TABLE 4

Statutory health insurance costs of diagnosing and monitoring pulmonary TB in the outpatient setting

Medical servicesIndividual payment €FrequencyPayment €Post-hospital payment €
General practitioner
  • 1. Flat rate coverage; irrespective of number of visits by patients per quarter (GOP 03 000)

16.995 [quarters]84.954 [quarters]: 67.96
  • Alternatively:

  • 2. Paediatric flat rate GOP 04 000 (age 0 to 4)

25.545 [quarters]127.704 [quarters]: 102.16
  • 3. Detailed conversation (GOP 04 230); can also be charged if the discussion is only with caregivers without the child's presence)

9.74219.481: 9.74
  • 4. Retainer fee (general practitioner), once per quarter (GOP 03 040); identical to the paediatric billing code GOP 04 040

15.585 [quarters]77.904 [quarters]: 62.32
Pneumological diagnostics
  • 5. Pneumological consultation; 6 to 59 years of age (GOP 13 641)

21.865 [quarters]109.304 [quarters]: 87.44
  • 6. Surcharge (pneumologist), once per quarter (GOP 13 644)

4.445 [quarters]22.204 [quarters]: 17.76
  • 7. Bronchoscopy (GOP 13 662)

106.931106.930
  • 8. Pneumologist BAL (GOP 13 663), additional fee on GOP 13 662

26.19126.190
Methods
  • 9. Mantoux TST (GOP 02 200)

0.9710.970
  • 10. IGRA testing (GOP 50 112 following GOP 0220)

58158
  • 11. ECG (GOP 27 320); cannot be charged separately

  • 12. X-ray in two planes (GOP 34 241); a consultation cannot be charged

16.458131.6098.70 (6 following initial hospitalisation)
  • 13. For ethambutol treatment: ophthalmologic consultation (GOP 06 211 for insured patients aged between 6 and 59 years)

13.69313.69 (only be charged as flat once per quarter)0
Microbiology
  • 14. Microscopy test for mycobacteria (GOP 32 176) (aspiration of gastric juice via tube in children cannot be charged separately)

5.205 (3 if closed TB)26 (15.60 if closed TB)15.60 (0 if closed TB)
  • 15. NAAT (GOP 32 825)

61.40161.40
  • 16. Culture test for mycobacteria (GOP 32 747) per material

34.904 (1 if closed TB)139.60104.70 (3 × 34.90; 0 if closed TB)
  • 17. Differentiation of mycobacteria (GOP32 764) if positive

28.401 (0 if closed TB)28.40
  • 18. Molecular fast resistance testing (GOP 50110 if NAAT or microscopy is positive)

82.031 (0 if closed TB)82.03
  • 19. Resistance definition GOP 32 770) per mycobacteria type

39.501 (0 if closed TB)39.50
Laboratory investigation
  • 20. HIV serology, immune-assay combination test (GOP 32 575)

4.4514.45
  • 21. Anti-HBc (GOP 32 614)

5.9015.90
  • 22. HBs-Ag (GOP 32 781)

5.5015.50
  • 23. Chloride (GOP 32 084)

0.25821.25 (5 × 0.25)
  • 24. Sodium (GOP 32 083)

0.25821.25
  • 25. Potassium (GOP 32 081)

0.25821.25
  • 26. Calcium (GOP 32 082)

0.25821.25
  • 27. Creatinine, Jaffe method (GOP 32 066)

0.25821.25
  • 28. Uric acid (GOP 32 964)

0.2520.50.25
  • 29. Urea (GOP 32 065)

0.25821.25
  • 30. Blood count (GOP 32 122)

1.1088.805.50
  • 31. Bilirubin total (GOP 32 058)

0.25821.25
  • 32. Gamma-glutamyl transferase (GOP 32 071)

0.25821.25
  • 33. Glutamate-oxaloacetate transaminase (GOP 32 069)

0.25821.25
  • 34. Glutamate-pyruvate transaminase (GOP 32 070)

0.25821.25

Anti-HBc: hepatitis B core antibody; BAL: bronchoalveolar lavage; HBs-Ag: surface antigen of the hepatitis B virus; NAAT: nucleic acid amplification test.