The reimbursement of services in the public outpatient sector in Germany is regulated in the EBM catalog (Einheitlicher Bewertungsmaßstab), updated once in a quarter (4 times a year). The adaption time frame of the EBM catalog for a specific code is around five years but varies depending on the evidence. The latest EBM (German Uniform Evaluation Standard) catalog came into force on July 1, 2021.
The most significant introduced changes concern inclusion of three biomarker tests in breast cancer, the inclusion of a number of services related to cryopreservation of egg and sperm cells in young cancer patients, new services dedicated to prenatal testing of the fetal rhesus factor, reduction of COVID-19 PCR testing reimbursement, as well as the inclusion of services related to the delivery of brachytherapy in prostate cancer and introduction of an IVD test for detection of specific anti-drug antibodies.
The list of the most important changes in EBM for the third quarter of 2021 is presented below. The examples of the new codes introduced in the EBM catalog:
EBM sub-chapter 1.7.4 “Prenatal care”
- 01869 Prenatal determination of the fetal rhesus factor D by examining the RHD gene on fetal DNA from maternal blood of RhD-negative pregnant women with a singleton pregnancy as part of maternity care with a tariff of €100.68;
EBM sub-chapter 8.6 “Cryopreservation of egg or sperm cells or germ cell tissue as well as appropriate medical measures due to germ cell-damaging therapy”
- 08637 Ultrasound-guided and/or laparoscopic follicular puncture for intended egg retrieval in connection with the cryopreservation of egg cells… with a tariff of €40.60;
- 08638 Surcharge for service 08637 for outpatient follicular puncture with a tariff of €49.37;
EBM sub-chapter 19.4.5 “Biomarker-based test methods”
- 19503 Biomarker-based test using the EndoPredict® method…, once in the case of disease, with a tariff of €1,699.80;
- 19504 Biomarker-based test using the MammaPrint® method…, once in the case of disease, with a tariff of €2,100.29;
- 19505 Biomarker-based test using the MammaPrint® method…, once in the case of disease, with a tariff of €2,100.29;
EBM sub-chapter 25.3.3 “Brachytherapy”
- 25335 Interstitial low-dose-rate (LDR) brachytherapy with permanent seed implantation for the treatment of patients with locally advanced prostate cancer…, once in the case of disease, with a tariff of €938.01;
- 25336 Post-implantation control and follow-up planning for interstitial LDR brachytherapy with permanent seed implantation for the treatment of patients with locally advanced prostate cancer…, once in the case of disease, with a tariff of €112.02;
EBM sub-chapter 32.3.5 “Immunological examinations”
- 32481 Detection of anti-drug antibodies according to the product information of a drug with the active ingredient Sebelipase alfa, per examination, with a tariff of €28.70.
Also, the reimbursement for PCR tests to detect SARS-CoV-2 (EBM code 32816) is reduced from €39.40 to €35 per test.
The full details in German can be found here.
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