As of 1 April 2026, the rules for settling certain outpatient diagnostic services in outpatient specialty care have changed.
The changes apply to the settling of procedures in four diagnostic areas: computed tomography, magnetic resonance imaging, gastroscopy, and colonoscopy.
The modified rules apply to procedures performed in excess of the National Health Fund (NFZ) contract value. These procedures will no longer be fully reimbursed.
The NFZ has established two levels of adjustment factors for settling procedures subject to an increase in the liability amount. For computed tomography and magnetic resonance imaging, this factor is 0.5. For endoscopic examinations of the gastrointestinal tract – gastroscopy and colonoscopy, this factor is 0.6.
This means that after exceeding the contract limit, the healthcare provider may still apply for reimbursement for the preformed procedures, but not at the full rate but instead, the reimbursement will be calculated using the appropriate reduction factor.
The provisions of the order apply to the settlement of procedures performed starting from 1 April 2026.
