office for Drugs and Medical Devices (BfArM). These applications can be prescribed by physicians and psychotherapists and will be reimbursed by health insurers.

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Sep 2019

In August 2019, the National Institute for Health and Care Excellence published one new MedTech innovation briefings for vacuum therapy for colorectal anastomotic leakage and two new interventional procedure guidance for endovascular insertion of an intrasaccular wire-mesh blood-flow disruption device for intracranial aneurysms and the Papillon technique for locally advanced rectal cancer.

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