Circular 13/2020/TT-BYT amends Circular 35/2016/TT-BYT on the List and ratio, conditions for payment of medical technical services within the scope of health insurance beneficiaries, issued by the Minister of Health.

MINISTRY OF HEALTH
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SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
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Number: 13/2020/TT-BYT

Hanoi, June 22, 2020

No.

Medical Technical Service / Group of Medical Technical Services

Conditions for Payment

Proportion, Payment Rate

4

Computed Tomography (CT) 64 slices to 128 slices

1. Performed in one of the following cases:

a) Angiography: brain, carotid, thoracic/abdominal aorta, lung, bronchus, mesentery, kidney, pelvis, coronary artery;

b) Visceral angiography;

c) Assessment of cerebral and visceral perfusion;

d) Arteriovenous angiography of extremities;

e) Cardiac and large vessel angiography to assess cardiac structures and related large vessels;

f) Staging, recurrence, metastasis, treatment response assessment for cancer, to determine surgical, chemotherapy, radiotherapy, targeted therapy, immunotherapy indications;

g) Simulation planning for radiation therapy: Brain tumor (cerebrum and/or cerebellum), Rectal cancer, Prostate cancer, Cervical cancer, Metastatic spinal cancer;

h) Three-dimensional airway reconstruction imaging;

i) Chest CT in patients with respiratory failure (breath-holding time <10 seconds).

Paid at the price of the Medical Technical Service, if more than two positions are imaged, the maximum payment will be the price of the Medical Technical Service "Whole-body CT".

2. Whole-body CT for staging of tumors or multiple traumas.

Criteria for determining multiple trauma cases are patients with two or more severe injuries simultaneously according to injury severity scales, including at least one severe injury affecting respiration, circulation, central nervous system, threatening the patient's life.

Paid at the price of the Medical Technical Service "Whole-body CT".

3. Other cases.

Paid at the price of the Medical Technical Service "CT from 1-32 slices".

No.

Medical Technical Service

Conditions for Payment

Proportion, Payment Rate

5

CT from 256 slices and above

1. Coronary angiography with heart rate over 70 beats per minute (after using medication to reduce heart rate, or on patients contraindicated for such medication) or arrhythmia; congenital cardiovascular disease in children under six years old; cardiovascular disease in people aged 70 and above.

Paid at the price of the Medical Technical Service.

2. Performed in one of the following cases:

a) Angiography: brain, carotid, thoracic/abdominal aorta, lung, bronchus, mesentery, kidney, pelvis, coronary artery;

b) Visceral angiography;

c) Assessment of cerebral and visceral perfusion;

d) Arteriovenous angiography of extremities;

e) Cardiac and large vessel angiography to assess cardiac structures and related large vessels;

f) Staging, recurrence, metastasis, treatment response assessment for cancer, to determine surgical, chemotherapy, radiotherapy, targeted therapy, immunotherapy indications;

g) Simulation planning for radiation therapy: Brain tumor (cerebrum and/or cerebellum), Rectal cancer, Prostate cancer, Cervical cancer, Metastatic spinal cancer;

h) Three-dimensional airway reconstruction imaging;

i) Chest CT in patients with respiratory failure (breath-holding time <10 seconds).

Paid at the price of the Medical Technical Service "CT from 64-128 slices".

3. Whole-body CT for staging of tumors or multiple traumas.

Criteria for determining multiple trauma cases are patients with two or more severe injuries simultaneously according to injury severity scales, including at least one severe injury affecting respiration, circulation, central nervous system, threatening the patient's life.

Paid at the price of the Medical Technical Service "Whole-body CT from 64-128 slices".

4. Other cases.

Paid at the price of the Medical Technical Service "CT from 1-32 slices".

No.

Medical Technical Service

Conditions for Payment

Proportion, Payment Rate

7.

Positron Emission Tomography/Computed Tomography (PET/CT)

1. Diagnosis of Cancer

a) A single indeterminate pulmonary nodule ≥ 8 mm in diameter that cannot be definitively classified as malignant or benign by other diagnostic methods.

b) Metastatic cancer without known primary tumor.

Paid once at the price of the Medical Technical Service for the first diagnosis.

2. Already diagnosed with cancer, other diagnostic methods cannot determine stage, recurrence, metastasis, or treatment response for one of the following cases:

a) Pre-treatment staging: Nasopharyngeal, hypopharyngeal, laryngeal cancer; Non-small cell lung cancer; Esophageal cancer; Gastric adenocarcinoma; Colorectal cancer; Breast cancer; Cervical cancer; Lymphoma (Hodgkin or non-Hodgkin lymphoma);

b) Recurrence/metastasis detection: Nasopharyngeal, hypopharyngeal, laryngeal cancer; Non-small cell lung cancer; Esophageal cancer; Colorectal cancer; Breast cancer; Cervical cancer; Ovarian cancer (when CA 125 > 35U/ml); Lymphoma (Hodgkin or non-Hodgkin lymphoma); Thyroid cancer (when 131I scan is negative); Prostate cancer (when PSA > 4ng/ml);

c) Treatment response evaluation: Hypopharyngeal, laryngeal cancer; Breast cancer; Cervical cancer.

Paid no more than once every 12 months per patient at the price of the Medical Technical Service.

3. Already diagnosed with cancer, other diagnostic methods cannot evaluate treatment response for one of the following cases:: (1) Lymphoma (Hodgkin or non-Hodgkin lymphoma); (2) Non-small cell lung cancer; (3) Colorectal cancer; (4) Esophageal cancer; (5) Nasopharyngeal cancer.

Payment shall not exceed two times/12 months/one patient within the first 12 months from the date of being diagnosed with cancer, and payment shall be made at the service fee rate.

4. In cases where PET/CT imaging has been prescribed for staging, diagnosing metastasis, or monitoring treatment if radiotherapy is indicated, the results of the PET/CT imaging shall be used for simulation and planning of radiotherapy.

Paid at the price of the Medical Technical Service.

5. In cases where PET/CT imaging is selected solely for radiotherapy simulation.

Payment shall be made according to the radiotherapy service fee using CT simulation.

Serial number

Medical Technical Service / Group of Medical Technical Services

Conditions for Payment

66

Coronary Angiography

Payment shall be made for the following cases:

a) Acute myocardial infarction with ST-segment elevation;

b) Unstable angina;

c) Non-ST-segment elevation myocardial infarction;

d) Stable angina but uncontrolled symptoms despite optimal medical therapy;

e) After resuscitation from cardiac arrest;

f) Recurrent chest pain after coronary intervention or bypass surgery;

g) Unexplained heart failure;

h) Patients with dangerous arrhythmias (ventricular tachycardia, atrioventricular block);

i) Patients who have been indicated for heart surgery, major vascular surgery, age > 45 for males or > 50 for females; Patients who have been indicated for organ transplantation;

j) Congenital or acquired abnormalities of the coronary system.

Serial number

Medical Technical Service / Group of Medical Technical Services

Conditions for Payment

84

Quantification of HbA1c [Blood] to determine the treatment regimen or to evaluate the treatment outcome of diabetes

1. Payment shall be made for the HbA1c blood test quantification for patients diagnosed with diabetes to determine the treatment regimen if the HbA1c test was not performed within the last 90 (ninety) days.

2. Payment shall be made for subsequent tests starting from the second test onwards to evaluate the treatment outcome of diabetes at least every 90 (ninety) days.

Serial number

Medical Technical Service / Group of Medical Technical Services

Conditions for Payment

87

HBV load measurement by Real-time PCR; HBV load measurement by automated system

Prescribed by a physician of a healthcare facility with a treatment unit for hepatitis, to be conducted in the following cases:

a) Initial testing;

b) For patients undergoing treatment, payment shall be made for the initial test and subsequent tests conducted at intervals of 90 (ninety) to 180 (one hundred eighty) days using the same testing method.

Payment shall not be made simultaneously for two testing methods for one patient during the same treatment period.

88

HCV load measurement by Real-time PCR; HCV load measurement by automated system

Prescribed by a physician of a healthcare facility with a treatment unit for hepatitis, to be conducted in the following cases:

a) Initial testing;

b) For patients undergoing treatment, payment shall be made for the initial test, the second test when conducted four weeks after the initial test, and subsequent tests conducted at intervals of 90 (ninety) to 180 (one hundred eighty) days using the same testing method.

Payment shall not be made simultaneously for two testing methods for one patient during the same treatment period.

 Place of Receipt:
- Deputy Prime Minister Vu Duc Dam (for certification);
- Minister (for signature);
- National Assembly's Committee on Social Issues (for certification);
- Office of the Government (Department of Legal Affairs, Official Gazette, Government Portal);
- Deputy Ministers (for coordination and guidance);
- Ministry of Justice (Legal Normative Documents Inspection Department);
- Ministries, ministerial-level agencies, and government-affiliated agencies;
- Vietnam Social Security;
- People's Committees of provinces and centrally governed cities;
- Health Departments of provinces and centrally governed cities;
- Units under the Ministry;
- Departments, Agencies, General Departments, Ministry Offices, and the Ministry Inspectorate;
- Health Departments of Ministries and sectors;
- Ministry of Health Electronic Portal;
- To be filed: VT, PC, BHYT.

DEPUTY MINISTER
DEPUTY MINISTER
(Signed)



Nguyen Truong Son