Procedure coding
Procedure coding for spine surgery is well-established in many European countries. The procedure codes distinguish between the different types of spine therapeutic interventions, including decompression, reduction or fixation of fracture, stabilization of the spine, and instrumental correction of spine deformity, prosthetic replacement of intervertebral discs, spine joint fusion, etc. In addition to procedure type, the code usually indicates the segment or level of the spine (e.g., cervical, thoracic, lumbar).
Due to the rapid development of minimally invasive spine surgery, new codes for spine surgery are frequently implemented in procedural nomenclatures. For example, in England, a new OPCS code V44.6 “Augmentation vertebroplasty of fracture of spine using intravertebral implant” was implemented under sub-chapter V43 “Decompression of fracture of spine” in 2023. The code includes the insertion of the intravertebral implant with cement for the fracture of the spine.
Payment mechanism
The payment model for spine surgery varies by country and the type of procedure.
In some European countries (England, Italy, and countries of the Nordic region), both conventional and minimally invasive spine surgery is reimbursed solely via the diagnosis-related group (DRG) mechanism. The DRGs might be different depending on the type of procedure. Due to the rapid development of minimally invasive spine surgery, the DRG systems are updated following the implementation of novel procedure codes. For example, in France, after the implementation of several novel CCAM procedure codes for transcutaneous image-guided spondyloplasty by intracorporeal implant in 2021, the new DRG root 08K05 “Spondyloplasties” was implemented in 2022. The current 2025 tariffs for DRG root 08K05 range from €2,078 to €8,148, depending on the DRG severity level.
In some countries (e.g., France and Germany), spine surgery devices attract additional reimbursement, paid on top of the DRG tariff. For example, in Germany, there is an add-on (ZE) category for implantation or replacement of an interspinous spacers (implants that are placed in the interspinous processes to distract the vertebrae and regain disc height for reduction of the pressure on the spreading intervertebral disc) with a national tariff ranging from €143 to €430, depending on the number of spine segments treated.
Policy considerations
Many types of spine surgery 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. The exception is novel spine surgical interventions involving innovative and expensive medical devices, which can be subject to specific policies. For example, NHS England is currently developing a Clinical Commissioning Policy on non-invasively lengthened spinal rods for scoliosis, which was initiated in October 2024.
New techniques of spine surgery frequently become a subject of innovative payment schemes. For example, in Germany, spine surgery procedures annually receive positive status 1 for innovation funding (NUB) – 17 methods since 2021, including four methods (treatment of scoliosis using an intracorporeally expandable screw-rod system, treatment of scoliosis using a growing screw-rod system, treatment of scoliosis using magnetically controlled rods, vertebral body growth modulation technique) in 2025.
Health technology assessment
Due to the rapid development and innovation of spine surgery technologies, they frequently become a subject of HTA. For example, in April 2023, the National Institute for Health and Care Excellence (NICE) developed interventional procedure guidance on radiofrequency ablation as an adjunct to balloon kyphoplasty or percutaneous vertebroplasty for palliation of painful spinal metastases, in which concluded that evidence on the safety and efficacy of the procedure is adequate to support using it with standard arrangements for clinical governance, consent, and audit.
In the Netherlands, the Dutch Healthcare Institute (ZIN) is currently assessing the effectiveness of vertebroplasty for painful vertebral metastases or multiple myeloma sites in the vertebrae. The main research topic is whether the procedure leads to a faster and longer-lasting reduction in pain complaints, better physical functioning of the patient, and a better quality of life compared to standard treatment. The publication of the Position by ZIN is scheduled for October 2025.
Future challenges
Many spine surgery techniques have established reimbursement and funding in most European countries. Rapid development of novel technologies, using innovative and expensive devices and integrated technologies (e.g., robotics, navigation systems, AI-assisted tools), would be a subject of health technology assessments.
Novel devices for spine surgery with unique designs might need to develop specific procedure codes and adjust payment mechanisms to fully leverage their unique technology or cost profile.
MTRC has experience with more than five projects related to spine surgery in Europe.
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