Stereotactic Radiosurgery

Series
Radiotherapy
Status
Published
Date
Number of report
025

Ask the expert

(we accept only company emails)

The report presents a summary of reimbursement situation for Stereotactic Radiosurgery (SRS) in European countries.      

The analysis covers the application of SRS in primary and secondary malignant brain tumours.

The analysis is provided for the session and out-patient treatment, including both preparation and delivery of SRS. The only reimbursement within public / statutory health insurance systems is considered.

The report includes essential information about reimbursement, including:

  • Brief country-specific overview of reimbursement system
  • Procedure coding for technology
  • Diagnosis coding
  • Payment mechanism for technology
  • Reimbursement tariffs for technology
  • Restrictions on indications or scenarios for the use of technology
  • Policy considerations by payers and policy-makers about technology

Reimbursement information is provided for the following geographies:

  • Austria
  • Belgium
  • Denmark
  • England (UK)
  • Finland
  • France
  • Germany
  • Italy
  • The Netherlands
  • Norway
  • Sweden
  • Switzerland

Manufacturers of equipment for stereotactic radiosurgery include:

  1. Accuray (CyberKnife)  
  2. Brainlab (Novalis)
  3. Elekta (Versa HD, Leksell Gamma Knife Icon, Leksell Gamma Knife Perfexion, Leksell Gamma Knife 4C, Leksell Gamma Knife 4)
  4. Varian Medical Systems (Edge, TrueBeam, Clinac iX)

Table of content 
1.    Introduction and summary
2.    Executive summary table

2.1.    Stereotactic radiosurgery
2.2.    Fractionated stereotactic radiotherapy
3.    Contents
4.    Abbreviations
5.    Methodology
6.    Reimbursement analysis in Austria

6.1.    Overview of the reimbursement system
6.2.    Reimbursement for stereotactic radiosurgery and radiotherapy
6.2.1.    Procedure coding
6.2.2.    Diagnosis coding
6.2.3.    Payment mechanism and reimbursement tariffs
6.2.4.    Health technology assessments by LBI-HTA
7.    Reimbursement analysis in Belgium
7.1.    Overview of the reimbursement system
7.2.    Reimbursement for stereotactic radiosurgery and radiotherapy
7.2.1.    Procedure coding
7.2.2.    Payment mechanism and reimbursement tariffs
7.3.    Policy considerations by the INAMI/RIZIV
7.4.    Health technology assessments by KCE
7.5.    Breast cancer in women: diagnosis, treatment and follow-up
8.    Reimbursement analysis in Denmark
8.1.    Overview of the reimbursement system
8.2.    Reimbursement for stereotactic radiosurgery and radiotherapy
8.2.1.    Procedure coding 
8.2.2.    Diagnosis coding
8.2.3.    Payment mechanism and reimbursement tariffs
8.2.4.    Policy considerations
9.    Reimbursement analysis in England
9.1.    Overview of the reimbursement system
9.2.    Reimbursement for stereotactic radiosurgery and radiotherapy
9.2.1.    Procedure coding 
9.2.2.    Diagnosis coding
9.2.3.    Payment mechanism and reimbursement tariffs
9.2.4.    Policy considerations 
9.2.4.1.    Specifics of commissioning of the procedure
9.2.4.2.    Health technology assessments by NICE
10.    Reimbursement analysis in Finland
10.1.    Overview of the reimbursement system
10.2.    Reimbursement for stereotactic radiosurgery and radiotherapy
10.2.1.    Procedure coding 
10.2.2.    Diagnosis coding
10.2.3.    Payment mechanism and reimbursement tariffs
10.2.4.    Policy considerations
11.    Reimbursement analysis in France
11.1.    Overview of the reimbursement system
11.2.    Reimbursement for stereotactic radiosurgery and radiotherapy
11.2.1.    Procedure coding 
11.2.2.    Diagnosis coding
11.2.3.    Payment mechanism and reimbursement tariffs for session treatment
11.2.4.    Payment mechanism and reimbursement tariffs in hospital admission
11.2.5.    Policy considerations by HAS
12.    Reimbursement analysis in Germany
12.1.    Overview of the reimbursement system
12.2.    Reimbursement analysis for stereotactic radiosurgery and radiotherapy in outpatient setting
12.2.1.    Procedure coding 
12.2.2.    Payment mechanism and reimbursement tariffs
12.3.    Reimbursement analysis for stereotactic radiosurgery in hospital admission
12.3.1.    Procedure coding 
12.3.2.    Diagnosis coding
12.3.3.    Payment mechanism and reimbursement tariffs
12.4.    Selective contracts
12.5.    Policy considerations by G-BA
13.    Reimbursement analysis in Italy
13.1.    Overview of the reimbursement system
13.2.    Reimbursement for stereotactic radiosurgery and radiotherapy
13.2.1.    Procedure coding at national level
13.2.2.    Procedure coding at regional level (Emilia-Romagna, Lombardy, Veneto regions)
13.2.3.    Diagnosis coding
13.2.4.    Payment mechanism and reimbursement tariffs at national level
13.2.5.    Payment mechanism and reimbursement tariffs at regional level
13.2.6.    Policy considerations
14.    Reimbursement analysis in the Netherlands
14.1.    Overview of the reimbursement system
14.2.    Reimbursement for stereotactic radiosurgery and radiotherapy
14.2.1.    Procedure coding 
14.2.2.    Diagnosis coding
14.2.3.    Payment mechanism and reimbursement tariffs
14.2.4.    Policy considerations by Dutch Healthcare Institute (ZIN)
15.    Reimbursement analysis in Norway
15.1.    Overview of the reimbursement system
15.2.    Reimbursement for stereotactic radiosurgery and radiotherapy
15.2.1.    Procedure coding 
15.2.2.    Diagnosis coding
15.2.3.    Payment mechanism and reimbursement tariffs
15.2.4.    Policy considerations 
16.    Reimbursement analysis in Sweden
16.1.    Overview of the reimbursement system
16.2.    Reimbursement for stereotactic radiosurgery and radiotherapy
16.2.1.    Procedure coding 
16.2.2.    Diagnosis coding
16.2.3.    Payment mechanism and reimbursement tariffs
17.    Reimbursement analysis in Switzerland
17.1.    Overview of the reimbursement system
17.2.    Reimbursement analysis for stereotactic radiosurgery and radiotherapy in outpatient setting
17.2.1.    Procedure coding 
17.2.2.    Payment mechanism and reimbursement tariffs
17.3.    Reimbursement analysis for stereotactic radiosurgery during hospital admission
17.3.1.    Procedure coding 
17.3.2.    Diagnosis coding
17.3.3.    Payment mechanism and reimbursement tariffs
17.4.    Policy considerations
18.    Summary of procedure codes
19.    Summary of reimbursement codes and tariffs
20.    Disclaimer

11

Apr 2018

Eight reimbursement reports with the total size of 882 pages cover the most common radiotherapy modalities including brachytherapy, 3D conformal radiation therapy, stereotactic radiosurgery, stereotactic body radiation therapy, intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), image-guided radiotherapy, proton therapy. The analysis covers procedure coding, payment mechanism, reimbursement tariffs and policy restrictions in 12 EU countries including Austria, Belgium, Denmark, England, Finland, France, Germany, Italy, the Netherlands, Norway, Sweden and Switzerland.

Read more

09

Apr 2018

In April 2018, Danish Health Authority published 163 new codes for the Health Care Classification System, including five diagnosis codes, 34 surgical and 29 medical procedure codes. These codes are used to classify procedures in Danish DRG system.

Read more

27

Mar 2018

The background for updating the National Clinical Guideline for Treatment of Brain Metastases is that local treatment (stereotactic radiation therapy) has gained more space in the treatment of brain metastases.

Read more

26

Mar 2018

The Clinical Coding and Schedule Development Group develops and maintains procedural and diagnostics nomenclature for private payers in England. In February new codes for preparation and delivery of radiotherapy, knee resurfacing arthroplasty, balloon dilatation of the Eustachian tube and MRI-guided focused ultrasound (MRgFUS) thalamotomy for essential tremor were added to the CCSD Schedule.

Read more

23

Mar 2018

Interstitial low-dose rate brachytherapy was commissioned to the Institute for Quality and Efficiency in Health Care (IQWiG) by the Federal Joint Committee (G-BA) in order to analyze the current knowledge on procedure.

Read more

13

Feb 2018

The background for updating the National Clinical Guideline for Treatment of Brain Metastases is that local treatment (stereotactic radiation therapy) has gained more space in the treatment of brain metastases.

Read more

10

Jan 2018

The Department of Home Affairs (EDI) in Switzerland decided upon the coverage with evidence development (CED) of two types of positron emission tomography as well as stereotactic radiotherapy (photons) of exudative age-related macular degeneration. The status is given to contested medical services for a specific period which is extended until evidence is complete.

Read more
(we accept only company emails)