Manual Therapy Fee Set at 43,850 Won Per Session... Limited to Twice a Week and Up to 24 Sessions Annually

At the 10th Health Insurance Policy Committee Meeting,
Managed Benefits and Home-Based Care Integration Approved


Pilot Project for Rural Health Care Service Reimbursement Launched Amid Sharp Decline in Public Health Doctors

Manual therapy, which has been cited as a primary cause of overtreatment and losses in indemnity health insurance, will now be subject to managed benefits under the National Health Insurance, with a fee of around 40,000 won per session. The number of sessions will also be limited to twice a week and up to 24 sessions per year. In addition, as a pilot project to address potential gaps in healthcare in rural and fishing communities due to a decrease in public health doctors, new reimbursement rates will be introduced for health care officials and non-face-to-face collaborative consultations.

The Ministry of Health and Welfare announced on June 4 that the 10th meeting of the 2026 Health Insurance Policy Deliberation Committee was held, chaired by Second Vice Minister Lee Hyung-hoon, where these agenda items were reviewed and approved.

As part of the second phase of medical reform aimed at reducing the public's out-of-pocket healthcare costs, manual therapy has been included under the "managed benefits" category of selective benefits. Manual therapy has long been associated with significant price disparities across medical institutions and concerns of misuse, but with this revision, clear pricing and clinical guidelines have been established.

The fee for manual therapy has been set at 43,850 won per session, applying a 95% coinsurance rate for patients. This rate was determined based on prices of similar insured services, market prices, and the time required. The same rate will be applied to all medical institutions, regardless of type. To guarantee patients' right to treatment while preventing overuse, the benefit standard allows up to two sessions per week and a total of 15 sessions per year in principle. However, in exceptional cases—such as a clearly documented joint contracture or stiffness due to surgery or fracture—a physician may authorize up to 24 sessions per year based on medical judgment.

Manual therapy cannot be billed together with other physical therapy services, and clinical details such as outcome assessments must be recorded without exception. In addition, basic physical therapy and simple rehabilitation must be administered first. The Ministry of Health and Welfare plans to re-evaluate the benefit standards for manual therapy every three years and will gradually strengthen the management system for non-insured services starting with this initiative.

Home-Based Care for Seven Diseases to Be Integrated Under 'Home Management'

During the committee meeting, it was decided to consolidate pilot home-based care programs for seven diseases—including type 1 diabetes, cancer, and heart disease—that had previously been run separately, into a unified "disease-specific home management pilot project."

The previously complex reimbursement criteria and coinsurance rates, which varied by disease, will be simplified by disease group, and the number of educational and counseling sessions that can be billed will be expanded overall to help patients better manage their conditions. For example, the number of annual education and counseling sessions for patients with type 1 diabetes (Education Counseling Fee I) will increase from 6–8 times to 8 times per year.

Additionally, patients with heart disease who have implanted devices will now include "patients with left ventricular assist devices (LVADs)," and all pilot programs, which previously had different end dates, will now conclude in December 2027. The government will also consider linking this main project with the institutionalization of non-face-to-face medical consultations in the future.

New Reimbursement Rate for 'Health Care Officials' in Rural Areas Without Public Health Doctors

Due to a sharp decline in the number of public health doctors, from 945 last year to 587 this year, a pilot project for "Rural Health Care Service Reimbursement" will begin on June 8 and run through the end of 2028, to minimize healthcare gaps in rural and fishing communities.

Currently, in 160 integrated health centers adjacent to public health clinics, health care officials with nursing qualifications are providing medical services. The government has decided to apply the same per-visit reimbursement (from 3,980 won, with a patient copayment of 900 won for up to four days of medication) as those used at public health clinics to their services.

Furthermore, when these health care officials conduct non-face-to-face collaborative consultations with doctors to ensure patient safety, the collaborating medical institution will be paid a "non-face-to-face consultation advisory fee" at the level of an in-person consultation (ranging from 17,500 to 21,440 won), to help ensure that residents in medically underserved areas have access to stable medical services.

Pilot Sickness Benefit Program: "Economic Anxiety of SME Workers Eased"

Meanwhile, the Ministry of Health and Welfare also announced the results of the performance evaluation of the "Sickness Benefit Pilot Program" that has been running in eight cities and counties since July 2022. The sickness benefit system provides financial support to workers who are unable to work due to injuries or illnesses unrelated to their job, helping them focus on treatment.

The survey found that recipients of the sickness benefit reported decreased anxiety over income loss and medical costs. Notably, among workers at small businesses with fewer than 30 employees—who often do not have access to paid sick leave—the proportion who "received timely treatment" increased by 17.1 percentage points, while the proportion who "worked during periods of illness" decreased by 32.0 percentage points, demonstrating improved access to care and greater encouragement of rest.

The Ministry stated, "Based on these evaluation results, we will collect a wide range of opinions from labor, management, the medical sector, and experts to formulate plans for the full-scale implementation of the sickness benefit system going forward."

This content was produced with the assistance of AI translation services.