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58 Multislice CT in Coronary Heart Disease <strong>KCE</strong> Reports 82<br />
Table 17: Reimbursement for a MSCT coronary angiography in different<br />
countries (2008)<br />
Country Anatomic localisation precision<br />
Technology<br />
specification<br />
Implicit<br />
assimilation<br />
Explicit<br />
exclusion Physician Fee (€)<br />
USA CT coronary angiography Some insurers Some insurers Some insurers +/- 75€<br />
CAN Thorax CT No Some regions No +/- 75€<br />
AUS (CT angiography - not coronary) No No Yes € 0<br />
EN CT, one area, pre and post contrast No Yes No +/- 160€<br />
NL Thorax CT No Yes No +/- 64€<br />
D Thorax CT No Yes No +/- 80€<br />
F CT heart and vessel angiography No Yes No +/- 25€<br />
Belgium Thorax CT No Yes No +/- 120€<br />
The non invasive CT coronary angiography is only considered as such in two countries:<br />
<strong>the</strong> United States and Australia. It can be reimbursed in some states of USA under<br />
specific conditions while <strong>the</strong> reimbursement was not allowed in Australia (until now but<br />
will be in a few months). In o<strong>the</strong>r countries, <strong>the</strong>re is no specific reimbursement for CT<br />
coronary angiography. USA is <strong>the</strong> only country, amongst <strong>the</strong> countries reviewed, where<br />
some local health insurers refer to a number of slices as a condition for <strong>the</strong> payment of<br />
cardiac CT.<br />
In Australia and France, CT reimbursement depends on <strong>the</strong> age of <strong>the</strong> CT unit used: <strong>the</strong><br />
older <strong>the</strong> machine, <strong>the</strong> lower <strong>the</strong> fee. In France, this amount is not a physician fee but a<br />
technical amount covering infrastructure and overheads. The link with <strong>the</strong> equipment<br />
age is double-edged as it is an incentive to renew old CT installations but, on <strong>the</strong> o<strong>the</strong>r<br />
hand, it might drive costs and push hospitals to acquire brand new technology while<br />
clinical evidence does not support its use (yet).<br />
Key points<br />
• The initial investment cost of a MSCT scanner ranges from<br />
€850 000 (64-SCT scanner) to €2 million (scanner with higher<br />
number of detectors). Additionally, <strong>the</strong> cost for software for <strong>the</strong><br />
coronary applications amounts to 20% of <strong>the</strong> device cost. The postprocessing<br />
software is €100 000 and its updating €20 000 per year.<br />
The yearly maintenance cost is €100 000.<br />
• Amongst <strong>the</strong> 240 Belgian CT scanners, 75% were already MSCT<br />
scanners (in 2005) from which 45% with more than 16 detectors.<br />
About 20% of <strong>the</strong> Belgian hospitals are doing cardiac CT.<br />
• Currently <strong>the</strong> MSCT coronary angiography is reimbursed to <strong>the</strong><br />
Belgian radiologist under a conventional thoracic or abdominal CT<br />
INAMI/RIZIV fee-for-service amounting to €121.4.<br />
• The MSCT coronary angiography is only specifically coded in two<br />
countries: in <strong>the</strong> United States where some states reimburse it<br />
under specific conditions and in Australia where it will reimbursed<br />
in <strong>the</strong> coming months.<br />
• Like in Belgium, <strong>the</strong> procedure is charged under a generic CT code<br />
in Québec, England, <strong>the</strong> Ne<strong>the</strong>rlands, Germany and France.