Billing of telemonitoring for heart failure in EBM
Twelve new fee schedule points (GOP) for primary care physicians (PBA) and cardiologists have been added to the EBM catalog for the reimbursement of telemonitoring for patients with statutory health insurance, which are paid extra budgetary and thus at fixed prices.
Primary care physicians
Primary care physicians, pediatricians, cardiologists, general internists, nephrologists and pulmonologists can use the new GOP 03325, 04325 and 13578, respectively, for indication and information. For further support in the context of telemonitoring, they receive an additional flat rate once per quarter (GOP 03326, 04326 or 13579).
|Indication: personal contact as well as education and counseling of the patient regarding his/her participation in telemonitoring.||03325 (general practitioners)|
04325 (pediatricians and adolescents)
13578 (specialists (cardiology, nephrology or pneumology)
|7.32 EUR, 65 points||Can be charged per full five minutes and a maximum of three times in case of illness..|
|Additional fee for care: communication with the responsible telemedicine center.||03326 (general practitioners)|
04326 (pediatricians and adolescents)
13579 (specialists (cardiology, nephrology or pneumology)
|14.42 EUR, 128 points||Can be charged once in the treatment case.|
Cardiologists who meet the requirements for working in a TMZ can bill the new GOP 13583 for instructing and educating patients on telemonitoring. Continuous telemonitoring of patients with cardiac aggregates (GOP 13584) or with external measuring devices (GOP 13586) includes the collection, analysis and review of data, documentation as well as notification and coordination with the PBA. With individual agreement between the PBA and TMZ, participating physicians may bill a supplement (GOP 13585 or 13587) for intensified monitoring on weekends and/or holidays.
For reimbursement of the costs of external measuring devices that record data on device function as well as medical data, such as body weight, electrical heart action, blood pressure and information on general health there is the new cost flat rate 40910.
|Guidance and education.||13583||10.70 EUR,|
|Once in case of illness.|
|Telemonitoring by means of cardiac aggregate.||13584||123.93 EUR, 1100 points||Once in a treatment case.|
|Telemedicine data retrieval and analysis for patients with an implanted cardioverter or defibrillator or an implanted cardiac resynchronization therapy system on weekends and/or holidays.||13585||26.48 EUR, 235 points||Surcharge for GOP 13584|
once per treatment case.
|Telemonitoring of a heart failure patient by means of external measuring devices.||13586||236.59 EUR, 2100 points||Once in a treatment case.|
|Data retrieval and evaluation on weekends and holidays by means of external devices.||13587||26.48 EUR,|
|Surcharge for GOP 13586|
once per treatment case.
|Equipment of the patient (by means of external devices).||40910||68 EUR||once in a treatment case.|