Organize a Korean provider quote for vitrectomy and membrane peeling, combined cataract surgery, admission, follow-up, confirmed private insurance, and the medical-expense tax credit.
The 2026 national fee schedule is a starting anchor. Replace it with the covered and non-covered totals from the provider quote for a useful cash plan.
Final planned cost after insurance and estimated tax credit
KRW 301,940
Includes surgery, admission, follow-up medical costs, and transport · 20%
Monthly reserve over 3 months
KRW 100,647
Monthly reserve over 6 months
KRW 50,323
3% salary threshold
KRW 1,500,000
Estimated annual credit after surgery
KRW 0
No gas is selected or the fill is not confirmed. Check the surgical instructions for the fill and positioning plan.
These amounts exclude tests, anesthesia, supplies, and admission.
| Provider | S5121 vitrectomy | S5145 second procedure | Combined |
|---|---|---|---|
| Clinic | KRW 1,172,950 | KRW 549,320 | KRW 1,722,270 |
| Hospital | KRW 1,028,180 | KRW 481,520 | KRW 1,509,700 |
| General or tertiary hospital | KRW 1,028,180 | KRW 674,130 | KRW 1,702,310 |
An epiretinal membrane is a thin layer over the macula that can distort central vision, while a macular hole is an opening at the center of the retina.
Vitrectomy, membrane peeling, intraocular gas, admission, and combined cataract surgery may appear in a treatment plan, but the diagnosis by itself does not determine which items are appropriate.
This calculator starts with a 2026 Korean national fee-schedule anchor and then lets you replace it with the covered and non-covered amounts on the provider quote.
The tool organizes an existing surgical quote.
It does not decide whether or when surgery is needed.
Covered totals, disclosed non-covered items, and confirmed insurer payments drive the result.
Hospital averages are not substituted for missing quotes.
The page is for planned macular surgery costs, not emergency retinal-detachment triage.
Sudden field loss or rapid visual change needs urgent eye care.
The Health Insurance Review and Assessment Service, known as HIRA, published the 2026 National Health Insurance fee schedule with an effective date of January 1, 2026.
The relevant rows include S5121 for total vitrectomy and S5145 for periretinal membrane removal.
When membrane removal is billed as an additional procedure on the same operative date, the second-procedure row can be 50% of the primary amount or 70% at a general or tertiary hospital under the applicable billing rule.
| Provider type | S5121 vitrectomy | S5145 second procedure | Combined anchor |
|---|---|---|---|
| Clinic | KRW 1,172,950 | KRW 549,320 | KRW 1,722,270 |
| Hospital | KRW 1,028,180 | KRW 481,520 | KRW 1,509,700 |
| General or tertiary hospital | KRW 1,028,180 | KRW 674,130 | KRW 1,702,310 |
The figures above are procedure fees before the national-insurance split.
Imaging, laboratory work, anesthesia, medicines, surgical supplies, gas, room and meals, cataract surgery, and a lens may be separate.
Actual billing follows the operative record, the simultaneous-procedure rule, the provider type, and HIRA review.
The general inpatient share is 20% of the covered total.
Outpatient rates are 30% at a clinic, 35% or 40% at a hospital, and 45% or 50% at a general hospital depending on location.
A tertiary outpatient pays the consultation fee in full plus 60% of the remaining covered amount.
The calculator does not invent an average non-covered charge.
Enter the amount disclosed by the provider under the Medical Service Act and the benefit-standards rules.
A confirmed expected payment is subtracted from the patient medical cost and capped at that cost.
Deductibles, exclusions, non-covered riders, limits, and final claim review still control the actual payment.
The planning formula applies 15% to eligible medical expenses above 3% of annual gross salary.
For the ordinary category, the eligible base is capped at KRW 7 million, while designated categories can be selected without that cap.
Admission and surgery cash = covered patient share + non-covered charges + admission extras.
Post-insurance medical cost = surgery cash + follow-up and medicines - confirmed insurer payment.
Final planned cost = post-insurance medical cost - incremental tax credit + transport.
A user can begin with the hospital combined anchor of KRW 1,509,700 and then replace it with the quote that includes the actual covered tests and anesthesia.
Adding two days of quoted room or meal patient charges, three follow-up visits, medicines, and transport separates cash needed around admission from the longer treatment budget.
Enter the cataract covered total separately and enter a premium-lens patient charge only when that lens is actually on the quote.
The calculator reports the incremental patient share caused by the cataract portion plus the premium lens, allowing two quote options to be compared without treating them as medical recommendations.
The admission and surgery cash figure may need to be paid before a private claim is processed.
The final planned cost can be lower after a confirmed insurer payment and an estimated tax credit, but those reductions do not necessarily arrive on the operation date.
Air, SF6, or C3F8 left inside the eye can expand when ambient pressure falls, creating a dangerous rise in intraocular pressure.
The calculator reuses the established travel-safety logic from the retinal-detachment calculator and displays planning periods of 10 days for air, 21 days for SF6, and 60 days for C3F8.
Concentration, fill volume, absorption speed, and surgical technique differ, so a calendar date is not proof that the bubble is gone.
No.
The anchor focuses on S5121 and S5145 procedure fees and omits many tests, anesthesia, medicines, materials, admission items, and non-covered charges.
Not necessarily.
Separate dates, simultaneous-procedure billing, and provider decisions can change the total, so the calculator requires the combined provider quote.
No.
The surgeon selects the fill and positioning plan from the clinical findings and technique, and the calculator never derives that choice from the diagnosis.
Policy generation does not reveal the final claim amount.
Deductibles, riders, exclusions, limits, and claim review vary, so only an insurer-confirmed amount is used.
No.
It is an incremental planning value, while the actual benefit depends on employment income, eligible family categories, documentation, insurance reimbursements, and tax liability.
Procedure amounts come from the HIRA 2026 National Health Insurance fee schedule, effective January 1, 2026.
Patient-share rules use Article 19 and Appendix 2 of the National Health Insurance Act Enforcement Decree current in 2026.
The non-covered disclosure model follows the Medical Service Act and the national benefit-standards rule, while the tax estimate reflects Article 59-4 of the Income Tax Act and Article 118-5 of its Enforcement Decree.
Disease and gas-safety context is supported by American Academy of Ophthalmology EyeWiki material on epiretinal membrane and macular hole.
This calculator is for planning and cannot diagnose disease, recommend surgery, predict vision, guarantee insurance, or guarantee a tax refund.
Sudden curtain-like field loss, flashes, a rapid increase in floaters, or abrupt vision loss requires prompt eye care regardless of the estimate.