This Circular amends and supplements certain provisions in the List of Medical Technical Services with specific conditions for payment of medical examination and treatment costs under health insurance. Specifically, this Circular adjusts services such as PET/CT scanning, coronary angiography, HbA1c testing, HBV and HCV testing to be consistent with current professional practices and legal regulations.
Scope of application
This Circular applies to the Director of the Ministry of Health's Office, the Inspector General of the Ministry of Health, Heads of Departments, Directors of Bureaus, General Directors of Departments, Bureaus, and General Bureaus under the Ministry of Health, Directors of Health Departments of provinces and centrally governed cities, Heads of health sectors, and related units.
Key points
- This Circular takes effect from August 10, 2020
- Abolish Section 6 of List 1 regarding Whole Body Computed Tomography Scanning
- Adjust the payment conditions for medical technical services such as PET/CT scanning, coronary angiography, HbA1c testing, HBV and HCV testing.
- The Vietnam Social Security shall implement the payment of medical examination and treatment costs under health insurance according to the regulations.
- The payment of medical examination and treatment costs under health insurance for cases that have undergone medical examination and treatment before the date this Circular takes effect and for patients admitted to hospital before the date this Circular takes effect but discharged after the date this Circular takes effect shall be implemented according to the regulations stipulated in legal normative documents issued before the date this Circular takes effect.
🌐 Social impact of this document
- To improve the quality of medical examination and treatment under health insurance
- Consistent with current professional practices and legal regulations
❓ Frequently asked questions
When does this Circular take effect?
This Circular takes effect from August 10, 2020.
Can cases that have undergone medical examination and treatment before the date this Circular takes effect apply the new regulations?
The payment of medical examination and treatment costs under health insurance for cases that have undergone medical examination and treatment before the date this Circular takes effect and for patients admitted to hospital before the date this Circular takes effect but discharged after the date this Circular takes effect shall be implemented according to the regulations stipulated in legal normative documents issued before the date this Circular takes effect.
What should relevant units do if they encounter difficulties during implementation?
In case of difficulties or obstacles during implementation, it is requested that agencies, organizations, and individuals report in writing to the Ministry of Health (Health Insurance Department) for consideration and resolution.
Full text
CIRCULAR
Amending and supplementing certain Articles of Circular No. 35/2016/TT-BYT dated September 28, 2016 of the Minister of Health on the List and Proportions, Conditions for Payment for Medical Technical Services within the Scope of Coverage for Persons Participating in Health Insurance
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Pursuant to the Health Insurance Law No. 25/2008/QH12 dated November 14, 2008, as amended and supplemented by Law No. 46/2014/QH13 dated June 13, 2014;
Pursuant to the Law on Medical Examination and Treatment No. 40/2009/QH12 dated November 23, 2009;
Pursuant to the Government's Decree No. 75/2017/NĐ-CP dated June 20, 2017 stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;
At the proposal of the Director of the Health Insurance Department;
The Minister of Health issues this Circular amending and supplementing certain Articles of Circular No. 35/2016/TT-BYT dated September 28, 2016 of the Minister of Health on the List and Proportions, Conditions for Payment for Medical Technical Services within the Scope of Coverage for Persons Participating in Health Insurance.
Article 1. Amending and supplementing certain Articles and Clauses of Circular No. 35/2016/TT-BYT dated September 28, 2016 of the Minister of Health on the List and Proportions, Conditions for Payment for Medical Technical Services within the Scope of Coverage for Persons Participating in Health Insurance as follows:
1. Amend Clause 1 of Article 1 as follows:
a) The list of medical technical specialties in medical examination and treatment issued together with Circular No. 43/2013/TT-BYT dated December 11, 2013 of the Minister of Health detailing the classification of medical technical specialties for the healthcare system (hereinafter referred to as Circular No. 43/2013/TT-BYT); Circular No. 21/2017/TT-BYT dated May 10, 2017 of the Minister of Health amending and supplementing the list of medical technical services in medical examination and treatment issued together with Circular No. 43/2013/TT-BYT dated December 11, 2013 of the Minister of Health detailing the classification of medical technical specialties for the healthcare system (hereinafter referred to as Circular No. 21/2017/TT-BYT);
b) The list of surgical and procedural classifications issued together with Circular No. 50/2014/TT-BYT dated December 26, 2014 of the Minister of Health on the classification of surgeries and procedures and staffing levels for each surgery and procedure (hereinafter referred to as Circular No. 50/2014/TT-BYT);
c) Medical technical services that have been approved by the Minister of Health for implementation at healthcare facilities but are not included in Circular No. 43/2013/TT-BYT, Circular No. 50/2014/TT-BYT, and Circular No. 21/2017/TT-BYT.
2. Amend Section 4 of List 1 - Medical Technical Services with specific conditions, proportions, and payment rates as follows:
|
No. |
DVKT/ Group of DVKT |
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) Organ angiography; c) Assessment of cerebral and organ perfusion; d) Angiography of extremity arteries and veins; e) Cardiac and large vessel imaging to assess cardiac structures and related large vessels; f) Evaluation of tumor stages, recurrence, metastasis, treatment response, to determine surgical, chemotherapy, radiotherapy, targeted therapy, immunotherapy indications; g) Simulation planning for radiation therapy: Brain tumors (diencephalon and/or cerebellum), Rectal cancer, Prostate cancer, Cervical cancer, Metastatic spinal cancer; h) Three-dimensional airway reconstruction; i) Chest CT in patients with respiratory failure (with breath-holding time less than 10 seconds). |
Paid at the rate of the DVKT, if more than two positions are imaged, the maximum payment will be the rate of the DVKT "Whole Body CT". |
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2. Whole-body CT for evaluating tumor stages 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 rate of the DVKT "Whole Body CT". |
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3. Other cases. |
Paid at the rate of the DVKT "CT from 1-32 slices". |
3. Amend Section 5 of List 1 - Medical Technical Services with specific conditions, proportions, and payment rates as follows:
|
No. |
DVKT |
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 heart rate-lowering medication, 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 rate of the DVKT. |
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2. Performed in one of the following cases: a) Angiography: brain, carotid, thoracic/abdominal aorta, lung, bronchus, mesentery, kidney, pelvis, coronary artery; b) Organ angiography; c) Assessment of cerebral and organ perfusion; d) Angiography of extremity arteries and veins; e) Cardiac and large vessel imaging to assess cardiac structures and related large vessels; f) Evaluation of tumor stages, recurrence, metastasis, treatment response, to determine surgical, chemotherapy, radiotherapy, targeted therapy, immunotherapy indications; g) Simulation planning for radiation therapy: Brain tumors (diencephalon and/or cerebellum), Rectal cancer, Prostate cancer, Cervical cancer, Metastatic spinal cancer; h) Three-dimensional airway reconstruction; i) Chest CT in patients with respiratory failure (with breath-holding time less than 10 seconds). |
Paid at the rate of the DVKT "CT from 64-128 slices". |
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3. Whole-body CT for evaluating tumor stages 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 rate of the DVKT "Whole Body CT 64-128 slices". |
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4. Other cases. |
Paid at the rate of the DVKT "CT from 1-32 slices". |
4. Amend Section 7 of List 1 - Medical Technical Services with specific conditions, proportions, and payment rates as follows:
|
No. |
DVKT |
Conditions for Payment |
Proportion, Payment Rate |
|
7. |
PET/CT Scan |
1. Diagnosis of Cancer a) A single indeterminate nodule in the lung with a diameter ≥ 8 mm that cannot be determined as malignant or benign by other diagnostic methods. b) Metastatic cancer without a primary tumor. |
Paid once at the rate of the DVKT for the first diagnosis. |
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2. Already diagnosed with cancer, other diagnostic methods cannot determine the stage, recurrence, metastasis, or treatment response for one of the following cases: a) Determining the stage before treatment: 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) Determining recurrence/metastasis: 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) Assessing treatment response: Hypopharyngeal, laryngeal cancer; Breast cancer; Cervical cancer. |
Paid no more than once every 12 months per patient and at the rate of the DVKT. |
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3. Has been definitively diagnosed with cancer, other diagnostic methods cannot evaluate treatment response for one of the following cases:: (1) Lymphoma (Hodgkin or non-Hodgkin malignant 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 in the first twelve months from the date of definitive diagnosis of cancer, and payment shall be made at the service fee rate. |
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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 scan shall be used for simulation and planning of radiotherapy. |
Paid at the rate of the DVKT. |
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5. In cases where PET/CT imaging is selected solely for radiotherapy simulation. |
Payment shall be made according to the radiotherapy service fee rate using CT simulation. |
5. Amend Item 66 of List 2 - Medical Technical Services with specific payment conditions as follows:
|
Serial number |
DVKT/ Group of DVKT |
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) Acute myocardial infarction without ST-segment elevation; d) Stable angina but symptoms are not controlled despite optimal medical therapy; đ) After cardiac arrest resuscitation; e) Chest pain recurrence after coronary intervention or bypass surgery; g) Heart failure of unknown cause; h) Patients with dangerous arrhythmias (ventricular tachycardia, atrioventricular block); i) Patients aged over 45 years for males or over 50 years for females who have indications for heart surgery, large vessel surgery, or organ transplantation; k) Congenital or acquired coronary artery diseases. |
6. Amend Item 84 of List 2 - Medical Technical Services with specific payment conditions as follows:
|
Serial number |
DVKT/ Group of DVKT |
Conditions for Payment |
|
84 |
Quantification of HbA1c [Blood] to determine treatment regimen or to assess diabetes treatment outcomes |
1. Payment shall be made for blood HbA1c quantification tests for patients definitively diagnosed with diabetes to determine the treatment regimen if the HbA1c test was not performed within ninety days. 2. Payment shall be made for subsequent tests starting from the second test to assess diabetes treatment outcomes at least every ninety days. |
7. Amend and supplement Items 87 and 88 of List 2 - Medical Technical Services with specific payment conditions as follows:
|
Serial number |
DVKT/ Group of DVKT |
Conditions for Payment |
|
87 |
HBV load measurement by Real-time PCR; HBV load measurement by automated system |
Prescribed by doctors of healthcare facilities with treatment units for hepatitis, to be conducted in the following cases: a) First test. b) For patients undergoing treatment, payment shall be made for the first test and subsequent tests conducted at intervals of ninety to one hundred eighty days using the same testing method. Simultaneous payment for two testing methods for the same patient during the same treatment period shall not be made. |
|
88 |
HCV load measurement by Real-time PCR; HCV load measurement by automated system |
Prescribed by doctors of healthcare facilities with treatment units for hepatitis, to be conducted in the following cases: a) First test; b) For patients undergoing treatment, payment shall be made for the first test, and the second test shall be paid when conducted four weeks after the first test, and subsequent tests conducted at intervals of ninety to one hundred eighty days using the same testing method. Simultaneous payment for two testing methods for the same patient during the same treatment period shall not be made. |
Article 2. Effective Date
1. This Circular takes effect from August 10, 2020.
2. Repeal Item 6 of List 1 - Medical Technical Services specifying detailed conditions, reimbursement rates, and fees (Whole-body Computed Tomography).
Article 3. Transitional Provisions
The payment of examination and treatment costs under health insurance for cases that have undergone examination and treatment before this Circular takes effect, and for patients admitted to hospital before this Circular takes effect but discharged after it takes effect, shall be governed by the provisions of laws and regulations issued prior to the effective date of this Circular.
Article 4. Reference Provisions
In case the referenced documents in this Circular are replaced or amended, they shall be implemented according to the replacement document or the amended document.
State-owned enterprises that have been assigned by the Ministry of Agriculture and Rural Development to conduct offshore wind power project surveys before the effective date of this Circular shall continue to implement according to the assigned documents; any new matters arising after the effective date of this Circular shall be implemented in accordance with the provisions of this Circular.
1. The Director of the Ministry's Office, the Inspector General of the Ministry, the Heads of Departments, Directors of Bureaus, and General Directors of the Ministries' Departments, Bureaus, and General Departments under the Ministry of Health, the Directors of Provincial Health Departments, the Heads of Health Services of centrally-administered cities, and relevant units are responsible for implementing the provisions of this Circular.
2. The Vietnam Social Security shall organize the implementation and payment of examination and treatment costs under health insurance according to the laws on health insurance and this Circular. Any difficulties or issues encountered during implementation should be reported in writing to the Ministry of Health (Health Insurance Department) for consideration and resolution.
Any difficulties or issues encountered during implementation should be reported in writing to the Ministry of Health (Health Insurance Department) for consideration and resolution./.
DEPUTY MINISTER
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