CT scans for horses: what does surgery cover pay?

The Barmenia horse surgery policy covers the cost as a pre-operative examination, but caps it through the contractual sublimit for imaging under clause 2.3.2 b) of the conditions.

Does surgery cover pay for a CT scan?

Equine surgery cover from Barmenia Allgemeine Versicherungs-AG pays for computed tomography (CT) where the scan is veterinarily necessary as a pre-operative examination performed immediately before a covered procedure. The CT then counts as part of the diagnostics preparing for the operation itself.

Reimbursement is bounded contractually, though. Under clause 2.3.2 b) of the conditions (AVB Pferde-OP-Kosten, as at 01.01.2024), computed tomography falls, along with other imaging such as MRI or scintigraphy, under a contractual sublimit. There is also only a claim where a covered operation follows the CT and neither waiting periods nor exclusions stand in the way.

• Veterinary necessity: the CT must be strictly required to prepare for a covered operation.
• The sublimit in clause 2.3.2 b): imaging is reimbursed up to the maximum agreed per insured event.
• Waiting periods run out first: no signs of trouble may have appeared before cover started or during the waiting period.
• No exclusion under clause 3.2: purely diagnostic scans with no surgical indication are not covered.

The timing of the first symptoms is decisive above all: if the condition appears before cover starts or inside the standard waiting period, that condition and its consequences are permanently outside cover. Diagnostics alone, with no surgery following, likewise fall outside what a horse surgery policy covers.

When does a horse need a CT scan?

In modern equine medicine, computed tomography is a central tool wherever conventional diagnostics reach their limits. Two-dimensional X-rays frequently superimpose structures in complex anatomy, whereas a CT delivers high-resolution three-dimensional slices of the tissue in question.

Vets use computed tomography above all around the skull, the teeth, the paranasal sinuses and the limbs. CT is especially valuable for conditions of bone, joints, teeth and sinuses, because it images complex regions without superimposition — and it doubles as a valuable planning tool for surgery.

Because nothing is superimposed, the surgeon sees exactly which structures are involved. That shortens the operation itself and cuts the horse's anaesthetic risk considerably.

CT versus MRI in practice

Computed tomography (CT) and magnetic resonance imaging (MRI) are both modern cross-sectional techniques, but what each is good for differs sharply in practice.

CT works with rotating X-ray beams and is the method of choice for hard bony structures, teeth and air-filled cavities. One decisive advantage is speed: with modern equipment, the imaging itself takes only seconds. MRI, by contrast, uses a strong magnetic field and is ideal for soft tissue such as tendons, ligaments and joint capsules.

Which method is chosen depends on the tissue involved. For reimbursement purposes, Barmenia's conditions place both under the same sublimit for imaging under clause 2.3.2 b).

Anaesthetic risk: general or standing sedation?

Going down and getting back up under general anaesthesia always carries some risk of injury for a large animal. Thanks to height-adjustable platforms and modern CT gantries, the head, much of the cervical spine and the limbs from the hoof up to the carpal and tarsal joints can today be scanned on the standing horse under sedation alone.

Under this standing sedation the horse is deeply sedated and locally anaesthetised so it feels no pain, but stays on its own legs. The scan is quick and gentle. General anaesthesia remains indicated where higher regions have to be imaged — the whole cervical spine, the shoulder, stifle, hip or pelvis.

• Standing sedation: gentle on the circulation and the musculoskeletal system, ideal for CT scans of head and teeth.
• General anaesthesia: needed for inaccessible regions, or where surgery follows straight away.
• Insurance cover: both forms are fully covered under clause 2.1.1.1 a).
• Monitoring: vital signs are checked continuously in specialist equine clinics.

Both are covered contractually: under clause 2.1.1.1 a), a veterinarily necessary procedure counts as a covered insured event whether performed under general anaesthesia or under sedation, local anaesthesia or standing sedation.

What a CT scan costs under the GOT 2022

A CT scan on a horse is billed under the official scale of fees for veterinary surgeons (GOT 2022). The fee schedule lists computed tomography at items 175 and 176: the single fee rate for scanning one body part is 350.00 euros net, and 500.00 euros net for several body parts or a whole-body CT, in both cases without distinguishing between species and therefore applying to horses as well. Because vets may bill up to three times the rate depending on the work involved, the range runs to 1,050.00 euros net for one body part and 1,500.00 euros net for a whole-body scan.

On top of the CT fee itself come sedation or general anaesthesia, contrast medium, medication and interpretation of the findings. Equine clinics often bill CT work at twice or three times the rate out of hours or where conditions are difficult, so the total cost of diagnosis multiplies accordingly. Choosing the right GOT rate in your policy is therefore critical.

Working out what you pay under the sublimit

What the owner ends up paying comes out of the interaction between the clinic's invoice, the reimbursement rate and the sublimit for imaging under clause 2.3.2 b).

1. Establish the total: add up the work-up, the CT, the operation and the aftercare.
2. Apply the sublimit: cap the reimbursable amount for the CT at the maximum agreed for imaging under clause 2.3.2 b).
3. Apply the reimbursement rate: use the rate, or the excess, recorded in your policy schedule.
4. Calculate your share: what is left above the sublimit, plus the excess, is yours to pay.

Before agreeing to an elaborate cross-sectional scan, owners should always check the contractual waiting periods and the limits recorded in the policy schedule. On nextsure, Barmenia horse surgery policies and their conditions can be compared transparently and bought online.