new medical methods

§87 SGB V Application

All new medical methods that are covered by the statutory health insurances in Germany in general have to be evaluated previously by the G-BA (Federal Joint committee). Applications to trigger such an assessment are regulated in paragraph § 135 Abs.1 SGB V for outpatient services and in § 137c Abs. 1 SGB V for inpatient services.

Direct application for reimbursement

However, a new service in the statutory covered sector that is not an entire innovative examination or treatment method is not relevant for neither § 135 (1) nor § 137c SGB V.

For these explicit services a direct application for reimbursement can be placed at the “Bewertungsausschuss” – evaluation committee – in order to set a specific compensation by the statutory health insurances on short track.

Kalms Consulting offers to assess your new medical technology/ product in order to define various routes to achieve substantial reimbursement. Using an § 87 application is one of those routes and needs, beside profound medical evidence, a clear communication of the methods specifications, as well as unambiguous classification and demarcation from the current services included in the reimbursement catalogue.

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