Out-Patient Reimbursement
Executive Summary
- For out-patients, new therapies are eligible for statutory health insurance which funds reimbursement only after testing and licensing
- The reimbursement of out-patient services in Germany is based on physician fee schedules
- The fee schedule for the SHI (Statutory Health Insurance) is named EBM (“einheitlicher Bewertungsmaßstab”) and an inclusion of a new diagnosis & therapy method requires a positive voting from the G-BA
- Where a medical device is being used at home by a patient, it must be included in the therapeutic appliance schedule in order to be reimbursable
- The fee schedule for Private health insurance is named GOÄ (“Gebührenordnung für Arzte”) and an application for the inclusion of a new diagnosis or therapy method will need to be made to the German Medical Association
- If the application for the inclusion in fee schedules fails, there are other options including:
- IGeL (Individuelle GesundheitsLeistungen) inclusion and selective contracts
- Obtaining reimbursement by single SHI funds is to negotiate selective contracts with local health insurances
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MAP Germany - Table of Contents