The Nomenclature of health benefits includes the benefits (with specific hospital and ambulatory codes) reimbursed by health care insurance, partially or totally. The Nomenclature and changes are published in the Belgian Official Gazette.
Changes will be made in nine chapters of Nomenclature. In relation to medical technologies and in-vitro diagnostics, the most important changes include changes in conditions for two ophthalmology and endoscopy codes, new conditions for reimbursement of photodynamic therapy in dermatology, introduction of two new codes for IVDs, and creating of requirements for reimbursement of number of IVD tests in pregnancy.
The changes of the following articles of the Nomenclature will come into force since June 1, 2017:
- Article 9 “Childbirth”
- Article 11 “General Special Benefits”
- Article 14 (g) “Gynecology and obstetrics”
- Article 14 (h) “Ophthalmology”
- Article 16 “Assistance and operational aid: implementing rules”
- Article 18 “Radiotherapy and Radiation Therapy - Nuclear Medicine”
- Article 20 “Internal Medicine”
- Article 21 “Dermatovenereology”
- Article 24 “Clinical biology”
Key changes in the "Ophthalmology" section
The following procedures cannot be certified as refractive surgery:
- Extraction of the crystalline lens (regardless the technique), including the possible intraocular implantation of a lens (246595-246606)
- Extracapsular extraction of the lens by fragmentation by ultrasound, laser or other similar method, including the possible implantation of a lens (246912-246923)
Key changes in the "Internal Medicine" section
Conditions of reimbursement for the following procedures have been updated:
- Examination of the upper digestive tract by endoscopy (473056-473060): the procedure should be reimbursed not more than once every 3 years unless the justification for a shorter period is included in the examination report
- Excision of colon, ileum or jejunum polyp (s), with a diathermic loop, by endoscopy (473211-473222 and 473955-473966): the procedure cannot be performed on rectosigmoid polyps ≤ 5 mm
Key changes in the "Dermatovenereology" chapter
New conditions of reimbursement for Dynamic phototherapy (532770-532781) have been implemented:
- The procedure is performed for the treatment of neoplastic or pre-neoplastic lesions of the skin and mucous membranes
- The procedure requires the application of a photosensitizer and artificial light
- The procedure is reimbursed up to 3 times per day
- The procedure is reimbursed only once for the treatment of lesions located in the same field of illumination
- For treatment of lesions in different illumination fields, the reimbursement of second and third procedures is reduced by 50%
- The service cannot be delivered together with:
- a dermabrasion procedure (532593-532604, 532210-532221)
- a procedure for the removal or destruction of mucocutaneous lesion (353231-353242, 532630-532641)
Key changes in the "Clinical biology" chapter
New codes for the following IVD-tests have been implemented:
- specific IgM antibodies against Cytomegalovirus during pregnancy (552274-552285 and 552296-552300
- specific IgG antibodies against Toxoplasma Gondii during pregnancy (552392-552403 and 552414-552425)
Specific conditions of reimbursement during pregnancy have been implemented for the following IVD-tests:
- specific IgM antibodies against Cytomegalovirus during pregnancy (552274-552285 and 552296-552300): can only be provided if there is a clinical presumption of acute Cytomegalovirus infection during pregnancy
- specific IgG antibodies against Toxoplasma Gondii during pregnancy (552392-552403 and 552414-552425): can be performed only twice during pregnancy
- specific IgM antibodies against cytomegalovirus (551316-551320 and 551331-551342): procedure code cannot be used during pregnancy
- IgG antibodies against Toxoplasma Gondii (551751-551762): procedure code cannot be used during pregnancy with the exception of a clinical presumption of an acute Toxoplasma Gondii infection
- specific IgM antibodies against Toxoplasma Gondii (551773-551784): procedure code cannot be used during pregnancy with the exception of a clinical presumption of an acute Toxoplasma Gondii infection
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