At the end of December 2018, the Federal Joint Committee (G-BA) decided that optical coherence tomography (OCT) for the diagnosis and therapy control of neovascular age-related macular degeneration (nAMD) and macular edema in diabetic retinopathy (DME) will be covered by the statutory health insurance (SHI).
OCT is an imaging technique that allows evaluating the retinal structures of the eye, as well as the fluid retention and changes in retinal thickness. In the future, it may be used at the expense of the SHI for patients with diagnosed nAMD and DME and in cases when the necessity of intravitreally drug administration should be checked. To ensure the quality of treatment, the G-BA has determined that OCT may only be performed by ophthalmologists.
The resolution was submitted to the Federal Ministry of Health for review and will enter into force in case of non-objection and after the announcement in the Federal Gazette. The OCT can only be provided as an outpatient benefit, once the Valuation Committee agrees upon the level of remuneration in the EBM catalogue.
This decision is based on the IQWiG’s (Institute for Quality and Efficiency in Health Care) report published in July 2017 (see here). IQWiG was assigned this task by the G-BA in October 2015.
The full details in German can be found here.
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