Echocardiography Insurance and Non-Covered Cost Calculator Korea

Compare two South Korean TTE, TEE, or stress echocardiography quotes using confirmed benefit, non-covered, add-on, indemnity-insurance, transport, and companion-cost amounts.

Prepare both itemized quotes first

Korean coverage and copay depend on the purpose, test type, frequency, and clinical record. This tool does not replace a provider or insurer decision; it only adds confirmed amounts you enter.

Provider A quote
Copy the itemized quote and billing-office answer. Zero means not entered; it is not a Korean national-average price.

Match the exact procedure name on the quote.

The calculator does not determine benefit eligibility.

KRW

Enter the gross covered charge, not an already reduced copay.

%

Confirm the rate for this test instead of guessing from provider type.

KRW

Use the provider-disclosed echocardiography fee.

KRW
KRW

Enter only a separately confirmed patient-paid amount.

KRW

For TEE, confirm sedation and recovery-room inclusion.

KRW

Do not duplicate interpretation, monitoring, or other included amounts.

times

Use only the schedule stated by the clinician.

Generation is recorded only; it never sets an automatic payout rate.

KRW

Use a payout confirmed for this procedure and coverage status, not a generation-only estimate.

KRW
KRW

Use an actual household value such as leave or replacement care.

Provider B quote
Copy the itemized quote and billing-office answer. Zero means not entered; it is not a Korean national-average price.

Match the exact procedure name on the quote.

The calculator does not determine benefit eligibility.

KRW

Enter the gross covered charge, not an already reduced copay.

%

Confirm the rate for this test instead of guessing from provider type.

KRW

Use the provider-disclosed echocardiography fee.

KRW
KRW

Enter only a separately confirmed patient-paid amount.

KRW

For TEE, confirm sedation and recovery-room inclusion.

KRW

Do not duplicate interpretation, monitoring, or other included amounts.

times

Use only the schedule stated by the clinician.

Generation is recorded only; it never sets an automatic payout rate.

KRW

Use a payout confirmed for this procedure and coverage status, not a generation-only estimate.

KRW
KRW

Use an actual household value such as leave or replacement care.

Provider A · Household cost per exam after payout

KRW 0

Annual budget KRW 0

Covered patient share
KRW 0
Non-covered exam fee
KRW 0
Medical add-ons
KRW 0
Medical cost before payout
KRW 0
Applied confirmed payout
KRW 0
Transport and companion cost
KRW 0

Checks to complete

  • All medical amounts are zero. Enter an itemized quote before comparing.
  • Coverage is unconfirmed. Ask the billing office about this exact test.
  • The procedure name and EDI code still need confirmation.
  • The included quote items still need confirmation.
  • The exam type or inclusion checks differ, so the two prices are not yet like-for-like.

Provider B · Household cost per exam after payout

KRW 0

Annual budget KRW 0

Covered patient share
KRW 0
Non-covered exam fee
KRW 0
Medical add-ons
KRW 0
Medical cost before payout
KRW 0
Applied confirmed payout
KRW 0
Transport and companion cost
KRW 0

Checks to complete

  • All medical amounts are zero. Enter an itemized quote before comparing.
  • Coverage is unconfirmed. Ask the billing office about this exact test.
  • The procedure name and EDI code still need confirmation.
  • The included quote items still need confirmation.
  • The exam type or inclusion checks differ, so the two prices are not yet like-for-like.

Like-for-like quote comparison

Align the exam type and included items first. The current difference may not compare equivalent quotes.

Provider A and Provider B echocardiography cost comparison
MeasureProvider AProvider BDifference
Household cost per examKRW 0KRW 0KRW 0
Annual household costKRW 0KRW 0KRW 0
Lower entered cost per exam: Same · Also compare scope, scheduling, clinical explanation, and possible add-on charges.

Related calculators

Compare the scope before comparing a South Korean echocardiography price

Echocardiography is not one identical billable product. A transthoracic echocardiogram may be described as a simple, general, advanced, or limited study, while a transesophageal or stress study can require a different preparation, monitoring plan, medicine, sedation, and recovery process. The final patient payment can also change with the purpose of the study, recognized frequency, provider, benefit status, and whether consultation or interpretation is already included.

This calculator does not publish or invent a Korean national-average price. It compares two itemized provider quotes that the user has already obtained. Each side separates the gross covered or selective-benefit charge, the copay rate confirmed by the billing office, the disclosed non-covered exam fee, patient-paid add-ons, insurer-confirmed reimbursement, transport, companion time, and planned annual frequency.

The result is a household budget, not a diagnosis, benefit-eligibility decision, imaging interpretation, test-frequency recommendation, insurer decision, or provider ranking. If the two exam types or included services do not match, the calculator keeps showing the arithmetic but warns that the comparison is not yet like-for-like.

What it calculates

Medical cost before and after a confirmed payout, household cost per exam, annual budget, and the difference between two quotes.

What it never decides

Medical necessity, Korean NHI eligibility, diagnosis, image findings, insurer payment, or which hospital a patient should choose.

The key prerequisite

Both providers must quote the same test and identify whether consultation, interpretation, medicine, sedation, recovery, and monitoring are included.

Four exam types and the quote details that matter

The roadmap grouped stress echocardiography as one of three broad exam groups. The implemented calculator separates pharmacologic stress from exercise stress because the medicines, exercise equipment, electrocardiogram and blood-pressure monitoring, recovery observation, and interpretation scope may be quoted differently. That split helps users detect a quote that looks cheaper only because a necessary add-on was omitted.

Echocardiography types and itemized quote checks
Exam typeConfirm on the quotePossible separate itemsComparison rule
Transthoracic echocardiographySimple, general, advanced, or limited study and the exact Korean procedure nameConsultation, interpretation, and contrast when usedDo not compare an unspecified “heart ultrasound” quote with an advanced study
Transesophageal echocardiographyTEE purpose, sedation method, and recovery arrangementsSedation, monitoring, medicine, and recovery roomAlign sedation and recovery inclusions before comparing the base exam fee
Pharmacologic stress echocardiographyStress method and medicine named by the providerStress medicine, ECG and blood-pressure monitoring, recovery observationConfirm whether medicine is included so it is not entered twice
Exercise stress echocardiographyTreadmill, bicycle, or other exercise protocolExercise test, monitoring, and additional interpretationDo not treat it as interchangeable with a pharmacologic stress quote
HIRA materials distinguish multiple cardiac ultrasound services. A statement may show codes in the EB431 through EB435 family for simple or general transthoracic and pharmacologic or exercise stress studies. A code is useful for matching a quote to a claim, but it does not by itself determine the individual patient's final benefit status. Ask for the Korean service name, EDI code, coverage classification, and recognized-frequency treatment together.

The 2026 Korean benefit and non-covered framework

Article 41 of the National Health Insurance Act, checked in MST 276651 effective January 2, 2026, places examinations and tests within medical-care benefits while allowing the ministry to designate non-covered subjects. Article 44 and Article 19 of the Enforcement Decree, checked in MST 283469 effective February 19, 2026, establish that the patient's share follows the applicable rules and Annex 2 structure. Those provisions do not create one universal outpatient percentage for every echocardiogram.

HIRA's published cardiac-ultrasound criteria explain that a physician may find a study medically necessary when cardiac disease exists or is suspected, but coverage still depends on the study type, diagnostic or follow-up purpose, age, procedure context, and recognized frequency. Adult diagnostic use, specified follow-up circumstances, post-procedure limited studies, pediatric rules, and preoperative-risk circumstances have separate conditions. Some excess-frequency studies may be selective benefits with an 80% patient share, while another study can be non-covered when the benefit criteria are not met and the required explanation and consent process applies.

Because those conditions require a clinical record, the calculator does not ask the user to self-diagnose or infer eligibility from a symptom checkbox. The safe input is the gross covered or selective-benefit amount and the exact copay rate confirmed by the provider's billing office for this test. If the classification has not been confirmed, leave it as unconfirmed and use the warning as a call checklist.

The current detailed benefit-criteria notice, Notice No. 2026-169 effective July 31, 2026, and the current service list and relative-value notice, Notice No. 2026-160 effective July 31, 2026, were rechecked for this implementation. Their latest amendments did not supply a universal echo price or a new automatic coverage formula appropriate for this calculator.

Covered or selective-benefit quote

  • Ask for the gross covered charge if the document shows only a patient payment.
  • Enter the gross charge before applying a percentage.
  • Enter the copay rate confirmed for this exact study.
  • If “selective benefit at 80%” is selected, verify that the entered rate is also 80%.

Non-covered or mixed quote

  • Use the provider-disclosed non-covered echocardiography amount.
  • Select mixed when the episode contains both benefit and non-covered parts.
  • Do not re-enter interpretation, contrast, or medicine already included in the base quote.
  • If the public price differs from the booking quote, ask which scope or add-on changed.

Why disclosed non-covered prices still need a booking quote

Article 45 of the Medical Service Act, checked in MST 285327 effective April 7, 2026, requires providers to disclose non-covered medical fees and bars charging more than the disclosed amount for the disclosed service. The “Standards for Reporting and Disclosing Non-Covered Medical Expenses,” Notice No. 2026-38 effective February 23, 2026, supports public comparison. HIRA also cautions that the same provider and item can vary with duration, site, or service detail. A public row therefore helps identify a question to ask; it is not a substitute for a same-scope itemized booking quote.

Ask whether consultation, interpretation, contrast, stress medicine, sedation, recovery, monitoring, and an extra limited study are included. Record the date and department that supplied the answer. After the study, compare the receipt and itemized statement with the quote, including the Korean service name and EDI code. HIRA's billing-review guidance also explains why the itemized statement matters when a patient believes a benefit service may have been billed as non-covered.

Step-by-step calculator workflow

  1. Match the test and code. Confirm whether both quotes are the same transthoracic, transesophageal, pharmacologic stress, or exercise stress service. Record the Korean procedure name and EDI code, then complete the code checkbox.
  2. Confirm the billing classification. Use covered benefit, selective benefit at 80%, non-covered, or mixed only after the provider answers for this episode. Keep “not yet confirmed” if an answer is pending.
  3. Separate amounts without duplication. Enter the gross benefit charge and confirmed rate, disclosed non-covered exam fee, consultation, contrast or stress medicine, sedation, and other patient-paid medical add-ons. Do not repeat an included amount.
  4. Use only an insurer-confirmed amount. Select the indemnity-policy generation as a record. Then ask the insurer about this service name, code, benefit status, deductible, rider, and limit before entering a payout per exam.
  5. Add household costs and clinical frequency. Enter actual transport and companion-time costs per exam and only the annual frequency stated by the clinician. The tool never recommends the next test date.
  6. Resolve the scope warning. A like-for-like status appears only when both exam types match and both inclusion checkboxes are complete. The lower-cost label remains arithmetic, not medical or provider advice.

Formula and a KRW 280,000 annual worked example

Covered patient share

Gross covered or selective-benefit charge × confirmed copay rate, rounded to won

Medical add-ons

Patient-paid consultation + contrast or stress medicine + sedation + other medical items

Medical cost before payout

Covered patient share + disclosed non-covered exam fee + medical add-ons

Applied reimbursement

The lower of medical cost and insurer-confirmed payout per exam

Household cost per exam

Medical cost after payout + transport + companion time

Annual household budget

Household cost per exam × clinician-stated annual frequency

The worked example is hypothetical and the figures are not Korean national averages. Provider A has a KRW 300,000 gross covered charge at a confirmed 20% copay, a KRW 50,000 non-covered exam fee, and KRW 60,000 of patient-paid consultation, contrast or medicine, and other medical add-ons. The insurer confirms KRW 80,000 per exam. Transport is KRW 20,000, companion time is KRW 30,000, and the clinician has stated two exams in the year.

Echocardiography worked example calculation
StepArithmeticResult
Covered patient shareKRW 300,000 × 20%KRW 60,000
Medical cost before payoutKRW 60,000 + KRW 50,000 + KRW 60,000KRW 170,000
Medical cost after payoutKRW 170,000 − KRW 80,000KRW 90,000
Household cost per examKRW 90,000 + KRW 20,000 + KRW 30,000KRW 140,000
Annual household budgetKRW 140,000 × 2 examsKRW 280,000

Indemnity insurance: record the generation, never guess the payout

South Korean indemnity medical insurance differs by generation, enrollment date, rider, benefit status, deductible, outpatient rules, annual limits, and claims review. The Financial Services Commission announced the launch of fifth-generation indemnity medical insurance on May 6, 2026, including a revised structure for covered and non-covered protection. That launch does not make one fifth-generation percentage valid for every echocardiography claim, and earlier generations also cannot be reduced to a single safe rate.

The generation selector is therefore informational. It never drives the formula. The reimbursement field should contain only a per-exam amount that the insurer has confirmed after receiving the exact procedure name or EDI code, the provider's benefit classification, and the expected itemized amounts. Even a pre-service answer may remain subject to the policy and final claims review, so the result is a planning amount rather than a payment guarantee.

The applied reimbursement is capped at the medical-cost pool. Transport and companion time remain household costs and are not assumed to be reimbursable. If a user enters a payout larger than medical cost, the tool subtracts only the medical cost and displays a cap warning instead of creating a negative bill.

Questions to ask the provider and insurer

Provider billing office or test unit

  • What are the exact Korean service name and EDI code?
  • Is this episode covered, selective benefit, non-covered, or mixed?
  • What are the gross benefit charge and the actual copay rate?
  • Are consultation, interpretation, contrast, stress medicine, sedation, recovery, and monitoring included?
  • Which items can be added on the day of the test?
  • Can the patient receive a receipt, itemized statement, and any claim certificate required?

Indemnity insurer

  • Is this procedure and benefit classification within this contract's coverage?
  • How do the outpatient deductible, copay, non-covered rider, and annual limit apply?
  • Are consultation, medicine, and sedation reviewed separately?
  • Can the insurer state a planning payout per exam for this itemized quote?
  • Which documents are required beyond the receipt and itemized statement?
  • Which final-review conditions could change the pre-service answer?

Frequently asked questions

Does suspected heart disease automatically make every echo covered?

No. Medical necessity is important, but HIRA criteria also distinguish exam type, purpose, age, diagnostic versus follow-up use, procedure context, and frequency. A provider must apply the clinical record; this calculator cannot self-adjudicate coverage.

Is an 80% selective benefit the same as non-covered care?

No. A selective benefit remains inside the NHI benefit framework with the specified high patient share. A non-covered service uses the provider-disclosed fee. Keep the classifications and amounts separate.

Can I use only the hospital website price?

Use it to start the conversation, then obtain an itemized booking quote. The public service may not include consultation, interpretation, medicine, sedation, recovery, monitoring, or a different study scope.

Why does selecting an insurance generation not calculate a refund?

Generation alone cannot establish riders, deductibles, limits, benefit status, medical-necessity review, or the contract terms. Enter only a payout confirmed for this exact proposed service.

What happens if confirmed insurance exceeds the medical cost?

The calculator applies reimbursement only up to medical cost and raises a warning. It does not use the excess to offset transport or companion time.

Can I compare TTE with TEE or pharmacologic with exercise stress?

The arithmetic remains visible, but it is not a like-for-like comparison. Match the test type and included services first because preparation, monitoring, medicine, sedation, and recovery can differ.

Should I choose the provider labeled lower cost?

Not on this result alone. The label compares entered household amounts and does not evaluate clinical suitability, physician expertise, urgency, scheduling, access, explanation quality, or safety.

Does this calculator interpret an echo or estimate cardiac risk?

No. It has no imaging, diagnosis, risk, or triage function. Urgent symptoms such as severe chest pain, marked shortness of breath, or fainting require prompt medical assessment rather than price comparison.

Official sources and verification date

Legal and administrative sources were rechecked on August 18, 2026. The implementation uses National Health Insurance Act MST 276651 effective January 2, 2026; Enforcement Decree MST 283469 effective February 19, 2026; Medical Service Act MST 285327 effective April 7, 2026; the HIRA cardiac-ultrasound criteria related to Notice No. 2023-293; benefit notices Nos. 2026-169 and 2026-160 effective July 31, 2026; and non-covered disclosure Notice No. 2026-38 effective February 23, 2026.

Align both quotes, then plan the cash requirement

Confirm the Korean procedure name, EDI code, benefit status, included services, and insurer planning amount before treating a price difference as meaningful. Save the result as a question list for the provider and insurer, and make the medical decision with the treating clinician.