If a new device or procedure costs more than the DRG pays, German hospitals can apply for an extra, temporary fee — but only hospitals can apply, only once a year, and only status 1 opens the money. Here is the cycle, step by step.
NUB (Neue Untersuchungs- und Behandlungsmethoden) lets a hospital agree a time-limited extra fee for a new method the DRG system does not yet pay adequately (§6(2) KHEntgG). Hospitals ask InEK by 31 October; InEK answers by 31 January with a status. Only status 1 allows a fee, which each hospital then negotiates with the insurers for one year. Requests must be repeated every year until the method is built into the DRG system. In the 2026 cycle, 326 of 1,084 methods (about 30%) received status 1.
German hospitals are paid per case through DRGs. A genuinely new method usually is not reflected in them yet — so the hospital loses money every time it uses it.
§6(2) of the Hospital Remuneration Act (KHEntgG) lets the hospital and the statutory insurers agree a time-limited, case-related extra fee for such a method, outside the hospital’s main budget. It applies only to methods the DRGs and existing additional payments (ZE) do not cover adequately and that the G-BA has not excluded. NUB is the bridge between a new method’s launch and its eventual inclusion in the DRG catalogue.
Status 1 is permission to negotiate, not a price. Each hospital agrees the amount with the insurers; if they cannot agree, the arbitration board decides on application within six weeks. The fee applies for the following calendar year only. If the method is still not adequately paid, the hospital must file again.
InEK automatically checks all status 1 methods for integration into the next DRG system and publishes which ones no longer need a request. With enough case data, a method moves into a nationwide additional payment (ZE) or into the DRGs themselves — usually after several cycles.
NUB prices differ by hospital. A launch plan that assumes one German NUB price is a plan built on a number that does not exist.
Drugs: from 2027, NUB fees for drugs with a new active substance may not exceed the AMNOG reimbursement amount; fees agreed earlier must be renegotiated once it applies.
When a hospital files the first NUB request for a method with a new scientific concept, it must also send the G-BA the evidence — for device methods in agreement with the manufacturer. The G-BA then decides within three months under §137h. If it finds potential but no proven benefit, only university hospitals and hospitals meeting quality requirements may agree NUB fees; if it finds no potential, NUB fees are excluded.
Until now this applied only to high-risk devices. Under a G-BA rule change effective no earlier than 3 November 2026 it covers any new method not based solely on a drug — so far more first NUB requests will come with an evidence test attached.
A request by a German hospital to InEK asking whether a new method can be billed adequately under existing DRGs. If InEK gives status 1, the hospital may agree a time-limited extra fee for the method with the statutory insurers.
No. Only hospitals with an institution code can submit NUB requests. Manufacturers can build templates in the InEK portal, prepare information packs and supply evidence that hospitals adapt and file.
Hospitals must submit requests to InEK by 31 October for the following year; ATMP methods have an additional window to 30 April. InEK publishes its answers by 31 January (by 30 June for the ATMP window).
That the method meets the criteria and the hospital may negotiate its own extra fee with the insurers. Status 2 means no fee is allowed; status 4 means the information was insufficient.
One calendar year. Hospitals must re-apply every year until InEK integrates the method into a nationwide additional payment (ZE) or into the DRG system itself.
We plan the OPS proposal, the hospital pathway and the information pack, check §137h exposure, and set up the multi-year route to a ZE or DRG.