Procedure coding
Procedure coding is well-established for cardiac pacemakers in European countries. Implantation, replacement, and removal of cardiac pacemakers are typically coded separately.
In many countries, the procedure codes for cardiac pacemaker implantation differ depending on its type (single-chamber, dual-chamber, leadless).
For example, in England, there are specific OPCS codes for transvenous implantation (code K60.5 – for single chamber cardiac pacemaker system, code K60.6 – for dual chamber cardiac pacemaker system), renewal (code K73.1 – for single chamber cardiac pacemaker system, code K73.2 – for dual chamber cardiac pacemaker system) and removal of intravenous cardiac pacemaker system (code K60.4). The procedures related to the epicardial pacemaker system are coded separately.
Payment mechanism
The payment model for cardiac pacemaker implantation or replacement is DRG in most European countries.
In some countries, the DRG allocation depends on the type of pacemaker (e.g., Austria, England, or Switzerland). In other countries, the clinical indication impacts the DRG allocation (e.g., Denmark, France). For example, in Germany, implantation of a single-chamber cardiac pacemaker is reimbursed via DRG F17B “Replacement of cardiac pacemaker, single-chamber system” with a tariff of €18,087. In contrast, implantation of a dual-chamber pacemaker is allocated to the DRG F17A “Replacement of cardiac pacemaker, multi-chamber system” with a higher tariff of €21,946.
In most European countries, cardiac pacemakers do not attract additional (top-up) reimbursement, which is paid in addition to the DRG tariff. One exception is England, where the intracardiac pacemaker system and wireless pacemakers are included in the High Cost Devices List and reimbursed in addition to the HRG tariff.
Policy considerations
As cardiac pacemaker implantation and replacement procedures are well-established technologies, they are unlikely to be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist.
Health technology assessment
Due to established reimbursement in European countries, cardiac pacemakers rarely become a subject of HTA.
Future challenges
Implementing cardiac pacemakers has established reimbursement and funding in most European countries. New health technology assessments are unlikely to be relevant. It is unlikely to benefit from the innovative payment schemes.
Novel cardiac pacemakers with unique designs or alternative stimulation modes might need to develop specific procedure codes and adjust payment mechanisms to fully leverage their unique technology or cost profile.
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