Circular No. 27/2013/TT-BYT Issuing the List of Medical Supplies within the Scope of Payment by the Health Insurance Fund

CIRCULAR

Issuing the list of medical supplies within the scope of payment of the Health Insurance Fund of Article 24health insurancepolicies

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Pursuant to Clause 2, Article 21 of the Health Insurance Law dated November 14, 2008;

Pursuant to Decree No. 62/2009/NĐ-CP dated July 27, 2009 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law; Bhealth insurance;

Pursuant to Decree No. 63/2012/NĐ-CP dated August 31, 2012 of the Government stipulating functions, tasks, powers and organizational structure of the Ministry of Health;

Pursuant to Clause 3, Article 7 of Circular Joint No. 09/2009/TTLT-BYT-BTC dated August 14, 2009 of the Ministry of Health and the Ministry of Finance guiding the implementation of health insurance;

The Minister of Health issues this Circular on the List of Medical Supplies within the Scope of Payment of the Health Insurance Fund,

Article 1. List of Medical Supplies

1. Attached to this Circular is the List of Medical Supplies within the Scope of Payment of the Health Insurance Fund, including common consumable medical supplies, artificial organ replacement supplies, specialized equipment and tools (hereinafter referred to as medical supplies) used for diagnosis, treatment and rehabilitation, aiming to meet professional requirements and service quality in medical examination and treatment.

2. The List of Medical Supplies attached to this Circular is the basis for the Health Insurance Fund to pay costs for medical supplies used for insured patients at medical examination and treatment facilities under health insurance.

Article 2. Construction of the List of Medical Supplies within the Scope of Payment of the Health Insurance Fund for Each Medical Examination and Treatment Facility

1. Basis for constructing the List of Medical Supplies within the Scope of Payment of the Health Insurance Fund for each medical examination and treatment facility:

a) The List of Medical Supplies prescribed in Clause 1, Article 1 of this Circular;

b) The level of treatment and the scope of professional technical services of the medical examination and treatment facility approved by the competent authority according to the regulations on professional technical service stratification of the Ministry of Health.

2. Selection of medical supplies for constructing the List of Medical Supplies used at medical examination and treatment facilities shall be carried out based on the principle of ensuring professional technical requirements and service quality; having reasonable costs and production prices.

3. Based on specific types of medical supplies that have been purchased, the medical examination and treatment facility compiles a list of medical supplies used at its facility (according to the model attached to this Circular) and sends it to the Social Insurance Fund for unified settlement purposes.

4. Within fifteen working days from the date of receipt of the List of Medical Supplies sent by the medical examination and treatment facility, the Social Insurance Fund has the responsibility to review and reply in writing; if

5. In cases where it is necessary to change or supplement medical supplies in the Medical Supplies List that has been agreed upon with the Social Insurance, the healthcare facility and the Social Insurance shall be responsible for uniformly implementing the supplementary Medical Supplies List in accordance with the provisions of Clauses 3 and 4 of this Article.

Article 3. Principles of Application and Payment Methods

1. General principles:

a) The cost of medical supplies is reimbursed by the Health Insurance Fund based on the actual quantity used for patients, the quantity of medical supplies used for patients is calculated according to the unit of measurement specified for each type of medical supply in the Medical Supplies List issued together with this Circular;

b) The price level for the Social Insurance to apply for reimbursement of medical supply costs used for insured patients:

- For state-run healthcare facilities: calculated based on the purchase price of the unit in accordance with the laws on purchasing medical supplies;

- For private healthcare facilities: calculated based on the purchase price of the unit but not higher than the lowest purchase price of state-run healthcare facilities in the same province (hereinafter referred to as the province) in accordance with the laws on purchasing medical supplies. In case state-run healthcare facilities in the province do not use such medical supplies, the Social Insurance will apply the lowest payment price by the Health Insurance Fund for state-run healthcare facilities to reimburse for such medical supplies;

c) Types of medical supplies that have been structured and included in the prices of technical services, daily bed charges, or package fees per case as stipulated in the regulations on service pricing for medical examination and treatment shall not be reimbursed separately by the Health Insurance Fund;

d) For types of medical supplies that have not been structured and included in the prices of technical services, daily bed charges, or package fees per case, the Health Insurance Fund shall reimburse them separately in accordance with the principle stipulated in Point a Clause 1 of this Article; the amount of reimbursement for medical supply costs for each patient shall not exceed the benefit level prescribed by the Health Insurance Law and guiding documents on health insurance benefits for different groups;

đ) Types of medical supplies classified by specialty, if used in other specialties, shall still be reimbursed by the Health Insurance Fund;

e) The Health Insurance Fund shall not reimburse types of medical supplies listed in the Medical Supplies List in the following cases: when they are paid for by other financial sources; when they are used in technical services outside the scope of health insurance benefits as prescribed by the Health Insurance Law and guiding documents for its implementation;

2. Application and payment in certain specific cases:

a) For medical supplies that are difficult to quantify when used and for which minimum usage standards have not been defined: healthcare facilities shall establish and agree with the Social Insurance on minimum usage standards for technical services using these medical supplies, ensuring sufficient quantities for service provision, appropriate storage and preservation conditions, and convenience in payment;

b) For medical supplies with units measured as "sets" that include multiple components or parts, all accompanying medical supplies are covered by health insurance reimbursement. If the prices of accompanying medical supplies are calculated individually, they shall be reimbursed according to their individual prices; if the price is calculated as a whole set, then they shall not be reimbursed separately for each component.

In cases where only a part or a component of a "set" is used, payment shall be made according to the cost of the used component for the patient if there is a separate price for each component; if there is no separate price for the used component, the basis shall be the purchase price and the special characteristics of each component, with the healthcare facility and the Social Insurance exchanging and agreeing on the payment amount for that component.

c) Payment for medical supplies used in high-tech services and large-cost services according to the List of High-Tech Services and Large-Cost Services prescribed by the Ministry of Health:

- In cases where the costs of these medical supplies are included in the service fee, they will not be calculated separately for payment according to the principle stipulated in Point c Clause 1 of this Article;

- In cases where they are not included in the service fee, the Health Insurance Fund shall pay separately according to the principle stipulated in Point d Clause 1 of this Article but not exceeding the benefit level specified for cases using high-tech services and large-cost services;

d) For medical supplies used multiple times:

- For reusable medical supplies with guidelines on reuse procedures and number of reuses issued by the Ministry of Health, they shall be implemented according to the guidelines of the Ministry of Health;

- For reusable medical supplies without guidelines on reuse procedures and number of reuses from the Ministry of Health or the manufacturer, the Hospital Director shall base on professional requirements, actual usage, and proposals from the Drug and Treatment Council, and agree with the Social Insurance to decide on the number of reuses. The payment price for each use is the same and determined by dividing the total value of the medical supplies plus the sterilization costs of each reuse by the total number of uses;

đ) For medical supplies with many types and different prices, such as artificial joints, joint replacements, intervertebral discs, artificial vertebrae, artificial bones, pacemakers, and implanted defibrillators with and without anti-tachycardia functions:

The Hospital Director shall base on professional requirements, actual usage, and proposals from the Drug and Treatment Council, and agree with the Social Insurance to select and decide on appropriate medical supplies that meet professional requirements and the Health Insurance Fund's payment capacity;

e) For Toric intraocular lenses: They can only be used in cataract surgery accompanied by astigmatism correction;

Article 4. Organization of Implementation

1. Healthcare facilities have the responsibility:

a) To establish and agree with the Social Insurance on the List of Medical Supplies for use at their facility. In case of disagreement, they shall report to the superior management authority for resolution;

b) To provide sufficient, timely, and in compliance with regulations, meeting the treatment needs of insured patients according to the established List of Medical Supplies, without requiring patients to purchase them themselves;

c) When establishing the service fee for diagnosis and treatment, they must list all necessary medical supplies required to perform technical services and clearly indicate which medical supplies are not included in the service fee for separate payment according to this Circular;

d) To manage the prescription and use of medical supplies reasonably and economically; to make timely payments accurately by type, quantity, and price;

đ) To compile and statistically record all types of medical supplies used for patients for settlement with the Social Insurance according to forms issued by the Ministry of Health;

2. Provincial Departments of Health have the responsibility:

a) To direct, guide, inspect, and audit the implementation of the provisions of this Circular and other relevant legal documents concerning the establishment of the List of Medical Supplies, procurement, supply, and payment for the use of medical supplies at healthcare facilities under their management;

b) To issue the List of Medical Supplies for use at Commune Health Stations, Ward Health Stations, and Town Health Stations within their jurisdiction;

3. The Social Insurance has the responsibility:

a) To review and promptly respond in writing regarding the List of Medical Supplies covered by the Health Insurance Fund for payment at healthcare facilities;

b) To implement payments strictly in accordance with this Circular and other relevant legal documents;

c) To cooperate in resolving issues arising during the implementation process;

4. The procurement of medical supplies shall be carried out in accordance with Circular No. 68/2012/TT-BTC dated April 26, 2012, of the Ministry of Finance, which regulates bidding for the procurement of assets to maintain the regular operation of state agencies, political organizations, social-political organizations, occupational social-political organizations, social organizations, occupational social organizations, and people's armed forces units.

Article 5. Transitional provisions and cross-referencing clauses

1. In cases where patients with health insurance cards are admitted to hospitals before this Circular takes effect but are still undergoing treatment at medical examination and treatment facilities, they shall be implemented according to the Medical Supplies List and the provisions set forth in this Circular.

2. For types of medical supplies included in the Medical Supplies Lists issued together with Decision No. 6282/2003/QĐ-BYT dated December 8, 2003 of the Minister of Health on the issuance of the List of Consumable Medical Supplies to be reimbursed by Social Insurance (Health Insurance) and Decision No. 21/2008/QĐ-BYT dated June 9, 2008 of the Minister of Health on the issuance of the List of Consumable Medical Supplies and Replacement Medical Supplies in medical examinations and treatments that have been purchased by medical examination and treatment facilities, the Health Insurance Fund will continue to reimburse until the quantity of medical supplies purchased through bidding, supply, and contracts signed with contractors before this Circular takes effect is exhausted.

3. In cases where legal documents referred to in this Circular are replaced or amended, the replacement or amended documents shall apply.

Article 6. Effectiveness 1. This Circular takes effect from February 15, 2026; Circular No. 24/2013/TT-BKHCN dated September 30, 2013 of the Minister of Science and Technology on activities related to calibration, verification, testing of measuring instruments, and measurement standards shall cease to be effective from the date this Circular takes effect.

1. This Circular takes effect from November 15, 2013.

2. Repeal Decision No. 6282/2003/QĐ-BYT dated December 8, 2003 of the Minister of Health on the issuance of the List of Consumable Medical Supplies to be reimbursed by Social Insurance (Health Insurance) and Decision No. 21/2008/QĐ-BYT dated June 9, 2008 of the Minister of Health on the issuance of the List of Consumable Medical Supplies and Replacement Medical Supplies in medical examinations and treatments from the date this Circular takes effect.

During the implementation process, if there are difficulties or obstacles, agencies, organizations, and individuals are requested to report to the Ministry of Health (Department of Health Insurance) for consideration and resolution./.