In the Netherlands, Basic Health Insurance is determined/guaranteed by the Health Insurance Law (Zorgverzekeringswet, Zvw). The Law describes care in very general terms, so there is a lack of clarity in many situations regarding what is covered. Dutch Health Care Institute (Zorginstituut Nederland) is responsible for determining the allocation of care under Basic Health Insurance. The position of the Institute is based on an assessment of clinical and economic evidence to determine the conformity of care with a “state of science and practice.”
According to the “Overview of care activities with a claim code” (2020), prostatic urethral lift belongs to the type of care with specific conditions of reimbursement within the basic health insurance and has a claim code “2601”. Prostatic Urethral Lift / Urolift in patients with non-neurogenic symptoms lower urinary tract (LUTS) in benign prostatic hyperplasia (BPH) meets the state of science and practice in the following indications:
- Patients with non-neurogenic LUTS due to BPH, for whom a prostatectomy is indicated, but the patient wants to maintain ejaculation and erections;
- Patients who have very debilitating or very limiting side effects of drug treatment of LUTS due to BPH and who wish to be treated using minimally invasive technique;
- Patients with higher ASA classification (3 or higher) and with non-neurogenic LUTS (with or without catheter), who underwent surgery and for whom the local anesthesia can take place. This is an indication for people who have complaints and who should undergo prostatectomy but cannot have surgery because the risk is too high for that.
To specify the use of the new care activity codes were added in 2020:
- Transprostatic placement of implants for urethral prostatic obstruction, using an implantation system (036522);
- Transprostatic implant for the reduction of urethral prostatic obstruction (190680).
See the full details here.
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