What this South Korean carotid ultrasound cost calculator compares
This calculator organizes two itemized quotes for a carotid Doppler ultrasound that a clinician has already discussed with the patient. It separates the gross Korean National Health Insurance benefit charge, the billing-office-confirmed copay rate, a disclosed non-covered exam fee, patient-paid consultation and interpretation, an insurer-confirmed payment, transport, companion time, and the clinician-stated annual frequency. The result is a per-exam household cash need and an annual follow-up budget.
It does not diagnose carotid stenosis, interpret an image, recommend screening, choose a follow-up interval, decide Korean NHI eligibility, guarantee private indemnity-insurance reimbursement, or rank providers. Every price starts at zero because the user must replace it with a current quote. Zero means not entered; it does not mean free care and it is not a Korean national-average price.
Who may find it useful
- A patient who has already been given a diagnostic carotid-ultrasound order and wants a booking budget
- A family preparing recurring follow-up costs after a clinician has stated the frequency
- An adult child who needs to add transport, leave, accompaniment, or replacement-care cost for a parent
- A patient comparing whether two Korean provider quotes include the same consultation and interpretation scope
- A policyholder who wants to use an insurer-confirmed KRW amount instead of guessing from the policy generation
Keep the clinical decision outside the calculator
Do not order, delay, repeat, or replace an exam because one result card is cheaper. Keep the clinician-stated purpose and schedule unchanged. Use the calculation only to prepare cash for an already discussed path and to identify questions that remain unanswered in the quote.
Meaning of every input
Exam purpose
Choose diagnostic or follow-up only from the clinical explanation already received. The tool does not infer the purpose from age, symptoms, a prior procedure, or a result.
Confirmed coverage status
Use the status confirmed by the billing office for this date and clinical record: covered, selective benefit at an 80 percent copay, non-covered, mixed, or not yet confirmed.
Gross covered charge and copay
The gross covered charge is the full benefit amount before the patient share. Enter the exact patient-share rate separately. Do not place an already reduced patient payment in the gross-charge field.
Disclosed non-covered exam fee
Use the current amount disclosed or quoted by the provider that will perform the exam. Do not use an old blog price, an advertising range, or a nationwide statistic as the booking quote.
Consultation, interpretation, and other medical cost
Enter only patient-paid amounts billed outside the exam fee. If interpretation or consultation is already included, leave the corresponding add-on at zero to avoid double counting.
Annual exam count
Use only the number stated by the clinician. This is a budgeting multiplier, not a recommended interval and not an assessment of whether another exam is medically necessary.
Insurer-confirmed payout
Give the insurer the procedure name, benefit status, and outpatient context, then enter the per-exam planning amount that the insurer confirms. Policy generation alone never determines this number.
Transport and companion cost
Add fares, fuel, parking, leave, accompaniment, or replacement care that the household will actually fund. The calculation never assumes that these indirect costs are reimbursable medical expenses.
Calculation flow
The pure calculation function connects confirmed quote lines in a fixed order. Korean won amounts are kept in whole KRW. Only the covered patient share is rounded to the nearest won after applying the entered percentage.
1. Covered patient share
round(gross covered or selective-benefit charge × confirmed copay rate ÷ 100)
2. Medical add-ons
patient-paid consultation + patient-paid interpretation + other patient-paid medical cost
3. Medical cost before reimbursement
covered patient share + disclosed non-covered exam fee + medical add-ons
4. Applied insurance payment
the smaller of medical cost before reimbursement and the insurer-confirmed payout
5. Household cost per exam
medical cost before reimbursement − applied payment + transport + companion cost
6. Annual household budget
household cost per exam × clinician-stated exams per year
A confirmed payout cannot reduce cost below zero
If the entered insurance amount exceeds the medical-cost pool, the function caps the applied amount at medical cost and shows a warning. Transport and companion time remain outside that pool. A pending insurer answer can be modeled with a zero payout so the household also sees the conservative no-reimbursement budget.
Worked example: two annual follow-up exams
The following amounts are fictional inputs that demonstrate the formula. They are not Korean market averages, recommended fees, or promises from a provider or insurer. Both quotes use the same clinician-stated follow-up purpose, two exams per year, and confirmed inclusion scope.
Fictional Provider A and Provider B carotid-ultrasound quote inputs and calculated results| Line | Provider A | Provider B | Interpretation |
|---|
| Gross benefit charge and rate | KRW 180,000 at 20% | KRW 0 at 20% | A covered patient share is KRW 36,000 |
| Non-covered exam fee | KRW 40,000 | KRW 150,000 | Provider-confirmed input |
| Consultation, interpretation, other | KRW 30,000 | KRW 30,000 | Included items are not repeated |
| Insurer-confirmed payout | KRW 30,000 | KRW 50,000 | Not a generation-based estimate |
| Transport and companion cost | KRW 40,000 | KRW 20,000 | Household cost outside medical care |
| Household cost per exam | KRW 116,000 | KRW 150,000 | KRW 34,000 difference |
| Annual household budget | KRW 232,000 | KRW 300,000 | KRW 68,000 difference |
Reproduce Provider A step by step
- Apply 20 percent to KRW 180,000, producing a KRW 36,000 covered patient share
- Add KRW 40,000 non-covered and KRW 30,000 add-ons, producing KRW 106,000 before insurance
- Subtract the confirmed KRW 30,000 payment, leaving KRW 76,000 medical cost
- Add KRW 40,000 transport and companion cost, producing KRW 116,000 per exam
- Multiply by two clinician-stated annual exams, producing a KRW 232,000 annual budget
Five-step workflow
1. Record the clinical instruction
Write down whether the clinician described a diagnostic or follow-up exam and the stated annual frequency. Do not select a schedule from the budget result.
2. Ask the billing office for this exact status
Confirm whether this exam date and clinical record are covered, selective benefit, non-covered, or mixed. Request the gross benefit amount and patient-share rate as separate figures.
3. Align the itemized scope
Ask for the procedure name, EB4820000 or another displayed classification, the actual billing code, and whether consultation, interpretation, image storage, documents, or other additions are included.
4. Add insurance and household cash needs
Enter only the per-exam amount confirmed by the insurer for this procedure and visit context. Add transport and companion cost separately.
5. Resolve warnings before booking
Treat a lower entered cost as a budget observation, not a recommendation. Resolve every unknown-status, scope, code, inclusion, and schedule warning with the provider or clinician.
Korean benefit framework verified on August 18, 2026
National Health Insurance Act ID 001971, MST 276651, is current with an effective date of January 2, 2026. Article 41 includes examinations in medical-care benefits while excluding matters designated as non-covered and delegates the detailed method, scope, and criteria. Article 44 requires a patient share under the Presidential Decree and permits a higher share for selective benefits.
National Health Insurance Act Enforcement Decree ID 002813, MST 283469, effective February 19, 2026, connects patient shares to Annex 2 through Article 19. Medical Care Benefit Rules ID 006697, MST 285513, effective April 15, 2026, Article 5 connects detailed coverage criteria to Ministry of Health and Welfare notices. Those layers do not create one universal carotid-ultrasound copay that this calculator can safely infer from a provider type.
The current umbrella administrative rule verified through the National Law Information OPEN API is the Detailed Standards for Medical Care Benefits, administrative-rule ID 2105208, serial 2100000283492, Notice No. 2026-169, effective July 31, 2026. The fact that this is the current notice does not allow a household calculator to adjudicate one patient record. The provider must apply the detailed criteria to the actual purpose, date, diagnosis, related condition, frequency, and documentation.
Covered
Apply the billing-office-confirmed percentage to the gross covered amount. Do not apply the rate again to an amount that is already the patient copay.
Selective benefit at 80%
Select this only after the provider confirms it for the current exam. A mismatch warning checks arithmetic consistency; it does not decide eligibility.
Non-covered or mixed
Add a disclosed non-covered amount in full. For a mixed quote, keep the gross benefit component and the non-covered component in separate fields.
EB4820000 and provider price disclosure
The 2026 Health Insurance Review and Assessment Service public non-covered-item PDF lists EB4820000 as vascular ultrasound, extracranial vascular Doppler ultrasound, carotid artery. Use that label as a conversation and search anchor. It is not a personal coverage certificate, and the actual detailed statement may use a billing code or modifier that reflects the performed scope.
Medical Service Act ID 001788, MST 285327, effective April 7, 2026, Article 45 requires providers to disclose non-covered fees in an accessible way and prohibits collection above the disclosed amount. The current reporting and disclosure rule is administrative-rule ID 54511, serial 2100000274952, Notice No. 2026-38, effective February 23, 2026. Public disclosure supports quote research, but it does not guarantee that two providers include the same consultation, interpretation, limited-study scope, or additional service.
What the April 23, 2025 HIRA case actually shows
A HIRA medical-expense review example described a regular outpatient carotid ultrasound after carotid stent placement. After reviewing the record, HIRA found that the exam in that case fell outside the special-case registration period and outside the applicable ultrasound-benefit criteria, so the non-covered billing was upheld. This is not a rule that every post-stent or every follow-up exam is non-covered. It demonstrates why purpose, timing, the related condition, the registration period, and the clinical record must be checked for the current exam instead of copied from an older receipt.
Practical planning scenarios
Two annual follow-up visits for a parent
Do not merely double the headline exam price. Include consultation, travel, parking, a half-day of companion leave, and any replacement-care amount on every visit. Subtract only a confirmed medical payout, then reserve the annual household total.
Two non-covered quote advertisements
One advertised fee may include interpretation while another bills it separately. Keep the inclusion checks incomplete until both billing offices answer. A displayed price difference is not yet a like-for-like comparison.
A mixed benefit and non-covered quote
Apply the confirmed copay only to the gross benefit component. Add the disclosed non-covered component in full. Ask whether an amount on the quote is a gross covered charge or an already calculated patient payment before entering it.
Insurance answer still pending
First retain a zero payout to see the full cash need. After the insurer supplies a planning amount, enter it and compare the difference. Until claim review finishes, keep the higher no-reimbursement figure available.
How to interpret the result safely
- A lower total is not a clinical-quality ranking. Exam scope, clinical judgment, scheduling, and care quality are outside the formula.
- The annual total is a repetition budget. Change the count whenever the clinician changes the stated schedule.
- An insurer-confirmed planning amount is not a claim guarantee. Ask about documents, deductibles, exclusions, and final review.
- Public non-covered data does not replace a booking quote. Provider scope and separately billed items can differ.
- The Korean annual out-of-pocket ceiling is not automatically applied. Non-covered and other excluded patient payments need separate treatment.
- This is not emergency triage. New neurological symptoms require prompt medical attention rather than cost comparison.
Questions to ask before booking
Provider checklist
- Is the procedure name extracranial vascular Doppler ultrasound, carotid artery?
- What classification and actual billing code will appear on the detailed statement?
- For this purpose and date, is the exam covered, selective benefit, non-covered, or mixed?
- What are the gross covered amount and the patient-share rate as separate values?
- Are interpretation, consultation, image storage, and document costs included?
- What other patient-paid line could be added on the exam date?
Insurer checklist
- After receiving the procedure name and benefit status, is the claim reviewable under this contract?
- What per-exam planning amount remains after the outpatient deductible and limit?
- Are consultation and interpretation handled in the same claim category?
- Which receipt, detailed statement, diagnosis document, or report is required?
- Must repeated exams submit the same documents again?
- Can the pre-claim answer be saved with a reference number?
Frequently asked questions
What is the national average carotid ultrasound price in Korea?
This calculator does not publish or invent a Korean national-average price. Search the HIRA disclosure service for the item, then replace all zeros with a current itemized quote from the provider that will perform the exam.
Does EB4820000 prove that my exam is covered?
No. EB4820000 is a public classification anchor for extracranial vascular Doppler ultrasound of the carotid artery. Personal benefit status still depends on purpose, timing, the clinical record, and the applicable criteria.
Is every carotid ultrasound after a stent non-covered?
No general rule can be drawn from one review case. The April 23, 2025 HIRA example turned on a regular outpatient exam outside the special-case period after record review. Ask the billing office about the current exam date and record.
Should I automatically select the 80 percent selective-benefit option?
No. Select it only after the provider confirms that status for this exam. The warning checks whether the selected status and entered rate agree; it never adjudicates eligibility.
Can the tool calculate reimbursement from my indemnity policy generation?
No. Generation, purchase date, and broad coverage labels are insufficient. Enter only the per-exam amount that the insurer confirms after reviewing the exact procedure and visit context.
What if I do not know whether interpretation is included?
Leave the inclusion confirmation unchecked and ask the billing office. Two prices cannot be treated as equivalent when one includes interpretation and the other may charge it separately.
How many follow-up exams per year are appropriate?
The calculator does not answer that medical question. Enter only the frequency stated by the clinician and update the budget if that instruction changes.
Does a zero result mean the exam is free?
No. Initial zeros mean that quote lines have not been entered. Resolve the empty-medical-cost and confirmation warnings before using the result for planning.
Official sources and maintenance date
The source set below was checked on August 18, 2026 through the Korean National Law Information OPEN API and official HIRA materials. Future maintainers must recheck current effective dates, ultrasound benefit criteria, public-item codes, disclosure files, and insurance practice before changing any rule-facing text.
- National Health Insurance Act ID 001971, MST 276651, Articles 41 and 44, effective January 2, 2026
- National Health Insurance Act Enforcement Decree ID 002813, MST 283469, Article 19, effective February 19, 2026
- Medical Care Benefit Rules ID 006697, MST 285513, Article 5, effective April 15, 2026
- Medical Service Act ID 001788, MST 285327, Article 45, effective April 7, 2026
- Detailed Medical Care Benefit Standards, administrative-rule ID 2105208, serial 2100000283492, Notice No. 2026-169, effective July 31, 2026
- Non-covered Reporting and Disclosure Standards, administrative-rule ID 54511, serial 2100000274952, Notice No. 2026-38, effective February 23, 2026
- HIRA 2026 public non-covered item EB4820000, extracranial vascular Doppler ultrasound, carotid artery
- HIRA medical-expense review example for carotid ultrasound published April 23, 2025
Turn two current quotes into a follow-up budget
Keep the clinical purpose and schedule exactly as stated, then enter the provider-confirmed benefit status, item inclusions, insurance amount, and household travel cost.
Use every remaining warning as a question for the provider, clinician, or insurer before booking.