Upcoming changes in reimbursement of human genetics tests in Germany

On June 11, 2026, the National Association of Statutory Health Insurance Physicians (KBV) announced a number of changes to the reimbursement of human genetics tests to be introduced as of October 1, 2026.

The package of changes includes, among other measures, a reduction in the reimbursement values for human genetic services and the introduction of additional volume-based reimbursement reductions at the practice level. These measures are intended to reduce expenditure on human genetic in vitro diagnostics (EBM subchapter 11.4 “In vitro diagnostics of constitutional genetic alterations”) by 31%.

The statutory sickness funds, which submitted the corresponding proposal to the meeting of the Extended Evaluation Committee, justified the reductions by citing “significantly decreased” costs of analytical equipment and consumables.

Some of the expected changes include:

• Restructuring of the relevant EBM subchapters, update of the service descriptions and/or billing conditions for multiple EBM codes;
• The reimbursement tariffs for all molecular genetic tests listed under subchapter 11.4 “In vitro diagnostics of constitutional genetic alterations” of the EBM catalog will be reduced. Sequencing tests for the diagnosis of rare diseases, listed in subchapter 11.4.3 “In vitro diagnostics of constitutional genetic alterations in syndromic or rare diseases” of the EBM catalog, will be particularly affected: their reimbursement will be cut by up to 25%. Furthermore, mutation screening using sequencing, previously reimbursed under code 11513 “Postnatal mutation screening to detect or rule out a disease-relevant or disease-causing constitutional genomic mutation”, will be replaced by four new codes, depending on the sequence length analyzed;
• A new EBM code will be introduced for a surcharge for overhead costs and the scientific medical assessment and evaluation of complex genetic analyses in the individual clinical context for rare diseases.

The corresponding decision was made by the Extended Evaluation Committee on June 9, 2026.

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