Planning an Achilles tendon repair bill in South Korea
An Achilles tendon rupture operation is not billed as one universal retail price. The final amount can combine the operative procedure, anesthesia, imaging, inpatient care, meals, sutures or fixation materials, a brace, follow-up visits, rehabilitation, and costs created by time away from work.
The composition can also change when the surgical discussion moves from open primary repair to minimally invasive or percutaneous repair, chronic-rupture reconstruction, or revision reconstruction after a rerupture. A technique name alone does not reveal which lines are National Health Insurance Service covered, which lines have a different patient-share rule, and which lines are non-covered.
This calculator therefore uses an itemised hospital quote. It separates the covered amount, the patient-share percentage, non-covered procedure or material charges, other medical payments, rehabilitation, income interruption, insurer-confirmed payment, and Korea’s medical-expense tax credit. It is a cash-planning tool, not a diagnosis or treatment selector.
Korea-based estimate and an important starting-value warning
The KRW 3,000,000 covered quote shown when the Korean calculator opens is a hypothetical worked input. It is not an official fee, a national average, a minimum, or a recommended price. Replace it with the amount on the hospital’s itemised estimate before using the result for a financial decision.
The calculator does not decide whether surgery is needed, whether direct repair is possible, or when weight bearing, exercise, driving, and work should resume. Those decisions belong to the treating clinical team.
The six cost groups in the estimate
Covered surgery and admission quote
Enter the part of the hospital estimate that is covered and uses the same patient-share percentage. The ordinary inpatient planning rate begins at 20%, but meals, outpatient lines, special rules, and other payer systems must be separated.
Non-covered procedure and materials
Enter only items the provider identifies as non-covered, such as a separately billed device, material, or tissue product. The words minimally invasive or revision do not by themselves establish non-covered status.
Other patient-paid medical costs
This can include patient payments for tests, meals, a private-room difference, a brace, or supplies that are outside the first two quote lines. Enter the patient payment, so the calculator does not apply the 20% rate again.
Clinic and hospital rehabilitation
Multiply the planned number of rehabilitation visits by the expected payment per visit. When covered and non-covered services are mixed, use the patient payment confirmed by the provider.
Income interruption and living costs
Multiply the planning weeks by the net weekly income gap after paid leave or benefits, then add transport and caregiver living costs. These are cash needs but are not treated as medical expenses for the tax-credit estimate.
Insurer payment and tax credit
Subtract only an amount confirmed by the insurer. The calculator then estimates the additional Korean medical-expense tax credit attributable to this episode instead of treating the full annual credit as surgery savings.
Four surgical paths used for quote organisation
The four choices below organise consultation questions and cost drivers. They do not form a clinical eligibility test. The calculator does not use elapsed days, a reported tendon gap, age, or activity level to prescribe a technique because tissue quality, skin and nerve considerations, comorbidities, imaging, examination, and surgeon judgment all matter.
Open primary repair
This path describes direct inspection and suturing of repairable tendon ends through an incision. Ask whether the quoted amount includes the procedure, anesthesia, admission, suture or fixation materials, the postoperative brace, and the first follow-up visits.
Minimally invasive or percutaneous repair
This path uses smaller incisions or a percutaneous technique. A smaller incision does not automatically mean a lower bill, a shorter admission, or a non-covered operation. Ask whether a dedicated repair device, disposable supplies, ultrasound, fluoroscopy, or other imaging guidance appears as a separate line.
Chronic-rupture reconstruction
When the clinical team considers direct repair unsuitable, the plan may include tendon lengthening, tendon transfer, or another reconstruction. V-Y advancement and flexor hallucis longus transfer are examples that may appear in a discussion, but the actual operation must come from the treating surgeon. Obtain the exact procedure names, materials, admission plan, and rehabilitation estimate.
Rerupture or revision reconstruction
Revision planning can include removal of prior material, additional fixation, autologous or donor tissue, and a different rehabilitation course. Separate every added procedure and material rather than assuming that a revision label makes the entire bill covered or non-covered.
What the 2026 official sources establish
HIRA procedure identifiers N0920 and N0921
The Health Insurance Review and Assessment Service, commonly called HIRA, lists code N0920 as Achilles tendon reconstruction and N0921 as Achilles tendon lengthening in the 2026 KDRG Classification Book Version 4.7. The source was checked on July 19, 2026.
The classification confirms that these named procedures exist in the Korean health-insurance procedure framework. It does not mean that every line in one hospital episode shares the same coverage status or patient-share rate. Surgery, anesthesia, tests, admission, meals, room differences, devices, tissue, and rehabilitation can follow separate billing rules.
The ordinary 20% inpatient planning rate
Article 19 of the Enforcement Decree of the National Health Insurance Act delegates patient cost-sharing to Annex 2. The current decree searched through the National Law Information OPEN API has law serial number MST 283469, current-history status, and an effective date of February 19, 2026.
Annex 2 uses 20% of the relevant covered amount as the ordinary inpatient patient-share starting point. Meals and several special categories follow separate rules. Medical Aid, lower-income relief, special-case registration, outpatient care, fully patient-paid lines, industrial accident insurance, automobile insurance, and other support systems can produce a different result. That is why the Korean input allows the percentage to be edited.
How to obtain an itemised hospital estimate
- Confirm the exact operation name and billing identifiers.
Match the consent form and estimate to the proposed direct repair, minimally invasive repair, lengthening, tendon transfer, graft, or revision procedure. Ask whether N0920, N0921, or another code is planned. - Group only covered lines that use the same patient-share percentage.
Do not combine an ordinary 20% inpatient line with meals, outpatient services, a special rate, or a fully patient-paid item and then multiply the total by 20%. - Request non-covered procedure and material amounts per operated side.
Ask for the item name and amount for any dedicated device, tissue, fixation material, brace, or supply identified as non-covered. - Add post-discharge medical spending.
Include follow-up examination, wound care, brace adjustment, imaging, medication, and the expected patient payment for rehabilitation visits. - Confirm insurance and employment support before subtracting it.
Give the insurer the procedure name, diagnosis, admission plan, and non-covered lines. Separately check paid leave, employer support, and any applicable benefit before estimating the net weekly income gap.
Calculation method
1. Covered patient payment
Covered charge equals the covered quote per side multiplied by the number of operated sides. Covered patient payment equals that charge multiplied by the entered patient-share percentage. The planning NHIS share is the covered charge minus the covered patient payment.
2. Medical out-of-pocket amount
Non-covered procedure cost equals the non-covered quote per side multiplied by the number of operated sides. Rehabilitation cost equals visits multiplied by the patient payment per visit. Medical out of pocket is the sum of covered patient payment, non-covered procedure cost, other medical cost, and rehabilitation cost.
3. Recovery cash need
Income interruption equals planning weeks multiplied by the net weekly income gap. Non-medical recovery cost equals that income interruption plus transport, caregiver, and other living costs. Gross cash need is medical out of pocket plus non-medical recovery cost.
4. Insurer payment and tax credit
Insurer payment is capped at the medical out-of-pocket amount. The calculator does not use it to erase income loss or living costs. Medical expense after insurance is added to other eligible annual medical expenses for the incremental Korean tax-credit calculation.
Korean medical-expense tax credit used in the result
Article 59-4(2) of the Income Tax Act provides the relevant framework. The current law record checked through the National Law Information OPEN API has MST 280405, and the medical-expense provision used here is effective January 1, 2026.
The standard credit rate is 15% of eligible medical expenses above 3% of gross salary. For ordinary dependent-family medical expenses, the credit base is capped at KRW 7,000,000. Medical spending for the employee, a person age 65 or older at year end, a person with a disability, and other statutory unlimited groups is not subject to that ordinary-family cap.
Incremental formula
- Threshold = gross salary × 3%.
- Unlimited-group base = max(0, eligible expense − threshold).
- Ordinary-family base = min(max(0, eligible expense − threshold), KRW 7,000,000).
- Incremental credit = (base after this medical episode − base before it) × 15%.
The result is a planning estimate, not a guaranteed cash refund. Insurance-reimbursed medical expenses must be excluded, and the actual benefit also depends on annual records, family grouping, timing, and available calculated income tax.
Worked hypothetical example
The following figures explain the model and do not describe a Korean market price. Replace every quote with provider-specific information.
Inputs
- One operated side
- Covered quote KRW 3,000,000
- 20% patient share and KRW 0 non-covered procedure quote
- Other medical payment KRW 300,000
- 12 rehabilitation visits at KRW 50,000 each
- Living cost KRW 300,000 and income interruption KRW 0
- Gross salary KRW 50,000,000 and other medical expense KRW 500,000
Outputs
- Covered patient payment KRW 600,000
- Other medical and rehabilitation cost KRW 900,000
- Total medical out of pocket KRW 1,500,000
- Gross cash need KRW 1,800,000
- Incremental medical-expense credit KRW 75,000
- Net patient burden KRW 1,725,000
- 10% planning range KRW 1,552,500 to KRW 1,897,500
Why rehabilitation and lost income are separate
A surgery-day bill can understate the cash needed after discharge. Follow-up examination, wound review, brace adjustment, physical therapy, and exercise rehabilitation can be spread across many visits. Coverage status can also differ by service. The calculator treats provider-based rehabilitation as medical spending and uses the patient payment per visit supplied by the user.
Work interruption is much more dependent on occupation. A seated worker, a person who stands and walks all day, and a worker who climbs, carries, or drives do not have one universal return-to-work period. The input is therefore a financial planning horizon agreed with the clinical team and employer, not an automated medical recommendation.
Do not classify ordinary living costs as medical expenses
Eligible rehabilitation paid to a medical provider may enter the Korean tax calculation, subject to the legal rules. Transport, caregiver meals, ordinary household spending, and lost earnings are still important cash needs, but this calculator keeps them outside the medical-expense tax-credit base.
Practical planning scenarios
Comparing two hospital estimates
Align the ordinary covered amount, differently rated lines, non-covered materials, and expected rehabilitation before comparing totals. A shorter admission does not guarantee a smaller net budget if dedicated devices or post-discharge care are higher.
Chronic reconstruction consultation
Ask whether tendon lengthening, tendon transfer, grafting, or additional fixation is included. Extend the income-gap planning weeks and rehabilitation visits only after discussing the expected course with the clinical team and employer.
Revision after rerupture
Prior-material removal, new tissue, additional imaging, and a different admission may not resemble the first operation. Put unresolved provider payments in the additional medical field and use a wider quote-variation percentage until the itemised plan is final.
Recalculating after insurer review
Give the insurer the confirmed operation, diagnosis, admission status, and non-covered items. Enter the insurer’s estimated payment rather than inferring reimbursement from a policy generation label. The calculation caps that amount at medical out of pocket.
Insurance, tax, and payer cautions
- Private indemnity reimbursement can depend on policy wording, enrollment date, admission recognition, deductibles, non-covered riders, exclusions, limits, and claim review.
- Medical expenses reimbursed by insurance should not also be treated as eligible expenses for the Korean medical-expense tax credit.
- A calculated credit does not guarantee the same cash refund because actual relief is limited by annual records and calculated income tax.
- When ordinary dependents and unlimited statutory groups both have expenses, the legal ordering is more detailed than this one-group planning switch. Review year-end tax records.
- Industrial accident insurance, automobile insurance, Medical Aid, veterans support, and other payer systems do not follow this ordinary NHIS inpatient model. Obtain payer-specific guidance.
- The out-of-pocket ceiling refund is not deducted automatically because it depends on annual covered payments, income tier, and excluded items.
Frequently asked questions
Is Achilles tendon repair covered by Korean national health insurance?
HIRA’s 2026 KDRG book lists N0920 Achilles tendon reconstruction and N0921 Achilles tendon lengthening. That supports the presence of the procedures in the insurance framework, but every line in one bill does not automatically share the same status. Obtain the hospital’s itemised covered, differently rated, and non-covered amounts.
Why does the starting covered quote show KRW 3,000,000?
It is a hypothetical input used to display the formula. It is not an official fee, national average, lowest price, or recommendation. Replace it with the provider estimate.
Is minimally invasive repair automatically non-covered?
No. A technique label does not determine the status of every procedure and material. Ask for separate status and amounts for the operative line, dedicated devices, disposable supplies, imaging guidance, anesthesia, and admission.
Should I select reconstruction automatically for an older rupture?
No. The calculator does not diagnose a chronic rupture or select an operation. Direct repair feasibility, tendon quality, lengthening, transfer, or graft needs require clinical examination, imaging, and surgeon judgment.
How many recovery weeks should I enter?
The opening eight-week value is a cash-flow example, not clinical advice. Enter a planning horizon based on the treating team’s restrictions, the physical demands of the job, paid leave, and employer arrangements.
Can I leave the patient-share rate at 20%?
It is an ordinary inpatient starting point for the relevant covered amount. Meals, outpatient services, special categories, Medical Aid, lower-income relief, and other payers can differ. Use the rate attached to the specific hospital quote lines.
Why is there no private-insurance generation selector?
A generation label cannot determine an actual claim. The Korean calculator instead accepts an amount confirmed by the insurer after reviewing the procedure, admission, non-covered lines, policy terms, deductibles, and limits.
Does the result include the Korean out-of-pocket ceiling refund?
No. The ceiling depends on annual covered patient payments, income tier, and excluded categories. Use the separate ceiling-refund calculator and confirm with the National Health Insurance Service.
Official sources and update assumptions
- Health Insurance Review and Assessment Service, KDRG Classification Book Version 4.7, publication G000EV3-2025-174: N0920 Achilles tendon reconstruction and N0921 Achilles tendon lengthening. Checked July 19, 2026.
- Enforcement Decree of the National Health Insurance Act, Article 19 and Annex 2, National Law Information OPEN API MST 283469, current version effective February 19, 2026.
- Income Tax Act, Article 59-4(2), National Law Information OPEN API MST 280405, medical-expense provision effective January 1, 2026.
Future maintainers should recheck the HIRA procedure classification, the ordinary inpatient patient-share rule, and the tax-credit threshold, rate, cap, effective dates, and current-history status together. When one changes, update the requirements, constants, deterministic tests, and both language guides in the same change.
Turn the itemised quote into a recovery budget
Enter the provider-confirmed covered and non-covered amounts, rehabilitation plan, and income gap to see a transparent planning range. Before relying on the result, recheck the operation name, billing identifiers, insurer-confirmed payment, and employment support.