What this Korean hyperbaric oxygen therapy cost planner estimates
Hyperbaric oxygen therapy, often shortened to HBOT, supplies high-concentration oxygen in a chamber above normal atmospheric pressure. In Korea, the patient bill can change with the covered indication, actual treatment minutes on the same day, number of treatment days, facility class, inpatient or outpatient setting, and any separately billed oxygen, tests, procedures, medicines, or non-covered services. This planner separates those layers instead of presenting one nationwide package price.
The Korean calculator uses the 2026 Health Insurance Review & Assessment Service fee schedule for the HBOT procedure itself. It then applies the ordinary National Health Insurance Service patient share selected for the care setting, or a 10%, 5%, or custom rate only when the user says that rate has been confirmed. A hospital quote can be added for covered extras and non-covered items, while a fully self-paid plan uses the hospital's daily HBOT quote rather than an invented market average.
A planning status is not an insurance approval
The result can show that the entered indication and duration fit a published planning rule, but it cannot review medical records or bind HIRA, NHIS, a hospital, or a private insurer. “Benefit planning available” means that the covered-fee formula is used for budgeting. It does not promise that every session, extension, or separately billed item will be covered.
2026 Korean HBOT procedure codes and relative-value points
HIRA lists hyperbaric oxygen therapy under Ja-586 and divides the fee by actual treatment time. Sessions performed in the morning and afternoon on the same calendar day are combined, and the corresponding time band is billed once. The planner therefore asks for combined actual treatment minutes per day, not the number of chamber entries.
Korean 2026 HBOT procedure codes and relative-value points by actual treatment duration| Actual treatment time | Base code | Base points | General/tertiary add-on | Add-on points |
|---|
| Up to 60 minutes | M0586 | 302.06 | M0581 | 116.51 |
| Over 60 and up to 120 minutes | M0587 | 734.83 | M0582 | 283.42 |
| Over 120 minutes | M0588 | 1,907.08 | M0583 | 735.54 |
The 2026 conversion factor used here is KRW 83.8 per point for hospitals, general hospitals, and tertiary hospitals, and KRW 95.6 per point for clinics. General and tertiary hospitals receive the duration-matched add-on points in the table. After conversion, the amount is rounded to the nearest KRW 10 and the normal facility-class add-on is applied: 15% for a tertiary hospital, 10% for a general hospital, 5% for a hospital, and 0% for a clinic.
Why oxygen and other services stay outside the official procedure line
The fee-schedule note allows oxygen to be billed separately. Consultation, admission, wound care, hearing tests, imaging, medicine, and supplies may also appear as separate claim lines. Enter the hospital's covered estimate and patient-paid non-covered quote in the adjustment fields so the planner does not silently treat those services as included.
Published Korean benefit criteria used by the planner
The indication groups come from HIRA's published HBOT benefit criteria associated with Ministry of Health and Welfare Notice No. 2018-254, effective January 1, 2019. The planner presents these groups as a discussion aid. It does not diagnose the disease, determine severity, or evaluate whether the medical record satisfies every claim requirement.
Acute published group
- Carbon monoxide poisoning
- Decompression sickness and gas embolism
- Anaerobic infection or gas gangrene
- Cyanide poisoning
- Acute central retinal artery occlusion within 24 hours of vision loss
- Excessive-blood-loss anemia when transfusion is impossible
Ordinarily within two weeks
- Burns and Buerger disease
- After skin graft, flap surgery, or digit replantation
- Radiation-induced tissue necrosis
- Diabetic foot ulcer at Wagner grade 3 or higher
- Treatment-resistant chronic refractory osteomyelitis
- Intracranial abscess
If an indication in the second group is entered with more than 14 treatment days, or the user flags a schedule extending beyond two weeks from treatment start, the calculator retains the benefit estimate but changes the status to “confirm extension beyond two weeks.” That flag is deliberately cautious: it does not say that day 15 is automatically non-covered, and it does not assume that an extension will be accepted. Ask the treating hospital how the additional sessions will be documented and billed.
Separate sudden hearing loss conditions
The published sudden hearing loss criteria refer to an initial hearing threshold of at least 80 dB and an actual HBOT duration of 60 to 120 minutes per session. The calculator can check only the entered duration. It cannot read an audiogram, so the user must confirm the initial threshold with an otolaryngology team. An entered duration below 60 minutes or above 120 minutes switches to the hospital-quote path without declaring that coverage is legally impossible.
Ordinary Korean NHI patient-share rates in this estimate
National Health Insurance Act Article 44 provides for partial patient payment, while Enforcement Decree Article 19 and Annex 2 set the detailed rates. For this planning model, ordinary inpatient care uses 20%. Ordinary outpatient care changes by facility class and, for a general hospital or hospital, by urban versus other-area classification.
Ordinary Korean National Health Insurance patient-share rates used for HBOT planning| Care setting | Facility class | Area | Planning rate |
|---|
| Inpatient | All four classes | No area split | 20% |
| Outpatient | Tertiary hospital | No area split | 60% |
| Outpatient | General hospital | Urban / other area | 50% / 45% |
| Outpatient | Hospital | Urban / other area | 40% / 35% |
| Outpatient | Clinic | No area split | 30% |
The Act version checked for this calculator took effect on January 2, 2026. The Enforcement Decree and Annex 2 version checked took effect on February 19, 2026. The calculator does not infer a special-case rate from the diagnosis. Choose a confirmed 10%, confirmed 5%, or custom rate only after the hospital has confirmed that it applies to the covered HBOT claim.
The rate is applied only to the covered estimate
A 5% or 10% selection does not discount non-covered charges. Non-covered chamber fees, supplies, room differences, or other quoted services remain fully patient-paid in this planner. Eligibility for Korea's annual out-of-pocket ceiling also depends on the claim category and the patient's broader annual covered spending, so this focused calculator does not promise a ceiling refund.
How the Korean procedure fee and patient estimate are calculated
The model first maps the entered minutes to one of the three official time bands. It calculates the official procedure reference for the selected facility, then uses either the covered path or the hospital-quote path based on the entered billing mode and published planning conditions. All entered costs are clamped to non-negative planning ranges so an incomplete field cannot create a negative reimbursement or bill.
Applied points = base points + eligible general/tertiary add-on points
Rounded base fee = round((applied points × conversion factor) ÷ 10) × KRW 10
Daily procedure fee = rounded base fee + rounded facility-class add-on
Covered gross = daily procedure fee × treatment days + quoted covered extras
Covered patient share = round(covered gross × confirmed patient-share rate)
Patient total = covered patient share + quoted non-covered total
Exact 90-minute, 10-day general-hospital example
Assume an ordinary outpatient plan at an urban general hospital, 90 actual minutes per day, 10 treatment days, and no extra quote. The 90-minute band uses 734.83 base points plus 283.42 add-on points. Multiplying 1,018.25 points by KRW 83.8 and rounding to KRW 10 gives KRW 85,330. The 10% facility add-on is KRW 8,533, so the daily procedure fee is KRW 93,863.
Exact 2026 general-hospital HBOT calculation example for 90 minutes over 10 days| Calculation item | Example amount |
|---|
| Daily official procedure fee | KRW 93,863 |
| Procedure fee for 10 days | KRW 938,630 |
| Ordinary urban general-hospital outpatient rate | 50% |
| Covered patient estimate | KRW 469,315 |
| Estimated NHIS share | KRW 469,315 |
This example deliberately excludes consultation, oxygen, tests, medicine, admission, and non-covered services. If the hospital quotes KRW 30,000 of additional covered cost per day and a KRW 100,000 one-time covered test, the calculator adds KRW 400,000 to the covered gross before applying 50%. Non-covered amounts are added after the covered patient-share calculation.
Step-by-step use
- Select the indication written in the Korean care plan. If no published item is a reasonable match, select the unlisted option and use the hospital's self-pay quote.
- Enter combined actual treatment minutes for one calendar day. Two 60-minute sessions on the same day should be entered as 120 minutes for this fee-band model.
- Enter distinct treatment days. A 15-day plan in the ordinarily-within-two-weeks group produces an extension-review warning without erasing the estimate.
- Confirm the Korean facility class and care setting. A branded hospital name does not by itself establish whether it is a clinic, hospital, general hospital, or tertiary hospital.
- Choose only a confirmed patient-share category. Leave the ordinary rate selected unless the billing desk confirms a 10%, 5%, or other rate for this covered treatment.
- Add an itemized hospital estimate. Keep covered extras, the self-pay HBOT quote, and other non-covered charges in separate fields to avoid double counting.
- Use the result as a question list. Compare the displayed fee band, days, rate, and missing quote lines with the hospital's written estimate before treatment.
Quote-driven planning scenarios
Diabetic foot ulcer or complex wound plan
Confirm the Wagner grade, treatment start date, expected days, and the hospital's process for sessions beyond 14 days. Ask whether wound debridement, dressings, surgery, antibiotics, supplies, and admission are inside or outside the HBOT quote. Enter only amounts that correspond to the estimate you received.
Sudden hearing loss plan
Confirm the initial audiogram threshold, actual chamber treatment time, and whether the hospital expects the published benefit conditions to apply. Steroid treatment, audiology, follow-up visits, imaging, and other ear-care costs are separate from this HBOT procedure calculation. Do not delay time-sensitive medical assessment to compare prices.
Fully self-paid or unlisted treatment purpose
Request the daily chamber quote, oxygen or facility charges, required tests, supplies, and cancellation terms in writing. Select the self-pay route and enter the daily HBOT quote rather than treating the official covered fee as the hospital's cash price. A default of KRW 0 means no quote has been entered, not that care is free.
Acute emergency indication
Carbon monoxide poisoning, decompression sickness, gas embolism, severe infection, cyanide poisoning, and other acute conditions require clinical triage. Emergency transfer, intensive care, surgery, laboratory tests, and admission may dominate the total bill. The calculator is suitable for later bill review, not for deciding whether to seek urgent treatment.
Frequently asked questions
Are two sessions on the same day counted as two treatment days?
No for this fee-band calculation. HIRA's published note says actual morning and afternoon treatment times on the same day are combined and the corresponding fee is counted once. A treatment performed on the next calendar day increases the treatment-day count.
Does treatment after day 14 automatically become non-covered?
The planner does not make that conclusion. For the ordinarily-within-two-weeks group, it retains the covered planning formula and adds a case-review warning. Ask the hospital how the additional sessions will be documented, reviewed, and quoted.
Is total time in the chamber the same as actual treatment time?
Not necessarily. Preparation, compression, decompression, and observation can make the visit longer than the billable treatment period. Confirm the actual treatment minutes used for the Korean claim rather than estimating from the appointment duration.
Why does the calculator not apply 5% automatically?
A diagnosis label alone does not establish registration, period, or claim-line eligibility for a special patient share. Select 5% or 10% only after the Korean hospital confirms that rate for the covered HBOT treatment. Non-covered costs remain outside that discount.
Will Korean private medical insurance reimburse the result?
Reimbursement depends on policy generation, wording, medical necessity review, covered versus non-covered classification, deductibles, exclusions, and limits. This calculator does not estimate a guaranteed private-insurance payment. Keep the itemized bill, medical certificate, treatment record, and insurer's document checklist.
Can I compare the three duration prices and choose the cheapest session?
The comparison explains the fee schedule and helps check a quote. It is not a menu for selecting pressure or duration without clinical guidance. Treatment pressure, oxygen exposure, and duration must follow the treating team's prescription and safety protocol.
Safety and bill-review checklist
Pressure changes can cause ear or sinus pain and pressure injury, including fluid, eardrum injury, or hearing changes. Tell the clinical team about cold symptoms, ear problems, lung disease, medicines, possible pregnancy, claustrophobia, and other requested history. Learn the facility's pressure-equalization method, prohibited items, and instructions for reporting symptoms during treatment.
- Confirm the Korean facility class and whether the plan is inpatient or outpatient
- Ask for actual treatment minutes per day and the expected number of distinct treatment days
- Confirm the published indication condition and the review plan for any extension
- Request separate lines for HBOT, oxygen, consultation, tests, procedures, medicine, admission, and non-covered services
- Confirm the patient-share rate and its effective period with the hospital billing desk
- Ask the private insurer which medical records and itemized receipts are required
- Prioritize emergency assessment over price calculation for acute poisoning, neurologic, respiratory, or diving-related symptoms
Source scope and verification date
The fee model uses HIRA's 2026 Health Insurance Medical Care Benefit Costs, including the Ja-586 codes, 2026 conversion factors, normal facility-class additions, and the note that oxygen may be billed separately. The indication guide uses HIRA's HBOT benefit criteria associated with MOHW Notice No. 2018-254. The ordinary patient-share guide uses National Health Insurance Act Article 44 and Enforcement Decree Article 19 with Annex 2.
These Korean sources and the calculator's constants were rechecked on July 24, 2026. The 2026 fee schedule reflects MOHW Notice No. 2025-186 and subsequent revisions for the January 1, 2026 schedule. The Act version checked was effective January 2, 2026, and the Enforcement Decree and Annex 2 version checked was effective February 19, 2026. A later notice or the rule in force on the treatment date takes priority.
Use the planner with an itemized Korean hospital quote. It is not medical advice, a diagnosis, a treatment recommendation, an NHIS or HIRA decision, a private-insurance decision, or a final bill.