New era in health payments from the Social Security Institution (SGK)

The Social Security Institution (SGK) has made comprehensive changes to the rules regarding the provision and financing of health services. With the communiqué published in the Official Gazette dated October 2, 2026, and numbered 33388, new provisions have come into effect for organ and tissue transplants, certain cancer drugs, bone marrow transplant packages, and surgical procedure points.

According to the regulation, if an organ or tissue transplant is deemed necessary for individuals covered by the SGK, the treatment expenses for both the recipient and the donor will be covered by the institution. Transplant procedures can only be performed in health facilities that have an organ transplant center on their premises.

Travel and transfer expenses incurred for the round-trip transportation of the patient or the organ to the transplant center during the domestic organ procurement process will also be paid within the scope of the Health Implementation Communiqué (SUT) provisions. The payment of a supply fee to the center providing the donor for each cadaveric donor reported to the National Organ and Tissue Transplant Coordination Center has also been included in the regulation.

In cases where the donor process cannot be completed, the initial 48-hour intensive care period during which the organ preservation protocol is applied can be billed to the SGK.

REIMBURSEMENT CONDITIONS REDETERMINED

The payment limit for ABO blood type incompatible kidney transplants has also been clarified with the communiqué. Incompatible blood type transplants, other than those for patients whose treatment is not possible with any dialysis method and whose condition is documented by a health board report from tertiary health facilities, will not be covered by the SGK. Apheresis procedures and medical supplies used in these transplants cannot be billed separately.

Reimbursement criteria for trastuzumab emtansine and pertuzumab combinations used in breast cancer treatment have also been reorganized. Usage durations, course limits, and prescription requirements for early-stage and metastatic breast cancer patients have been tied to a health board report that includes medical oncology specialists.

The drug with the active ingredient satralizumab, used in the treatment of Neuromyelitis Optica Spectrum Disorder (NMOSD) characterized by relapses, has been included in the reimbursement scope for patients over 12 years of age who meet the specified criteria. The drug in question has been added to the list of drugs to be paid for only in inpatient treatments in the SUT annex.

Changes have also been made to the Fee-for-Service and Diagnosis-Related Procedure Point Lists. While the points for the bronchoscopy procedure have been updated to 1,073.67, the way has been cleared for intensive care specialists, as well as thoracic and pediatric surgery specialists, to bill for this procedure. The thoracoscopic esophageal atresia primary repair procedure has been added to the list with the code 609541, and its points have been set at 25,278.02.

The scope of package pricing for bone marrow transplants has been expanded. Donor tests and procedures, blood components, medical supplies, and complication treatments have been included in the package price. Drugs used in the treatment of existing chronic diseases prior to the transplant and drugs brought from abroad for personal use have been excluded from the package scope.

Package durations have been set as 15 days before and 90 days after the operation for allogeneic transplants; and 15 days before and 60 days after the operation for other transplants.

The provisions in the communiqué will be applied on different dates. The provisions regarding organ and tissue transplants will come into effect 30 days after the date of publication. Regulations regarding cancer drugs, procedure points, and satralizumab will begin to be applied after 5 business days. The regulation regarding the bone marrow transplant package came into effect on the day of publication, effective from September 5, 2026.

News Source: 12punto