What does this calcific tendinitis cost planner do?
A shoulder calcific tendinitis budget may stop after consultation, an X-ray, medicine, and physical therapy, or it may later include extracorporeal shock wave therapy, an injection or image-guided procedure, arthroscopic surgery, and rehabilitation.
The benefit classification, provider level, quoted unit, number of sessions, and disclosed non-covered price can all change the patient payment.
This South Korea-specific calculator starts every price at KRW 0 and converts an itemised provider quote into cumulative 3-, 6-, and 12-month household budgets.
Scope of the result
- Enter a current hospital or clinic quote instead of treating an editable example as a national average.
- Keep covered gross charges separate from amounts that are already patient payments.
- Use the care-stage buttons only to reveal cost groups, not to grade severity or select treatment.
- Read the result as a budget simulation, not a diagnosis, prescription, NHI review, or indemnity-insurance decision.
Clinical context that the budget preserves
Seoul National University Hospital describes calcific tendinitis as a self-limiting painful condition in which calcium deposits infiltrate a tendon, most often the supraspinatus tendon at the shoulder.
The information page explains that symptoms and history can suggest the condition and an X-ray can identify it relatively simply, while MRI or another examination may be used to assess a concurrent disorder or plan surgery.
Its stated treatment goal is improvement of symptoms rather than automatic removal of every deposit visible on an image.
Conservative care
Physical therapy, including stretching, and medication may be used first. The calculator does not select an exercise, medicine, schedule, or duration.
Shockwave therapy or injection
These may be considered when pain is severe or conservative care has not helped. The calculator records the provider quote without predicting effectiveness or risk.
Needling, lavage, or another procedure
Enter the exact billed name, unit, and coverage classification shown on the quote. An injection and ultrasound-guided needling or lavage are not the same procedure.
Arthroscopic surgery and rehabilitation
Surgery may be considered after non-surgical treatment has not helped. A calendar month never establishes the indication, technique, or recovery plan.
Sudden severe shoulder pain can occur in calcific tendinitis, but that fact does not make self-diagnosis safe.
Seek medical assessment before comparing costs when there is a recent injury with deformity or near-complete loss of movement, new numbness or weakness, or severe swelling, redness, or fever.
The 2026 Korean NHI planning shares
The National Health Insurance Act Enforcement Decree current text verified through the National Law Information OPEN API on July 26, 2026 is MST 283469, effective February 19, 2026.
Article 19 points to Annex 2 for patient cost sharing, and the verified annex identifier is 17976571.
This calculator uses ordinary comparison shares of 30%, 40%, 50%, or 60% for covered outpatient gross charges at a clinic, hospital, general hospital, or tertiary general hospital, and 20% for an ordinary covered inpatient surgery gross charge.
Ordinary 2026 South Korean National Health Insurance planning shares by provider level| Care setting | Planning share | Amount entered |
|---|
| Clinic outpatient care | 30% | Covered gross before copay |
| Hospital outpatient care | 40% | Covered gross before copay |
| General-hospital outpatient care | 50% | Covered gross before copay |
| Tertiary general-hospital outpatient care | 60% | Simplified gross-charge comparison |
| Ordinary inpatient care | 20% | Covered surgery gross charge |
Why these are comparison rates
Tertiary outpatient consultation and other benefit lines can have a more detailed structure than a single 60% multiplication.
Age rules, Medical Aid, industrial-accident or motor-vehicle insurance, selective benefits, meals, room charges, and other payer rules can change the real bill.
Do not multiply a pharmacy receipt, a patient-paid therapy unit, or a non-covered charge by an outpatient rate again, and always prefer the provider’s estimated patient-payment statement.
Non-covered disclosure and HIRA code SZ0840000
Medical Service Act Article 45 in current MST 285327, effective April 7, 2026, requires a medical institution to disclose non-covered charges so that a patient or guardian can readily understand them and prohibits collection above the disclosed amount.
The 2026 HIRA public non-covered item list identifies extracorporeal shock wave therapy for musculoskeletal disease as SZ0840000 and expressly includes shoulder calcific tendinitis in its use context.
SZ0840000 is a search and bill-check anchor, not a national tariff, clinical approval, recommended session count, or insurance-payment guarantee.
- Search the HIRA non-covered price portal for the provider and the SZ0840000 shockwave item.
- Ask whether the disclosed figure is per session, per shoulder, per treatment site, or for a whole course.
- Confirm whether consultation, imaging guidance, medicine, or a material is included in that figure.
- Separate covered gross, full patient payment, selective-benefit, and non-covered lines on the itemised quote.
- For an injection, needling, lavage, or surgery, obtain the exact billed name and a written whole-plan estimate.
How to enter each part of the quote
Initial covered gross and non-covered assessment
Put consultation and X-ray gross charges before copay in the initial covered field. Put ultrasound, MRI, or another item that the provider labels non-covered in the initial non-covered patient-payment field.
Recurring covered care and pharmacy payment
The monthly covered gross repeats through the selected horizon. Enter the monthly amount actually paid at the pharmacy separately so the outpatient share is not applied twice.
Physical or exercise therapy
The formula is patient payment per session multiplied by monthly sessions and treatment months. It does not prescribe an exercise or decide whether a billed therapy is covered.
Shockwave therapy
When the start month falls within a horizon, the planner adds unit patient payment multiplied by the planned total sessions once. Confirm the provider unit before entering it.
Injection, needling, lavage, or another procedure
Choose covered gross only when the quote gives a gross benefit amount, or non-covered patient payment when it gives the amount owed. Separate scenarios are clearer when procedures have different classifications.
Surgery, rehabilitation, and work interruption
The planner applies 20% to the covered inpatient surgery gross and adds the entered non-covered amount. Rehabilitation starts in the surgery month, while work loss uses leave days multiplied by daily income value.
Confirmed insurance or other support
Enter only a payment already confirmed by an insurer, employer, or support program. It applies from the selected month and cannot reduce that horizon medical cost below zero.
Formulas and milestone timing
Medical cost
- Covered outpatient payment = covered gross × selected 30% to 60% share.
- Covered inpatient surgery payment = covered surgery gross × 20%.
- Therapy = patient unit payment × monthly sessions × applied months.
- Shockwave or procedure = unit payment × planned total sessions.
- Medicine, supplies, and non-covered charges are added directly.
Support and indirect cost
- Medical cost after support = medical cost before support - confirmed support applied.
- Applied support is capped at medical cost in that horizon.
- Visit time = monthly visits × months × hours per visit × hourly value.
- Surgery leave = leave days × daily income value.
- Household burden = medical cost after support + visit time + surgery leave.
A shockwave or procedure start month of 4 excludes that planned block from the 3-month result and includes it in the 6- and 12-month results.
A surgery month of 7 excludes surgery, postoperative rehabilitation, and surgery leave from the 3- and 6-month results.
The three columns are cumulative checkpoints rather than independent monthly payment plans.
Worked budget example
The built-in example uses hypothetical amounts only and does not represent a Korean official fee or national average.
It selects a hospital outpatient share of 40%, KRW 100,000 initial covered gross, KRW 60,000 monthly covered gross, physical therapy at KRW 15,000 four times a month for three months, shockwave therapy at KRW 70,000 for four sessions, and a non-covered procedure at KRW 120,000 for two sessions.
Surgery and rehabilitation start in month 7, confirmed support of KRW 300,000 also starts in month 7, and the example adds visit time and ten work-leave days.
Hypothetical calcific tendinitis budget at three, six, and twelve months| Horizon | Medical before support | Support | Medical after support | Household burden |
|---|
| 3 months | KRW 666,000 | KRW 0 | KRW 666,000 | KRW 846,000 |
| 6 months | KRW 1,002,000 | KRW 0 | KRW 1,002,000 | KRW 1,362,000 |
| 12 months | KRW 2,494,000 | KRW 300,000 | KRW 2,194,000 | KRW 3,914,000 |
The KRW 3,914,000 twelve-month household result is not a hospital bill alone.
It combines KRW 2,194,000 medical cost after support with KRW 1,720,000 of visit-time and surgery-leave value, so those result lines should be reviewed separately.
Fifth-generation indemnity insurance
The Financial Services Commission release dated May 6, 2026 states that fifth-generation indemnity insurance excludes certain non-severe non-covered items, including musculoskeletal physical therapy, extracorporeal shock wave therapy, and non-covered injections.
The calculator therefore never guesses a reimbursement merely from the selected insurance generation and subtracts only the amount that the user has already confirmed.
A needling or lavage line can have a different billing and contract classification, so the tool warns the user to confirm that exact item instead of automatically calling every procedure an excluded injection.
Questions for the insurer
- What is the exact classification of each line on the medical expense statement?
- Does the contract impose a per-visit deductible, payment ceiling, or session limit?
- Which clinical record, imaging report, opinion letter, or prior-care document is required?
- How much of the confirmed payment relates to covered copay versus non-covered treatment?
Practical comparison scenarios
Compare shockwave quotes
Normalize the unit, shoulder or site, session count, consultation, and imaging guidance before comparing two advertised per-session prices.
Keep a clinical reassessment plan separate because the lower total does not prove the better treatment result.
Compare a procedure scenario
Run one scenario with conservative care only and another with the quoted injection, needling, or lavage line.
The difference is a budget difference and never an effectiveness or safety conclusion.
Prepare for surgery and recovery
Separate surgery, rehabilitation, transport time, companion arrangements, and work interruption instead of treating the operation quote as the whole household cost.
Confirm whether one hospital quote already includes admission, anaesthesia, tests, materials, meals, and follow-up.
Reconcile the final bill
Replace each estimate with the final receipt and medical expense statement after care.
Leaving support at KRW 0 until payment is confirmed gives a conservative cash-flow view and avoids counting the same benefit twice.
Frequently asked questions
Does deposit size select a treatment?
No. An image measurement alone does not establish the cause of pain, need for a procedure, or expected outcome, and the calculator does not interpret a clinical image.
Where should an X-ray, ultrasound, or MRI go?
Enter covered gross before copay under initial covered care and a provider-labelled non-covered patient payment under initial non-covered assessment. Do not enter one test twice.
Is SZ0840000 one national shockwave price?
No. It is the HIRA non-covered disclosure classification anchor for musculoskeletal shockwave therapy. The current provider disclosure controls the quoted price and included services.
Can an injection and ultrasound-guided lavage be combined?
A single bundled quote can be entered as one total for budgeting, but the procedures remain different. Use separate scenarios when the classifications or units need comparison.
Does a tertiary general hospital always charge exactly 60%?
No. The 60% figure is a simplified comparison applied to entered covered gross charges. Consultation, individual benefit lines, non-covered care, and special payer rules can differ.
Does the insurance-generation selector calculate a claim?
No. It triggers contract cautions only. The result subtracts an insurer or support payment only after the user enters a confirmed amount and application month.
Is an early surgery month rejected?
No. The tool shows a warning because the cited hospital information places arthroscopy after failed non-surgical care, but the diagnosis, concurrent disorder, urgency, and treatment decision belong to the clinical team.
Official sources and update boundary
- Seoul National University Hospital calcific tendinitis information: condition, examination, conservative care, injection, shockwave, and arthroscopic-surgery context.
- National Health Insurance Act Enforcement Decree Article 19: MST 283469 effective February 19, 2026, together with Annex identifier 17976571.
- Medical Service Act Article 45: MST 285327 effective April 7, 2026, for disclosure of non-covered charges.
- HIRA non-covered price information: current provider disclosure lookup and SZ0840000 shockwave classification.
- Financial Services Commission release dated May 6, 2026: fifth-generation indemnity-insurance exclusions for the listed musculoskeletal non-covered categories.
Statutes, insurance products, HIRA classifications, and provider disclosures can change.
This guide reflects official material checked on July 26, 2026 and should be rechecked with the provider, NHIS, HIRA, and the individual insurer before care or a claim.
Normalize the quote before comparing the totals
Separate covered gross from patient-paid charges, and separate per-session figures from whole-course figures before reviewing the 3-, 6-, and 12-month checkpoints.
The essential follow-up is still the diagnosis, treatment goal, reassessment point, and written itemised provider quote.