The government said it would reduce health insurance coverage for lower abdominal and urinary ultrasound exams, beginning next year. This initiative is aimed at curbing overtesting and preventing the misallocation of health insurance funds. 

Earlier this year, the government reduced benefits for upper abdominal and multisite ultrasounds, as well as brain and cerebrovascular MRI exams.

Currently, there is no established reimbursement standard for preoperative ultrasounds focused on the lower abdomen and urinary tract. Consequently, certain medical institutions have received reimbursements for preoperative ultrasound exams.

As a result, the expenditure on lower abdominal and urinary ultrasound examinations has surged by 60.6 percent, rising from 50.35 billion won in 2019 to 80.08 billion won in 2022, according to the Ministry of Health and Welfare.

This amount is projected to exceed the estimated expenditure on lower abdominal and urinary ultrasound in 2022, which is approximately 49.9 billion won, by more than 1.6 times, the ministry said.

However, effective from the upcoming year, coverage for lower abdominal and urinary ultrasounds conducted for preoperative risk assessment purposes will be limited to cases deemed medically necessary, the ministry said.

Reimbursement for ultrasounds conducted on the day of the examination—previously billed uniformly without specific justification—will only be acknowledged if a clear reason, such as the basis for the medical judgment of the treating doctor, is explicitly stated.

Kang Joon, director general of the Health Insurance Innovation Division at the Ministry of Health and Welfare, said, "By clarifying the criteria for MRI and ultrasound reimbursements based on medical necessity, we aim to prevent financial leakage.”

The funds saved through this measure will be redirected to essential medical care, ensuring that health insurance funds are allocated where they are most needed, he added.