Non-Covered Service Fees

Non-covered medical fees are disclosed pursuant to Article 45 of the Medical Service Act and Article 42-2 of its Enforcement Rules.
Procedure fees are for individual items and may vary depending on the number of procedures, scope, and surcharges. Therapeutic materials and medications are charged separately when required.

Procedure Fees

As of April 23

Mid-Category	Category	Item		Medical Fees (Unit: KRW)						Remarks
		Name	Code	Division	Cost	Cost		Inclusion
		Name	Code	Division	Cost	Min	Max	Material Cost	Medication Cost
Examination Fees	Visual Function Test	Ocular Biometry [Unilateral] - Ultrasound	E7800	Unilateral	38,490			X	X	Non-covered when performed outside covered criteria
		Ocular Biometry [Unilateral] - Laser Interferometry	E7801		47,660			X	X
		Optical Coherence Tomography	EZ796		37,950			X	X
		Laser Flare Photometry	EX797			15,000	900,000	X	X	May vary depending on the number of procedures, scope, and surcharges.
		Anterior Segment OCT				20,000	900,000	X	X
		Tear Film Lipid Layer Thickness Measurement by Interferometry	EZ799			30,000	100,000	X	X
Ultrasound Examination	Ultrasound Examination	Head & Neck Ultrasound - Eyeball	EB411		84,320			X	X	Non-covered when performed outside covered criteria
Ultrasound Examination	Ultrasound Examination	Head & Neck Ultrasound - Orbit	EB412		84,320			X	X	Non-covered when performed outside covered criteria
Procedures & Surgeries	Intravitreal Injection	Intravitreal Injection	S5070	Unilateral	131,830			O	X
	Physical Therapy	Massage Therapy for Dry Eye Treatment	MZ013			10,000	65,000	O	X	May vary depending on the number of procedures and scope.
	Physical Therapy	Laser Phototherapy for Dry Eye	MZ015		70,000			O	X	May vary depending on the number of procedures and scope.
Vision Correction Surgery	Laser Epithelial Keratomileusis (LASEK)	Laser Epithelial Keratomileusis (LASEK)				1,400,000	1,600,000	O	O	* Both eyes * Pre-surgery eye exam costs excluded
Others	Others	Implantable Contact Lens (ICL)				5,000,000	5,500,000	O	O	Price varies by ICL/TICL specifications/ Pre-surgery eye exam costs excluded
		Phakic IOL Implantation (Monocular) - SML		Unilateral		5,000,000	5,500,000	O	O
		Phakic Lens Removal (Monocular)		Unilateral	500,000			O	X
		Corneal Astigmatic Keratotomy			290,000			X	X
		Re-cut Slide Preparation (per slide)			20,000			X	X
		Conjunctival/Periocular Nevus Removal			200,000			O	X	Non-covered when performed outside covered criteria
		Clinical Photography (Skin/Cosmetic/Hair)				1,000	10,000	O	X	May vary depending on the number of procedures, scope, and surcharges.

Certificate Fees

Item		Medical Fees (Unit: KRW)				Remarks
Name	Code	Division	Cost	Cost
Name	Code	Division	Cost	Min	Max
Diagnosis Certificate (General)	PDZ010000		20,000			A diagnosis certificate prepared by a doctor based on examination or test results per Medical Service Act Enforcement Rules [Appendix Form 5-2]
Diagnosis Certificate (Work Capacity Evaluation)	PDZ010002		10,000
Disability Assessment Certificate - Physical Disability	PDZ070001	General Disability	15,000			Per Article 3 of the Enforcement Rules of the Act on Welfare of Persons with Disabilities [Form 3] * Documents required for issuing disability registration certificate * Documents required under the Act on Welfare of Persons with Disabilities
Visual Disability Opinion Letter			15,000
Residual Disability Diagnosis Certificate	PDZ070003	Residual Disability Diagnosis Certificate	100,000			A diagnosis certificate for physical disability caused by disease or injury, where the doctor determines no further treatment effect can be expected
National Pension Disability Assessment Certificate	PDZ100000		15,000
Military Service Diagnosis Certificate	PDZ080000		20,000			Per Articles 87, 95 of the Military Service Act Enforcement Rules [Form 106] Bring 3×4 photo
Injury Diagnosis Certificate	PDZ020001	Over 3 weeks recovery	150,000
Injury Diagnosis Certificate	PDZ020002	Under 3 weeks recovery	100,000
English Diagnosis Certificate	PDE010001	General	20,000			A 'general diagnosis certificate' written in English by a doctor per Medical Service Act Enforcement Rules [Appendix Form 5-2]
Admission/Discharge Confirmation	PDZ090002		3,000
Treatment Confirmation	PDZ090007		3,000
Surgery Confirmation			3,000			Diagnosis name included
Hospitalization Proof	PDZ150000		3,000			A confirmation document containing the patient's personal information and admission date, with fees equivalent to admission/discharge confirmation
Medical Cost Estimate	PDZ140001	Under 10 million KRW	50,000
Medical Cost Estimate	PDZ140002	Over 10 million KRW	100,000
Disability Certificate (Year-End Tax Settlement)	PDZ170000		1,000			A certificate indicating eligibility for disability deduction per Income Tax Act Enforcement Rules [Appendix Form 38] * Documents proving eligibility for disability deduction under the Income Tax Act
Medical Record Copy (1-5 pages)	PDZ110101		1,000			Medical record copy issuance fee (up to 5 pages - per page) * Test results, progress notes, etc. * Price per page
Medical Record Copy (6+ pages)	PDZ110102	6+ pages	100			Medical record copy issuance fee (from page 6 - per page)
Medical Record Video - USB		USB	20,000			USB price included
Certificate Copy			1,000			Per page / Refers to copying (reissuing) existing certificates (When issuing multiple copies of the same certificate simultaneously, additional copies beyond the first are considered copies)
Other Certificates				3,000	100,000	Insurance company form certificate
Medical Opinion Letter			20,000			Company form medical opinion
English Certificates (Various)				20,000	100,000	Company form certificate
Assistive Device Inspection Certificate			-
Assistive Device Prescription			-
Medical Aid Extension Application			-
Operating Room CCTV USB			20,000
Operating Room CCTV Viewing Fee (per recording)			10,000

Therapeutic Materials

Category	Item		Medical Fees (Unit: KRW)				Remarks
	Name	Code	Division	Cost	Cost
	Name	Code	Division	Cost	Min	Max
Accommodative IOL	TECNIS EYHANCE IOL	BI0207LN	Unilateral	1,900,000
	TECNIS EYHANCE toric IOL	BI0200LN		1,900,000
	TECNIS PureSee IOL	BI0212LN		2,900,000
	TECNIS PureSee Toric IOL	BI0213LN		2,900,000
	ACRYSOF IQ PANOPTIX IOL	BI0208EB			3,800,000	4,800,000	Price varies by specification
	ACRYSOF IQ PANOPTIX TORIC IOL	BI0200EB			3,800,000	4,800,000
	Clareon PanOptix IOL	BI0211EB			4,800,000	5,800,000
	Clareon PanOptix Toric IOL	BI0212EB			4,800,000	5,800,000
	TECNIS Odyssey	BI0214LN			4,800,000	5,800,000
	TECNIS Odyssey Toric	BI0215LN			4,800,000	5,800,000
	ARTIS toric	BI0202HY		1,400,000
Refractive Correction Lens	Ortho-K LK®-Lens PREMIER	4Z0440302		600,000
	Ortho-K LK-Lens Toric PREMIER	4Z0440303		700,000
	Paragon CRT 100	4Z0440401		600,000
	Paragon CRT 100 Dual Axis	4Z0440402		700,000
	MiSight (1-month supply)			70,000
Others	SL-NS (Vision Correction Glasses)			10,000
	Iris Lens				120,000	150,000	Price varies by specification
	T-lens			10,000
	OLOGEN			600,000

Medications

Item		Medical Fees (Unit: KRW)	Remarks
Name	Code	Medical Fees (Unit: KRW)	Remarks
Lucentis Prefilled Syringe (Ranibizumab) 0.5mg/0.05mL_(1.65mg/0.165mL)	653603131	576,879	Full medication cost borne by patient when outside covered criteria
Vabysmo (Faricimab)_(28.8mg/0.24mL)	645001571	695,857
Vabysmo Prefilled Syringe (Faricimab)_(21mg/0.175mL)	645001661	695,857
Beovu Prefilled Syringe (Brolucizumab)_(19.8mg/vial)	653603301	735,050
Visudyne (Verteporfin)_(15mg/vial)	055500101	1,129,069
Celltrion Uflyma Pen 40mg/0.4mL (Adalimumab, Biosimilar)_(40mg/0.4mL)	623800211	244,221
Idenzelt Prefilled Syringe (Aflibercept)_(7.28mg/0.182mL)	623800261	330,000
Eylea Prefilled Syringe (Aflibercept)_(7.08mg/0.177mL)	641105771	493,543
Eylea 8mg Prefilled Syringe (Aflibercept)_(21.03mg/0.184mL)	641106241	795,000
Afillibu Prefilled Syringe (Aflibercept)_(6.6mg/0.165mL)	051500171	198,000
Ozurdex Implant 700μg (Dexamethasone)_(0.7mg/unit)	624900490	729,253
Humira Pen 40mg/0.4mL (Adalimumab, Biosimilar)_(40mg/0.4mL)	624900271	284,677
Avastin Injection		120,000	Non-covered
EMLA 5% Cream		4,600	Non-covered