Planning a GERD endoscopic-treatment or anti-reflux surgery bill in South Korea
A gastroesophageal reflux disease treatment plan rarely fits one nationwide retail price.
The plan may include gastroscopy, 24-hour ambulatory pH monitoring, esophageal manometry, endoscopic treatment, sedation or anesthesia, admission, hiatal hernia repair, medication, and follow-up testing.
A single provider estimate can also mix ordinary National Health Insurance benefits, selective benefits, full patient payment, and non-covered items with different patient-share rules.
This Korea-specific planner starts every provider price at KRW 0 instead of inventing a national average.
Choose the care path already discussed with the clinician, then enter the provider’s ordinary covered gross charge, Q7600 selective-benefit gross charge, full patient payment, non-covered charge, and patient-paid test or admission items without overlap.
The calculator does not diagnose GERD, recommend a treatment, interpret a pH or manometry result, or predict symptom improvement, recurrence, complications, admission length, or recovery.
Collect these four records first
- A consultation note stating the procedure name, access route, and provider-confirmed billing identifier
- An itemized estimate separating pre-treatment tests, ordinary covered gross charges, selective benefits, full patient payment, and non-covered items
- A one-year plan for follow-up visits, tests, and medication with patient-paid amounts
- An insurer-confirmed expected payment and a household plan for leave from work, transport, and caregiver costs
How is this different from the sedation endoscopy cost calculator?
Diagnostic or screening endoscopy
The existing sedation endoscopy calculator covers upper and lower endoscopy, sedation fees, test purpose, biopsy, and polyp removal.
It is designed for the diagnostic or screening stage.
Post-diagnosis GERD treatment planning
This page covers additional assessment and an endoscopic or surgical anti-reflux path discussed after diagnosis.
It combines the initial treatment event with one year of follow-up, medication, and household recovery cash needs.
Avoid counting a test twice
Do not add gastroscopy or 24-hour pH monitoring again when it is already included in the treatment estimate.
If a test was paid separately before the treatment quote, enter only that patient-paid amount in the pre-treatment test field.
2026 HIRA consultation and billing-verification identifiers
The Health Insurance Review and Assessment Service, or HIRA, lists endoscopic radiofrequency treatment, thoracic and abdominal anti-reflux surgery, and hiatal hernia repair in the 2026 KDRG Classification Book Version 4.7.
These identifiers help a patient ask the provider what is being quoted; they are not codes a patient should assign from symptoms or a verbal procedure description.
2026 HIRA identifiers for GERD endoscopic treatment, anti-reflux surgery, and hiatal hernia repair| Identifier | Official Korean classification in English | Quote question |
|---|
| Q7600 | Endoscopic radiofrequency treatment for gastroesophageal reflux disease | Separate the Q7600 selective-benefit gross charge from ordinary covered and non-covered lines |
| Jo-934 | Endoscopic anti-reflux mucosal resection, commonly called ARMS | Confirm the current non-covered disclosure, quote unit, 24-hour pH test, and included sedation |
| QA424 | Esophagogastric cardia surgery, anti-reflux surgery by abdominal approach | Confirm laparoscopic or open access, anesthesia, admission, materials, and any hernia repair |
| QA423 | Esophagogastric cardia surgery, anti-reflux surgery by thoracic approach | Confirm why thoracic access is planned and which admission and associated-procedure lines are included |
| Q2352 | Hiatal hernia repair by abdominal approach | Confirm whether QA424 is combined and obtain one itemized combined estimate |
| Q2351 | Hiatal hernia repair by thoracic approach | Confirm whether QA423 is combined and obtain one itemized combined estimate |
Inclusion in the KDRG book does not create one national patient price or automatic benefit approval.
Procedure, testing, anesthesia, materials, admission, meals, room choice, medication, and follow-up may appear under different benefit statuses and patient shares.
When hernia repair and anti-reflux surgery are combined, do not add stand-alone code prices; enter the provider’s itemized combined estimate once.
Q7600 and the 90% selective-benefit patient share
HIRA’s published criteria describe Q7600 in the context of at least six months of medication without an adequate result, or difficulty continuing medication because of adverse effects or a similar reason.
The criteria effective January 1, 2024 exclude a patient under age 18, pregnancy, a hiatal hernia measuring 2 cm or greater, achalasia or incomplete lower-esophageal-sphincter relaxation, and Barrett’s esophagus.
The list also excludes a patient whose poor general condition, such as chronic disease or systemic impairment, makes surgery difficult.
This calculator deliberately does not collect those facts to decide eligibility; the treating clinician, provider, and HIRA process remain authoritative.
Verified planning rate
The Q7600 selective-benefit patient share changed from 80% to 90% on September 1, 2024.
The 2026 full list associated with Ministry of Health and Welfare Notice 2026-44 still shows 90% and that effective date.
Where the rate applies
Apply 90% only to the pre-copay gross charge the provider identifies as Q7600.
Do not merge a different ordinary covered charge or non-covered line into that field.
What it does not prove
A selective-benefit classification does not prove individual suitability, final approval, effectiveness, or indemnity-insurance reimbursement.
The result is an estimate-based patient-payment plan.
Why Jo-934 ARMS belongs in the non-covered field
HIRA’s published health-technology reassessment describes Jo-934 endoscopic anti-reflux mucosal resection after a pre-procedure 24-hour pH test for a GERD patient for whom maintaining or taking medication is inappropriate.
The published context also refers to a patient at high surgical risk or one who refuses surgery, and excludes a hiatal hernia over 2 cm.
Because long-term evidence and standard guideline support were considered insufficient, the procedure was determined to be non-covered under Ministry of Health and Welfare Notice 2025-136, effective September 1, 2025.
A non-covered classification is not a treatment recommendation
The published context is used here to define a cost field and consultation questions.
Whether ARMS is suitable, how it compares with surgery, and what outcome to expect require a treating clinician’s assessment.
Enter only the provider’s current Jo-934 disclosure and the confirmed scope of that quote.
Separating the ordinary 20% inpatient share from other patient payments
Article 19 and Annex 2 of Korea’s National Health Insurance Act Enforcement Decree, effective February 19, 2026, generally use a 20% patient share for ordinary inpatient covered charges after separately governed items are excluded.
Meals generally use a 50% patient share, while outpatient shares vary by provider type and location.
Selective benefits, full patient payment, non-covered care, higher-room charges, and special-case rules must not be treated as ordinary inpatient 20% lines automatically.
Ordinary covered gross charge
Enter only covered charges before copay that share the selected ordinary rate, using 20% as an editable inpatient planning default.
Q7600 selective-benefit gross charge
Enter only the provider-identified Q7600 amount; the calculator applies the fixed 90% patient share.
Full patient payment
Enter the amount the estimate assigns entirely to the patient, without applying the ordinary covered rate again.
Non-covered treatment or materials
Enter the patient charge currently disclosed by the provider for Jo-934 or another non-covered line.
Pre-treatment test patient payment
Enter the amount after any outpatient patient share has already been reflected, so no second rate is applied.
Anesthesia and admission patient payment
Enter the already-calculated patient amount for meals, room, anesthesia, or mixed lines without duplicating another field.
Article 45 of the Medical Service Act requires providers to make non-covered prices easy for patients or guardians to find and prohibits collecting more than the disclosed amount.
Check the provider’s current website or billing desk disclosure for the item name, amount, quote unit, number of sessions, and included services before entering it.
What each input means
Meaning and calculation treatment of each GERD cost-planner input| Input | What to enter | Calculation treatment | Allowed input |
|---|
| Pre-treatment test patient cost | Patient-paid gastroscopy, 24-hour pH monitoring, manometry, or related assessment not included elsewhere | Added once to the initial medical event | KRW 0–100,000,000 |
| Ordinary covered gross quote | Covered charge before the selected ordinary copay | Multiplied by the editable zero-to-one-hundred-percent share, with ordinary inpatient care defaulting to twenty percent | KRW 0–200,000,000 |
| Q7600 selective-benefit gross quote | Only the provider-confirmed Q7600 pre-copay charge | Multiplied by the ninety-percent selective-benefit patient share | KRW 0–200,000,000 |
| Full patient payment | A line identified as 100% patient payment | Added at the entered amount | KRW 0–200,000,000 |
| Non-covered treatment cost | Current provider-disclosed Jo-934 or other non-covered patient charge | Added at the entered amount | KRW 0–200,000,000 |
| Anesthesia and admission patient cost | Already-calculated patient amount for mixed admission, meal, room, or anesthesia lines | Added without another copay | KRW 0–100,000,000 |
| Follow-up visits and unit cost | Provider-planned one-year visits and patient cost per visit | Visits multiplied by unit cost | 0–100 visits; KRW 0–5,000,000 each |
| Medication months and monthly cost | Up to 12 months of patient-paid medication in the plan | Months multiplied by monthly cost | 0–12 months; KRW 0–5,000,000 monthly |
| Recovery days and daily income loss | Household cash-flow assumption after paid leave | Days multiplied by daily net loss | 0–365 days; KRW 0–20,000,000 daily |
| Confirmed insurance payment | Amount confirmed by the insurer, not a product-name estimate | Capped at one-year medical cost | KRW 0–300,000,000 |
| Alternative one-year medical cost | A genuinely comparable quote with the same time horizon and scope | Compared before insurance, tax, and non-medical recovery costs | KRW 0–300,000,000 |
Calculation formulas and result interpretation
Initial event and one-year medical cost
ordinary covered copay = ordinary covered gross quote × entered patient-share rate
Q7600 patient payment = Q7600 selective-benefit gross quote × 90%
initial treatment medical cost = pre-treatment tests + both copays + full patient payment + non-covered treatment + anesthesia and admission patient cost
one-year medical cost = initial treatment medical cost + follow-up visits × unit cost + medication months × monthly cost
Cash need, range, and monthly reserve
Income interruption equals planned recovery days multiplied by the daily net income loss, then transport and caregiver costs are added.
The net one-year burden subtracts the insurer-confirmed payment, capped at medical cost, and the incremental medical-expense tax-credit plan from total cash need.
The selected variation percentage is applied above and below that net burden, and the high end divided by the selected funding months is rounded up for the monthly reserve.
The range is not a statistical confidence interval or a provider-price forecast.
It is a household cash buffer chosen by the user for unresolved tests, admission days, room choice, medication, or follow-up frequency.
Step-by-step use
- Select the discussed path. Choose Q7600, Jo-934, abdominal or thoracic anti-reflux surgery, combined hiatal hernia repair, or a provider-defined plan only after a clinician has presented it.
- Separate assessment and initial quote lines. Copy ordinary covered gross, Q7600 selective benefit, full patient payment, non-covered, and already-calculated patient amounts into distinct fields.
- Add the one-year plan. Enter provider-advised follow-up visits, patient cost per visit, medication months, and monthly patient cost.
- Add household recovery cash. Use the clinician’s plan and actual paid leave to estimate days of net income interruption, plus transport and caregiver spending.
- Use confirmed support only. Enter an insurer-confirmed expected payment, annual gross salary, and other eligible medical expenses after reimbursement.
- Compare like with like. The alternative must cover the same testing, treatment, one-year follow-up, and medication horizon.
- Reconcile the result with the provider. The provider’s current item classification, quote unit, and included scope take priority over this planning output.
Worked arithmetic example
These values are a deterministic formula check, not a national average or recommended price.
Every editable provider and follow-up price in the live calculator starts at KRW 0.
Worked GERD treatment cost-planning example in Korean won| Result | Arithmetic | Amount |
|---|
| Ordinary covered copay | KRW 4,000,000 × 20% | KRW 800,000 |
| Q7600 patient payment | KRW 1,000,000 × 90% | KRW 900,000 |
| Initial treatment medical cost | Tests 300,000 + both copays + full patient payment 100,000 + non-covered 500,000 + anesthesia/admission 400,000 | KRW 3,000,000 |
| One-year medical cost | Initial 3,000,000 + 4 follow-ups × 50,000 + 12 medication months × 20,000 | KRW 3,440,000 |
| Gross cash need | One-year medical 3,440,000 + 5 recovery days × 100,000 + transport/caregiver 100,000 | KRW 4,040,000 |
| Incremental tax-credit plan | Medical cost after KRW 1,000,000 insurance = 2,440,000; subtract 3% of KRW 40,000,000 salary, then × 15% | KRW 186,000 |
| Net one-year burden | KRW 4,040,000 − insurance 1,000,000 − tax-credit plan 186,000 | KRW 2,854,000 |
| Budget range | Net burden ±10% | KRW 2,568,600 to 3,139,400 |
| 12-month reserve | High end ÷ 12, rounded up | KRW 261,617 |
If a like-for-like alternative has a one-year medical cost of KRW 3,000,000, the current input is KRW 440,000 higher.
That comparison excludes insurance, tax, and non-medical recovery costs, so it is meaningful only when both quotes have the same scope.
Insurance and the Korean medical-expense tax credit
Enter only an insurer-confirmed amount
Indemnity coverage can vary by policy generation, deductible, non-covered rider, admission treatment, exclusion, and contract limit.
The planner does not infer reimbursement from a product name; it subtracts only an insurer-confirmed expected payment and caps it at one-year medical cost.
Income interruption, transport, and caregiver cost are not erased automatically by a medical reimbursement input.
15% after the gross-salary 3% threshold
Article 59-4 of the Income Tax Act applies a basic 15% credit rate to eligible medical expenses above 3% of gross salary.
The eligible-base cap for ordinary dependent-family medical expenses is KRW 7,000,000, while specified groups including the taxpayer have no such cap for those expenses.
The calculator removes confirmed insurance and measures only the incremental base and credit caused by this plan.
The tax result is not a refund guarantee
Actual year-end settlement depends on family expense ordering, simplified tax records, reimbursement timing, other deductions, and tax liability.
This is a simplified incremental planning value under the Article 59-4 rule effective January 1, 2026, not tax advice.
Practical scenarios
A provider quotes Q7600
Ask for the Q7600 selective-benefit gross charge separately from ordinary covered tests and anesthesia, then confirm which line actually receives the 90% patient share.
A clinician discusses ARMS
Confirm the current Jo-934 non-covered disclosure and whether 24-hour pH monitoring, sedation, and follow-up endoscopy are included.
Abdominal or thoracic surgery is discussed
Confirm QA424 or QA423, whether Q2352 or Q2351 hiatal hernia repair is combined, and how admission, meals, room, and materials are classified.
Two providers are compared
Align pre-treatment testing, anesthesia, admission, follow-up horizon, and medication before entering an alternative one-year medical cost.
An insurance claim is planned
Do not assume the diagnosis name guarantees payment; verify the exact procedure, benefit status, detailed receipt, policy terms, and expected payment with the insurer.
Leave or family care is needed
Use the clinician’s schedule and actual paid leave to plan net income interruption and caregiver cash, without treating the calculator as a recovery-duration prediction.
Tips, limits, and safety cautions
- Ask for the exact procedure name, identifier, benefit category, quote unit, and included scope instead of relying on a single treatment label
- Apply the Q7600 90% share only to the provider-confirmed Q7600 selective-benefit gross charge
- Do not merge Jo-934 and Q7600 merely because both are described as endoscopic anti-reflux treatments; their published benefit classifications differ
- Do not apply the ordinary inpatient 20% default to outpatient tests, meals, rooms, selective benefits, full patient payment, or every surgical line
- Check whether pre-treatment tests and anesthesia or admission amounts already include a patient share before entering them, and avoid duplicating a gross-charge field
- Do not use an alternative comparison unless testing, anesthesia, admission, follow-up duration, and medication scope are aligned
- Do not infer recovery time, medication discontinuation, symptom improvement, recurrence, or complications from a budget result
- Seek prompt medical assessment for severe or sudden chest pain, difficulty breathing, vomiting blood, black stool, or progressive difficulty swallowing rather than delaying for a cost comparison
Frequently asked questions
Does selecting Q7600 automatically qualify me for the 90% selective-benefit rule?
No.
The selection displays the published context and quote questions.
The calculator applies 90% only to an amount the provider identifies as Q7600; the clinician, provider, and HIRA process determine actual recognition.
Is Jo-934 ARMS always entered as non-covered?
This page uses HIRA’s published reassessment and Ministry Notice 2025-136, effective September 1, 2025, as its 2026 cost-classification boundary.
Confirm the provider’s actual procedure name, current disclosure, and every associated line.
Why can I edit the ordinary covered patient-share rate?
The 20% value is an ordinary inpatient planning default.
Outpatient provider type, meals, special cases, Medical Aid, and patient status can change actual shares, so a provider- or NHIS-confirmed rate can replace it.
Why does the calculator not ask for hiatal hernia size?
Hernia size is important in the published Q7600 and Jo-934 contexts, but a cost tool should not interpret a test result to decide eligibility or treatment.
The treating clinician measures and interprets it; the planner supplies a consultation question only.
Why is insurance capped at medical cost?
The input represents a medical reimbursement confirmed by an insurer.
The cap prevents the calculator from assuming that income loss, transport, or caregiver spending is automatically reimbursed.
Does the 15% tax credit mean a refund equal to 15% of the hospital bill?
No.
It is 15% of the incremental eligible base after confirmed reimbursement, the gross-salary 3% threshold, and any applicable cap.
Actual refund and credit use depend on the full tax return and tax liability.
Does a KRW 0 alternative mean the alternative is free?
No.
KRW 0 means no comparison.
Enter only a real one-year medical quote with the same scope and time horizon.
Can I use the result to choose endoscopic treatment or surgery?
No.
Cost is only one consideration.
Test findings, anatomy, risks, expected benefits, and alternatives require a treating clinician.
The planner makes no treatment recommendation or outcome prediction.
Official 2026 sources and update boundary
- HIRA 2026 KDRG Classification Book Version 4.7: publication registration G000EV3-2025-174; Q7600, QA423, QA424, Q2351, and Q2352.
- HIRA Q7600 published recognition criteria: six-month medication context and the age, pregnancy, hiatal-hernia, esophageal-function, Barrett’s-esophagus, and poor-general-condition exclusions effective January 1, 2024.
- HIRA Q7600 selective-benefit patient-share change: 80% to 90%, effective September 1, 2024.
- HIRA Jo-934 endoscopic anti-reflux mucosal resection reassessment page: 24-hour pH context, hiatal-hernia exclusion, and non-covered status effective September 1, 2025.
- National Health Insurance Act Enforcement Decree Article 19 and Annex 2: law ID 002813, MST 283469, Annex 2 serial 17976571, effective February 19, 2026.
- Medical Service Act Article 45: law ID 001788, MST 285327, non-covered price disclosure, effective April 7, 2026.
- Income Tax Act Article 59-4: law ID 001565, MST 280405, article effective January 1, 2026; gross salary × 3%, × 15%, and the KRW 7,000,000 ordinary-family eligible-base cap.
The evidence was last checked on July 29, 2026.
Recheck the Q7600 patient share and criteria, Jo-934 benefit status, statutory copays, and Article 59-4 rules before a future annual update, then update constants, tests, and both language guides together.
Turn an itemized provider quote into a one-year cash plan
Collect the confirmed procedure name, identifier, benefit category, and included scope, then enter the actual provider figures above.
Review the initial treatment event together with one year of follow-up and medication, household recovery cash, confirmed insurance, and the incremental tax-credit plan.
Before relying on the result, reconcile every line with the provider billing desk and insurer, and keep the treating clinician’s medical judgment primary.