Expanding indications…TAVI reimb still limited

While age criteria are expanding globally, Korea's policy mismatch is intensifying

TAVI fee is 1/3 of PCI…halting expanded treatment

The government, "We will discuss improving the policy by collecting opinions within the first half of this year"

While TAVI (Transcatheter Aortic Valve Implantation) is becoming the standard for aortic valve replacement globally, in Korea, it remains tied to reimbursement criteria of '80 years old and inoperable.'

While technology is advancing, the system remains in place.

In the global market, TAVI has surpassed surgical aortic valve replacement (SAVR). 

According to U.S. Medicare claims data, since the number of TAVI procedures overtook SAVR starting in 2016, the gap has continued to widen.

The biggest problem is the reimbursement criteria, which are out of step with global trends. The U.S. (65 and older) and Europe (70 and older) already recommend TAVI as standard treatment, significantly lowering age and risk thresholds. In contrast, Korea still divides reimbursement benefits (5% patient co-payment) based on age 80.

For this reason, although TAVI procedures increased rapidly after the 5% co-payment reimbursement was introduced in May 2022, most of the increase was among elderly patients aged 80 and older. The patient group in their 70s appears relatively unchanged.

Currently, for a patient in their 70s to receive TAVI, they must either bear costs totaling tens of millions of won, even with selective reimbursement, or receive an "inoperable" determination from two thoracic surgeons.

The fact that the procedure fee for TAVI, which requires a high level of concentration from medical staff and cooperation from a multidisciplinary team, is only about one-third that of a general stent insertion (PCI) is also a factor hindering market growth.

Presentation materials from the Insurance Committee session of the Korean Society of Interventional Cardiology (KSIC) 2026 Conference in Winter, reorganized by DailyPharm.

Currently, the TAVI reimbursed fee is around KRW 540,000. This is significantly lower than PCI (about KRW 1.5 million) or pediatric pulmonary valve implantation (about KRW 2 million). In contrast, the U.S. reflects complexity through a co-surgeon extra-charge structure.

Particularly, during a TAVI procedure, an 'integrated heart medical team,' a so-called Heart Team consisting of thoracic surgery personnel, anesthesiology, and radiology, is mandatory.

Experts point out that, given labor costs, such a Heart Team has a structure in which the hospital loses money the more procedures it performs. Under the current 'low fee structure,' it inevitably reduces the incentive for medical institutions to actively expand the procedure. 

Ultimately, advances in technology and the limitations of the system are leading to longer wait times for patients and reduced access to treatment.

However, another hurdle, namely the leadership between medical departments, is also mentioned as a limitation to the expansion of reimbursement. Under current law, to decide whether to perform a TAVI procedure, 'unanimous agreement' from an integrated medical team, including two thoracic surgeons, is required.

In reality, the procedure is fundamentally impossible in small-to-medium-sized hospitals where only one thoracic surgeon is stationed. For these reasons, concerns are raised that it may serve as a threshold for entering reimbursement rather than as a consultative body to discuss treatment methods.

The government stated it would accelerate system improvements by conducting public opinion surveys in the first half of 2026.

정부는 2026년 상반기 의견수렴을 통해 제도 개선에 속도를 내겠다고 밝혔다

On the one hand, given the need for long-term survival rate research and valve durability, some view the expansion of TAVI reimbursement for low-risk groups as premature.

Conversely, it is argued that consideration is needed to select the best treatment for the patient rather than simply applying it uniformly by age.

Because of this, the current discussion on expanding TAVI reimbursement can be seen as a conflict between exercising a veto to protect the number of surgeries rather than for the patient's benefit, and concerns about the abuse of procedures whose long-term safety has not been verified.

The government signaled visible institutional changes within the first half of 2026. 

Yoo Jung-min, director of the Division of Health Insurance Benefits at the Ministry of Health and Welfare (MOHW), who spoke at the Insurance Committee session of the recently held the Korean Society of Interventional Cardiology (KSIC) 2026 Conference in Winter, emphasized three major principles: ▲reflecting international trends ▲respecting medical judgment ▲ expanding patient treatment choice.

The policy is to restructure the system so that the integrated medical team can discuss "the best treatment" rather than "inoperability."

However, industry experts agree that "simple modification of wording is not enough." The opinion is that the distorted growth of the TAVI market can only be corrected if complex factors such as ▲a rational lowering of the age criteria (to age 75, etc.) ▲the realization of fees matching the difficulty of the procedure ▲the incentivization of formal Heart Team operations are considered in the reimbursement discussion.

Yoo stated, "We will speed up discussions on system improvement by broadly collecting opinions from various expert groups, such as related academic societies and patient organizations, during the first half of this year," and added, "The Ministry will strive to bring changes that can be made across the overall TAVI reimbursement criteria."