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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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Upcoming changes in the coverage of medical procedures in Switzerland

On December 22, 2020, the Swiss Federal Office of Public Health announced the changes that will occur to the Services Ordinance (KLV/OPre). The updates will enter into force on January 1, 2021 (unless specified otherwise), and they include:

  • Mostly wording changes will occur in the general part of the Services Ordinance (KLV/OPre)
  • Various changes in coverage of explicitly evaluated services, such as different reimbursement conditions, the extension of reimbursement of certain services, and new reimbursement decisions will occur in Annex 1 of the Services Ordinance (explicitly evaluated services). The most important examples are:
    • Service “Metabolic surgery” was introduced instead of “Surgical therapy of obesity”. This service is covered with evidence development until the end of 2025. Reimbursement is provided in certain conditions, only
    • Coverage of evidence development of “Autologous Chondrocyte Transplant” is extended until the end of 2024
    • Coverage of evidence development of ultrasound focused therapy of pallidum, thalamus and subthalamus, for the treatment of severe chronic neuropathic pain refractory to therapy is extended until the end of 2025
    • Various other changes in conditions for reimbursement of other services
    • Removal of various services from Annex 1  
  • Mostly wording updates will occur in Annex 1a of the Services Ordinance (ambulatory-before-stationary services)
  • Various updates regarding reimbursement of medical aids will occur in Annex 2 of the Services Ordinance (List of Medical Aids and Equipment). The changes will enter into force at different times - January 1, 2021; April 1, 2021; July 1, 2021; and January 1, 2022
  • Changes in Annex 3 of the Services Ordinance (List of Analyses). The changes will enter into force on the first of February 2021.
    • The most important change is the inclusion of one new test (Mycobacterium tuberculosis complex, rifampicin resistant bacteria, antibiogram, with the code 3488.00 and tariff of CHF 47) will be reimbursed since January 1, 2021
    • Several wording updates will also occur
  • Changes in Annex 4 of the Services Ordinance (List of Medications with Tariff)

See more details here.

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