Pediatric Congenital Heart Disease Surgery Cost Calculator
This calculator estimates the out-of-pocket cost of surgery for congenital heart disease (congenital heart defects) in children in Korea, split into covered (benefit) and non-covered amounts. It uses the same pure calculation model as the Korean page for the main defects: ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), tetralogy of Fallot (ToF), transposition of the great arteries (TGA), and single-ventricle staged repair (the Fontan pathway). Congenital heart disease occurs in about 1 in 100 newborns, and most repairs are covered by Korean National Health Insurance, so the figures follow 2026 Korean rules. Because congenital heart surgery is a covered service, hospitals do not publish per-procedure prices, so the covered totals are complexity-based market estimates (anchored to the government statistic of about KRW 28.3 million average per cardiac surgery, 2017) that you can override with a hospital quote.
Defect types and covered fees
Patent ductus arteriosus (PDA) and secundum atrial septal defect (ASD) are often closed with a catheter-delivered device (coil or occluder) through a leg vessel, with no chest incision; the stay is short and the covered total is lower than open surgery (roughly KRW 5-12 million). Device closure is covered when clinical criteria (such as a suitable secundum ASD) are met.
Ventricular septal defect (VSD) is the most common congenital heart defect; a large defect is closed by open-heart surgery under cardiopulmonary bypass, with ICU recovery and a 1-2 week stay (covered total near KRW 20 million). Tetralogy of Fallot (ToF) complete repair and transposition of the great arteries (TGA) arterial switch are high-complexity neonatal/infant open-heart operations with long ICU stays (covered total near KRW 30-35 million). Single-ventricle hearts (such as hypoplastic left heart syndrome) cannot be fixed in one operation and follow a three-stage path — Norwood, then bidirectional Glenn, then Fontan — over several years, each stage a separate surgery.
- PDA / ASD device closure: catheter-based, no incision, short stay, lower cost.
- VSD open repair: cardiopulmonary bypass, the most common defect.
- ToF / TGA: high-complexity neonatal open-heart surgery (complex congenital defect, 60-day special case).
- Single ventricle: Norwood → Glenn → Fontan, three separate staged operations.
- Covered totals are estimates; a hospital quote can be entered directly.
Two paths to a 5 percent copay: child reduction plus cardiac special case
A child’s covered self-pay is low because two rules both land at 5 percent. First, inpatient care for a child aged 15 or under has a 5 percent covered copay (National Health Insurance Enforcement Decree Annex 2, in force since October 2017). Second, congenital heart surgery is a cardiac special-case condition (special code V192), so registration drops the covered copay to 5 percent for 5 years. Because both are 5 percent, a child aged 15 or under is guaranteed 5 percent either way — even without special-case registration, the child inpatient reduction alone gives 5 percent, and registering the special case extends 5 percent to later outpatient and re-operation care for 5 years.
By contrast, a patient aged 16 or over (including adults with congenital heart disease, ACHD) has no child inpatient reduction, so the cardiac special case (V192) is the only path to 5 percent — without it the ordinary 20 percent inpatient copay applies. Note that congenital heart disease is a cardiac severe-disease special case at 5 percent (V192, target codes Q20-Q25 and similar), NOT a rare-disease special case at 10 percent. A few specific diagnoses (for example congenital heart block, Q24) may fall under a separate rare-disease code with a different rate, so confirm the exact code with the hospital admissions desk and the HIRA annex.
Complex congenital defects get 60 days, and staged single-ventricle repair
The cardiac special case normally applies for up to 30 days per operation, but for complex congenital heart defects (single ventricle, ToF, TGA, and similar) or heart transplantation it applies for up to 60 days, so the 5 percent covered copay holds through the long ICU and hospital stay of a high-complexity repair. The calculator sets the complex flag automatically from the defect type and lets you override it.
For single-ventricle hearts the calculator projects the three-stage Fontan pathway — Norwood, bidirectional Glenn, and Fontan — with an estimated covered total and 5 percent self-pay for each stage and the cumulative sum. Each stage is a separate operation and admission, so the special case and the annual out-of-pocket ceiling apply stage by stage. Because this is long-term, multi-stage care, families should line up the congenital-anomaly medical support, the catastrophic medical expense program, and Korea Heart Foundation support in advance.
Ceiling, private indemnity, tax credit, and government support
The 2026 annual out-of-pocket ceiling ranges from about KRW 900,000 (income decile 1) to KRW 8,430,000 (decile 10) and refunds covered self-pay above the cap, usually the following August; covered self-pay is already low at 5 percent, so the ceiling mainly matters for high-cost staged or long-ICU cases (non-covered items such as upper-grade room surcharges are excluded). Congenital heart surgery is reimbursed as inpatient medical expense by private indemnity insurance (the ceiling-refunded amount is not double-paid, and upper-grade room surcharges are usually reimbursed only up to 50 percent); for children, a fetal or child insurance rider for congenital anomalies depends on when it was bought and disclosed.
The Korean medical expense tax credit (Income Tax Act Article 59-4) refunds 15 percent of expense above 3 percent of the payer’s salary. Crucially, for a child aged 6 or under, or for a registered severe-disease (special-case) patient, the usual KRW 7,000,000 cap does not apply (Enforcement Decree Article 118-5), so even large self-pay is fully creditable; a parent who paid claims it on their own year-end settlement. The congenital-anomaly medical expense support program (through public health centers) helps families whose child was diagnosed with a congenital anomaly (a Q-code) within 2 years of birth and had inpatient surgery: it supports the full-self-pay portion of covered care and non-covered fees (100 percent up to KRW 1,000,000, then 90 percent), with a limit that varies by local government (this calculator assumes a conservative KRW 5,000,000), applied within 6 months of discharge. The Korea Heart Foundation, the catastrophic medical expense program, and hospital social-work funds can add further support.
How to read the result
Enter the defect type (VSD, ASD, PDA, ToF, TGA, or single ventricle), the covered total (an editable estimate), the patient age band, whether the cardiac special case is registered, whether it is a complex congenital defect, stay days, hospital level, insurance type, any non-covered items, whether congenital-anomaly support applies, private indemnity generation, income decile, and the payer’s salary. The result shows covered and non-covered self-pay, the ordinary 20 percent versus reduced 5 percent comparison, which 5 percent paths apply, the staged-surgery projection for single ventricle, the ceiling refund, the congenital-anomaly support estimate, and the final cost after indemnity, support, and tax credit.
This is a cost-planning estimate based on 2026 Korean rules, not medical advice. Public single-price tables do not exist for covered congenital heart surgery, so the covered totals are defensible complexity-based estimates that vary with hospital, defect, and patient condition; exact benefit codes, special-case eligibility, and fees should be confirmed with the treating team, the hospital admissions desk, the National Health Insurance Service, and the insurer.
This calculator is based on Korean rules (2026 National Health Insurance covered fees, the child inpatient reduction of 5 percent for ages 15 and under, the cardiac special case V192 at 5 percent for 5 years with up to 60 days for complex congenital defects, the annual out-of-pocket ceiling, Income Tax Act Article 59-4 medical expense tax credit with the child/severe-disease cap exemption, and the congenital-anomaly medical support program). Figures are planning estimates, not medical advice, an insurer decision, or a hospital quote.