The reimbursement landscape for public outpatient services in Germany has undergone revisions with the latest update to the EBM catalog (Einheitlicher Bewertungsmaßstab), which governs these payments and is refreshed quarterly. Effective from October 1, 2023, the updated EBM catalog introduces several notable changes, including the addition of new EBM codes for various in-vitro diagnostic (IVD) tests, prostate-specific membrane antigen (PSMA) positron emission tomography, and stereotactic radiosurgery (SRS) for vestibular schwannomas.
Among the key updates are the introduction of the following EBM codes:
EBM sub-chapter 25.3.2 “High-voltage therapy (at least 1 MeV)”
- Code 25322: “Single-stage SRS for the first target volume; once in the case of disease” with a tariff of €1,252.
- Code 25323: “Surcharge for code 25322 for the SRS of more than one target volume; per each additional target volume” with a tariff of €312.91.
- Code 25348: “Radiation planning for SRS; once in the case of disease” with a tariff of €3,651.
EBM sub-chapter 32.3.7 “Infection immunological examinations”
- Code 32572: “Qualitative detection and/or quantitative determination of Toxoplasma antibodies of the immunoglobulin class IgM and/or IgG, also for monitoring purposes” with a tariff of €11.75.
- Code 32573: “Surcharge for code 32572 for determining the avidity of Toxoplasma IgG antibodies as a clarification test after positive IgM antibody determination, in several batches, in total” with a tariff of €25.90.
EBM sub-chapter 34.7 “Diagnostic positron emission tomography (PET), diagnostic positron emission tomography with computed tomography (PET/CT)”
- Code 34720: “Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) of the trunk with technical image fusion of a diagnostic computed tomography (CT) for the indication of therapy with (177Lu) lutetium vipivotide tetraxetan, if diagnostic CT examinations are available” with a tariff of €512.06.
- Code 34721: “PSMA positron emission tomography (PET) of the trunk with technical image fusion of a diagnostic computed tomography (CT) for the indication of therapy with (177Lu) lutetium vipivotide tetraxetan, with diagnostic CT” with a tariff of €649.61.
In conjunction with these procedures, a new code, 40585, titled “Flat rate for material costs in connection with the performance of the services under the codes 34720 and 34721 when using a Ga-68-PSMA ligand,” has been introduced under the EBM sub-chapter 40.10 “Performance-related flat rates for radionuclides,” with a tariff of €1,100.
These updates aim to ensure that the reimbursement framework aligns with the evolving landscape of medical services and technologies, facilitating fair compensation for healthcare providers while maintaining high standards of patient care in Germany’s public outpatient sector.
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