Extracorporeal Shockwave Therapy Limited to '6 Sessions Per Area, 12 Per Year'; Out-of-Pocket Costs Will Apply Beyond Limits

Starting in July, patients undergoing extracorporeal shockwave therapy (ESWT) in South Korea will face stricter limits on insurance coverage, potentially increasing out-of-pocket expenses.

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Starting July, the number of times patients can claim private health insurance after receiving non-covered extracorporeal shockwave therapy will be limited to six times per area and 12 times per year.

The Ministry of Health and Welfare announced new guidelines that cap ESWT treatments at six sessions per affected area per year. Any sessions exceeding this limit will not be covered by private health insurance, requiring patients to bear the full cost. The therapy is generally recommended to be administered once a week.

The guidelines also specify seven approved areas for ESWT treatment, including the shoulder, elbow, hip joint, and ankle, for musculoskeletal conditions. While doctors can still prescribe ESWT for other conditions at their discretion, patients must be informed that such treatments will not be eligible for insurance reimbursement.

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The principle is to administer extracorporeal shockwave therapy once a week.

Certain conditions are explicitly prohibited for ESWT, such as those with a high risk of bleeding, pregnant individuals, patients with tumors in the treatment area, acute fractures, ruptures, or individuals under 18 with lesions near growth plates.

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The treatment areas for extracorporeal shockwave therapy are limited to seven areas for diseases of the shoulder, elbow, hip joint, and ankle.

This initiative marks the first time the medical community has proposed self-regulation for non-covered medical treatments. The Financial Supervisory Service plans to inform policyholders about these guidelines to encourage informed choices regarding treatment methods. A health ministry official stated that the plan is to standardize guidelines for frequently used non-covered items like ESWT.

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The extracorporeal shockwave therapy will be prohibited for those with a high risk of bleeding, pregnant women, patients with tumors in the treatment area, acute fractures, ruptures, and those under 18 with lesions near growth plates.