Korea Pterygium Surgery Cost Calculator

Estimate the Korean NHI copay for pterygium surgery from an itemized hospital quote, then account for confirmed indemnity-insurance payment, the medical-expense tax credit, and a literature-based recurrence reserve.

Calculate from a Korean hospital quote

The official fee is only a starting anchor. Replace it with the total covered amount on the quote.

1. Procedure

For both eyes, enter the hospital's combined quote; the calculator does not double the fee.

2. NHI quote

Ordinary Korean NHI copays under the 2026 Enforcement Decree Annex 2.

Covered total on the quote

KRW

Include the insurer-paid and patient-paid covered portions. A procedure fee alone is not a full surgery quote.

KRW

Use the quote's classification. Amniotic-membrane surgery is not automatically fully non-covered.

3. Indemnity insurance and tax
KRW

Enter an amount confirmed under your policy, rather than a generation-based estimate.

KRW
KRW

Enter the amount after subtracting insurance reimbursements.

Effective cost after insurance and estimated tax credit

KRW 75,735

Effective covered copay 30%

Calculation

Covered total
KRW 252,450
Covered copay
KRW 75,735
Non-covered / full self-pay
KRW 0
Gross patient payment
KRW 75,735
Confirmed insurance payment
− KRW 0
After insurance
KRW 75,735
Incremental medical tax credit
− KRW 0
Effective cost
KRW 75,735

3% salary threshold

KRW 1,500,000

Annual credit after surgery

KRW 0

Six-month recurrence planning range

Observed literature range 3.3%–16.7%.

KRW 2,522–KRW 12,648

Based on a Cochrane review of 20 randomized trials and 1,947 eyes. It is not your predicted recurrence risk.

Important limits

  • S5341 and S5342 are procedure-fee anchors, not complete surgery prices.
  • For both eyes, use the combined hospital quote because second-procedure billing can differ.
  • Amniotic-membrane ocular-surface surgery moved to NHI coverage in December 2020; follow the itemized quote.
  • The insurance and tax figures are planning estimates, not payment or tax decisions.

Related calculators

What this Korea pterygium surgery calculator actually estimates

A pterygium is conjunctival tissue that grows onto the cornea and is sometimes called surfer's eye in English.
An ophthalmologist may discuss surgery when growth threatens the visual axis, induces astigmatism or reduced vision, causes repeated inflammation, or creates persistent discomfort.
This page does not decide whether surgery is necessary or which graft is medically best.
It is a financial-planning tool for a person who has received a Korean hospital quote and wants to translate the covered total, non-covered items, confirmed private-insurance payment, and year-end medical tax credit into an estimated effective cost.

Procedure fee

S5341 or S5342 is the official fee for the operative act.
It is not the entire hospital bill.

Covered total

This combines the NHI-paid and patient-paid covered portions before applying the copay.

Non-covered total

Use only items that the provider labels non-covered or full self-pay on the quote.

A complete pterygium episode can also contain a consultation, diagnostic testing, anesthesia, medicines, treatment materials, and follow-up care.
Hospital level, inpatient or outpatient billing, one or both eyes, a primary or recurrent lesion, and the documented indication can all change the total.
The calculator therefore starts with an official procedure-fee anchor but expects you to replace it with the total covered amount on the real quote.

Official 2026 Korean fees: S5341 and S5342

The Health Insurance Review and Assessment Service fee file effective January 1, 2026 separates complex flap or graft surgery from other pterygium operations.
Neither base row carries a special 50%, 80%, 90%, or 95% patient-rate flag, so ordinary NHI cost sharing applies unless the patient has another independently confirmed rule.

Official 2026 Korean pterygium procedure fees for S5341 and S5342
CodeEnglish fee-file nameClinic feeHospital-level feeRelative value
S5341Operation of Pterygium — Flap Transposition Etc.KRW 252,450KRW 221,2902,640.71
S5342Operation of Pterygium — OthersKRW 145,150KRW 127,2401,518.32

Do not simply double the fee for both eyes

The same official file contains second-procedure rows S5341001 and S5342001 at 50% of the base procedure fee.
Actual simultaneous-surgery billing still depends on the claim and operative record.
When both eyes are planned, enter the combined covered total supplied by the provider instead of multiplying a one-eye estimate.

How the 20% to 60% NHI copay is applied

Article 19 and Annex 2 of Korea's National Health Insurance Act Enforcement Decree set ordinary cost sharing by care setting and provider level.
The operation name by itself does not determine one universal percentage.
Check whether the provider will bill the case as inpatient or outpatient before choosing a rate.

Inpatient20% of the covered total
Clinic outpatient30%
Hospital outpatient40% urban · 35% rural
General hospital outpatient50% urban · 45% rural
Tertiary outpatientConsultation 100% + remaining covered charge 60%
Manual rateUse only a separately confirmed rule

Tertiary outpatient example

Suppose the covered total is KRW 400,000 and KRW 30,000 of that amount is the outpatient consultation fee.
The patient pays the KRW 30,000 consultation in full plus 60% of the remaining KRW 370,000, or KRW 222,000.
The covered copay is therefore KRW 252,000 before adding any non-covered items.

This tool does not automatically deduct Korea's annual out-of-pocket ceiling from one surgery bill.
That program requires annual accumulated covered copays, excluded items, an income tier, and possible retrospective reimbursement.
Use the separate ceiling calculator when your annual covered spending may approach the cap.

Conjunctival autograft, amniotic membrane, and coverage

Older Korean cost articles may describe amniotic membrane transplantation as entirely non-covered.
That shortcut is outdated.
HIRA announced that ocular-surface amniotic membrane transplantation and the relevant treatment material moved into NHI coverage effective December 1, 2020.
The precise classification still depends on indication and billing, so follow the itemized hospital quote instead of labeling every amniotic-membrane amount as non-covered.

Six-month recurrence ranges in randomized trials

  • Conjunctival autograft: 3.33% to 16.7%.
  • Amniotic membrane transplantation: 2.6% to 42.3%.
  • Evidence base: a Cochrane review of 20 randomized trials and 1,947 eyes.

These are observed ranges across different patients, surgeons, fixation methods, and follow-up conditions, not a personalized recurrence forecast.
The optional reserve multiplies the current after-insurance payment by that observed range only to illustrate financial uncertainty.
Recurrent disease can involve adhesion and limited healthy conjunctiva, so the surgeon's examination and operative plan matter more than a generic price or recurrence percentage.

Step-by-step use

  1. Choose the procedure family.
    This loads the matching 2026 S5341 or S5342 procedure-fee anchor.
  2. Choose the actual billing setting.
    A same-day operation can still be billed under a provider-specific inpatient or outpatient arrangement, so use the quote or booking information.
  3. Replace the anchor with the covered total.
    Enter the amount before the patient copay, including both NHI and patient covered shares.
  4. Add only documented non-covered items.
    Do not infer non-covered status from the word amniotic or from an old blog post.
  5. Enter an insurer-confirmed expected payment.
    Policy generation alone cannot resolve per-visit deductibles, outpatient limits, non-covered riders, or exclusions.
  6. Enter salary and earlier eligible medical spending.
    The tool compares the annual tax credit before and after this surgery so it does not incorrectly call 15% of the receipt a refund.

Private indemnity insurance and the Korean medical tax credit

Use a confirmed insurance amount

Therapeutic covered copays and some non-covered items may be reimbursable, but the actual amount depends on policy dates, inpatient or outpatient classification, deductibles, outpatient limits, non-covered riders, exclusions, and claim review.
The calculator avoids pretending that one generation-wide percentage resolves those terms.
Enter an amount confirmed by the insurer, and remember that an insurance reimbursement must also be excluded from tax-credit medical expenses.

The tax credit is not automatically 15% of this bill

Income Tax Act Article 59-4 generally applies a 15% credit to eligible medical expenses above 3% of gross salary.
If gross salary is KRW 50,000,000, the threshold is KRW 1,500,000.
With no other eligible expenses, a KRW 300,000 after-insurance surgery payment does not cross that threshold and creates no incremental credit.
If earlier eligible spending is KRW 1,400,000, the same surgery moves KRW 200,000 above the threshold and creates a simple estimated incremental credit of KRW 30,000.

Ordinary dependent medical expenses have a KRW 7,000,000 eligible-base cap.
The cap does not apply to medical expenses for the taxpayer, people aged 65 or over, disabled people, registered serious or rare-disease and tuberculosis patients, or children aged six or under.
Cosmetic or appearance-only expenses are excluded under Enforcement Decree Article 118-5, and the real benefit can be smaller when final tax liability is insufficient.

Questions to ask the hospital

Billing setting

Will this be billed as inpatient or outpatient, and what is the provider level?

Procedure code

Is S5341, S5342, or another additional procedure expected?

Both eyes

How will a same-session second eye and second procedure be billed?

Graft materials

Which amniotic-membrane or other material lines are covered, non-covered, or full self-pay?

Included services

Does the quote include preoperative tests, anesthesia, medicines, a bandage lens, and follow-up?

Claim documents

Can the provider issue the diagnosis, itemized statement, receipt, and operation confirmation needed by the insurer?

Frequently asked questions

Is every pterygium operation covered by Korean NHI?

S5341 and S5342 exist in the benefit fee schedule, but final coverage depends on medical indication and claim details.
Confirm the covered and non-covered split on the provider's itemized quote.

Is amniotic membrane transplantation always non-covered?

No.
Ocular-surface amniotic membrane transplantation and related material entered NHI coverage in December 2020, so use the current itemized classification.

Does the official fee equal the total operation price?

No.
It is one procedure-fee component and does not automatically include every consultation, test, anesthetic, medicine, material, or follow-up charge.

Does the recurrence range choose a procedure for me?

No.
It is a research-based planning range, while the appropriate operation depends on lesion size, recurrence, available conjunctiva, ocular-surface condition, and the surgeon's assessment.

Sources and limitations

  • The S5341 and S5342 anchors come from the HIRA 2026 health-insurance fee file.
  • Korean NHI copays follow National Health Insurance Act Enforcement Decree Article 19 and Annex 2 as in force in 2026.
  • The medical tax calculation follows Income Tax Act Article 59-4 and its Enforcement Decree Article 118-5.
  • The recurrence ranges come from a Cochrane systematic review of randomized trials and are not an individual prognosis.

Prepare the covered total and non-covered lines from the hospital quote, then replace the fee anchor in the calculator.

This Korea-based 2026 tool is for planning only and is not medical advice, an insurer decision, or tax advice.