Carotid Artery Stenting (CAS) and Endarterectomy (CEA) Cost Calculator
This calculator estimates the out-of-pocket cost of treating carotid artery stenosis in Korea and keeps the same pure calculation model as the Korean page. It covers carotid artery stenting (CAS, an endovascular procedure with a filter-type embolic protection device and a self-expanding stent) and carotid endarterectomy (CEA, open surgery that removes the plaque directly). The carotid artery carries blood from the heart to the brain, so plaque there can break off and block a brain vessel, causing an ischemic stroke — the goal of both treatments is stroke prevention. Its defining point is that carotid stenosis is treated very differently from lower-extremity PAD for cost: leg atherosclerosis (I70.2) is NOT a special-case condition (ordinary 20 percent), but carotid stenosis is a cerebrovascular disease (I60-I67, carotid stenosis I65), so a patient who undergoes stenting or endarterectomy qualifies for the cerebrovascular special case (code V191) at a 5 percent benefit self-pay for up to 30 days. All figures are planning estimates based on 2026 Korean rules, not medical advice.
Treatment options and covered fees
Carotid artery stenting (CAS) reaches the narrowed carotid artery through a catheter from the groin (or arm) and expands a mesh stent to hold the vessel open from the inside. A filter-type embolic protection device (EPD) is used so that debris dislodged during the procedure does not travel to the brain and cause a stroke; both the EPD and the self-expanding carotid stent are covered materials. Because there is no incision, CAS is done under local anesthesia with a short 2 to 4 day stay, followed by a period of dual antiplatelet therapy (for example aspirin plus clopidogrel) to prevent stent thrombosis.
Carotid endarterectomy (CEA) opens the carotid artery through a neck incision and removes the built-up plaque directly, sometimes with a patch angioplasty to widen the closure, then sutures the vessel. Because it removes the cause instead of placing a stent, restenosis is low and long-term results are excellent. It is done under general anesthesia with a 5 to 7 day stay, and rarely a neck-incision nerve injury (hoarseness, swallowing difficulty) can occur, so recovery is longer than with stenting. Medical therapy alone — antiplatelet plus high-intensity statin, blood pressure and glucose control, and smoking cessation — is an option for mild asymptomatic stenosis or high surgical risk; it is outpatient benefit and not a special case, and is shown only as a reference row in the comparison.
- CAS — endovascular stent, local anesthesia, EPD + stent covered, 2 to 4 day stay, dual antiplatelet after.
- CEA — open plaque removal (standard), general anesthesia, 5 to 7 day stay, low restenosis.
- Medical therapy — antiplatelet + high-intensity statin, no procedure, outpatient benefit, not a special case (reference only).
- CAS covered total is roughly KRW 8-13 million (procedure + stent + EPD + ward); the model default is about KRW 8.35 million.
Why carotid stenosis IS the 5 percent special case
The Korean special-case program (Ministry of Health and Welfare notice on special-case cost sharing, notice 2026-101, effective 2026-05-01) lowers the copay for listed severe conditions. Its cerebrovascular special case lowers the benefit self-pay to 5 percent (special code V191) for up to 30 days when a patient with a cerebrovascular disease (diagnosis range I60-I67) receives a listed surgery or procedure. Occlusion and stenosis of the carotid artery (I65) is within that I60-I67 range, so carotid stenting or endarterectomy makes the patient eligible and the copay drops from 20 percent to 5 percent.
This is the exact opposite of lower-extremity PAD. Leg atherosclerosis (I70.2) is not on the special-case list, so it stays at 20 percent, but the carotid artery in the neck is a cerebrovascular disease directly linked to stroke, so it gets 5 percent. For an identical KRW 10,000,000 covered total, a leg stent at 20 percent costs KRW 2,000,000 while a carotid stent at the 5 percent special case costs KRW 500,000. Just as a coronary (heart) stent gets 5 percent under the cardiac special case (code V192), the carotid gets 5 percent under the cerebrovascular special case (code V191).
Stenting is explicitly listed; confirm endarterectomy with the hospital
The special-case surgery annex lists carotid stenting as percutaneous intravascular metal stent insertion (codes M6601, M6602, M6605), so carotid stenting is clearly a 5 percent special case (V191). Open carotid endarterectomy, however, is not listed under that exact name with its own independent code in the annex. In practice it is generally registered and recognized as a cerebrovascular surgery, but because application can vary by hospital and review, if you plan an endarterectomy you should confirm special-case registration and recognition with the hospital administration office during admission.
This calculator lets you toggle special-case registration directly, so it shows both the 5 percent registered case and the 20 percent unregistered case. When you select stenting it explains the explicit-listing basis, and when you select endarterectomy it shows the confirm-with-hospital note, so you can gauge the real difference in advance. Actual application depends on the medical record and claim criteria, so use the result as a planning estimate.
Asymptomatic versus symptomatic, and degree of stenosis
Carotid stenosis is divided into asymptomatic and symptomatic. Asymptomatic stenosis is found incidentally on a check-up or carotid ultrasound and is treated electively with a relatively short stay. Symptomatic stenosis means a transient ischemic attack (TIA) or stroke within the last 6 months; the recurrence risk is high, so it is treated early, and extra brain imaging, intensive monitoring, and periprocedural stroke-risk management add to the length of stay and cost. Selecting symptomatic in the calculator automatically adds a severe-care surcharge and extra ICU and ward days.
The degree of stenosis also affects the decision and cost. Intervention is generally considered beneficial at 50 to 70 percent or more for symptomatic disease and 70 percent or more for asymptomatic disease, and severe or bilateral disease makes treatment more complex. The choice between CAS and CEA depends on stenosis severity and location, age, and comorbidities: stenting favors older or high-surgical-risk patients with a fast recovery and no general anesthesia, while endarterectomy is chosen when the anatomy is suitable for its low restenosis and durable result.
Private indemnity, the ceiling, and the tax credit
Carotid stenting and endarterectomy are mostly inpatient, so they are reimbursed as inpatient medical expenses under private indemnity insurance: the benefit self-pay is reimbursed after the generation-based deductible, while upper-grade room charges are usually reimbursed up to 50 percent. Covered self-pay above the income-tier out-of-pocket ceiling (about KRW 900,000 to 8,430,000 in 2026) is refunded, but the ceiling refund is not double-paid by indemnity, and non-covered items and the upper-grade room difference are outside the ceiling.
Carotid treatment cost is eligible for the medical expense tax credit — 15 percent of the amount above 3 percent of total salary is refunded at year-end (Income Tax Act Article 59-4). The ordinary credit is capped at KRW 7,000,000 per year, but treatment received under the special case (a severe illness) is exempt from that cap, so the full amount counts. Amounts reimbursed by private indemnity and refunded by the out-of-pocket ceiling are excluded, so only the real out-of-pocket amount after insurance and refunds is credited; if a supporting child paid a parent’s cost, the child can claim it.
How to read the result
Enter the symptom status (asymptomatic or symptomatic), the treatment (carotid stenting or endarterectomy), the embolic protection device toggle (stenting only), special-case registration, and ICU and ward days. Then set hospital grade, insurance type, upper-grade room days, other non-covered cost, private indemnity generation, income decile, and the out-of-pocket ceiling. The result shows the covered self-pay after the ceiling, the 20 percent versus special-case 5 percent comparison, a CAS versus CEA comparison (with medical therapy as a reference), the ceiling refund, and the final cost after private indemnity and the tax credit.
This is a cost-planning estimate based on 2026 Korean rules, not medical advice. Public single-price tables for carotid procedures do not exist, so the device and fee figures are defensible market estimates that vary with hospital, degree and location of stenosis, materials, symptom status, and complications. Confirm details with the treating vascular or neurointervention team, the insurer, and the hospital quote, and remember that smoking cessation and risk-factor control (blood pressure, glucose, high-intensity statin, antiplatelet) are the best way to prevent disease in the opposite carotid or coronary arteries and avoid repeat-procedure costs.
This calculator is based on Korean rules (2026 National Health Insurance: carotid stenosis is a cerebrovascular disease within I60-I67, so carotid stenting or endarterectomy qualifies for the cerebrovascular special case at 5 percent for up to 30 days under special code V191, unlike lower-extremity PAD I70.2 which stays at the ordinary 20 percent inpatient copay; carotid stenting is explicitly listed as percutaneous intravascular metal stent insertion M6601/M6602/M6605, while open endarterectomy registration should be confirmed with the hospital; the embolic protection device and stent are covered materials; the out-of-pocket ceiling; and the Income Tax Act Article 59-4 medical expense tax credit with the cap exemption for special-case severe illness), with market cost estimates for devices and procedure fees. Figures are planning estimates, not medical advice, an insurer decision, or a hospital quote.