Ministry of Health updates list of codes for medical examination and treatment under health insurance

The Ministry of Health has just issued Decision No. 3276/QD-BYT on promulgating the List of codes for medical examination and treatment and fuel codes for sending electronic data on medical examination and treatment costs under health insurance, which clearly states that some cases are entitled to 50-100% of medical examination and treatment costs according to the scope of benefits and benefit levels.

Báo Nhân dân•21/10/2025

The Ministry of Health updates the list of codes for medical examination and treatment under health insurance. (Illustration photo)

Vietnam Social Security receives and synchronizes common data nationwide

The Ministry of Health abolishes Appendix 5 of the list of gasoline and oil codes issued with Decision No. 824/QD-BYT dated February 15, 2023 of the Minister of Health promulgating additional lists of common codes applied in management and appraisal, payment of medical examination and treatment costs under health insurance and Appendix 5 of the list of codes for subjects coming for medical examination and treatment issued with Decision No. 2010/QD-BYT dated June 19, 2025 of the Minister of Health temporarily promulgating a number of common code lists serving the sending of data on medical examination and treatment costs under health insurance.

In case from July 1, 2025 to October 17, 2025, medical examination and treatment facilities have applied a code for medical examination and treatment subjects different from the provisions of this Decision, they shall re-extract electronic data on medical examination and treatment costs under health insurance and re-send replacement records to the Data Receiving Portal of the Social Insurance agency according to the code prescribed in this Decision, ensuring the same scope of benefits and levels of enjoyment of health insurance participants as prescribed.

Vietnam Social Security under the Ministry of Finance receives electronic data from medical examination and treatment facilities to ensure synchronization and uniformity of common data nationwide.

In case the medical examination and treatment facility does not extract and send back the replacement records, the Social Insurance agency shall conduct an appraisal according to the code of the subject coming for medical examination and treatment that the medical examination and treatment facility has used, but must be within the same scope of benefits and levels of enjoyment of the health insurance participant as prescribed in this Decision.

During the transition period from the date of issuance of this Decision to December 31, 2025, in case the application of the code prescribed in this Decision has difficulties or problems due to objective reasons, medical examination and treatment facilities are allowed to re-extract electronic data on medical examination and treatment costs under health insurance and re-submit replacement records to the Data Receiving Portal of the Social Insurance agency according to the code prescribed in this Decision and ensure the correct scope of benefits and levels of enjoyment of health insurance participants according to regulations.

Vietnam Social Security under the Ministry of Finance receives electronic data from medical examination and treatment facilities to ensure accuracy, synchronization, and uniformity of general data nationwide.

Target groups and benefit levels

According to the new list, patients coming for health insurance examination and treatment will be identified with a specific subject code with corresponding benefits. Some notable cases include:

Examination at the original registered place: enjoy 100% of the cost within the scope of health insurance benefits.

Examination at other primary facilities (health stations, family medicine, military-civilian medicine...): still enjoy 100% of the cost, regardless of the benefit level on the card.

Examination according to referral form or re-examination appointment form: enjoy 100% of the cost.

Organ donors, newborns treated immediately after birth: enjoy 100% of costs.

Outpatient examination at basic level facility with 50-70 points: from July 1, 2026, enjoy 50% of the cost, previously not covered by health insurance.

Examination at central level when not in the right line: only enjoy 40% of inpatient costs, no outpatient costs.

Emergency examination or ethnic minorities, poor households in difficult areas, island communes: enjoy 100% of costs.

In cases of receiving medicine according to appointment, authorization to receive medicine or medical facilities delivering medicine to patients in the context of group A epidemics or force majeure, patients are still entitled to 100% of medical examination and treatment costs according to regulations.

Patients who do not have health insurance or do not go for medical examination as prescribed will not be paid for medical examination and treatment costs.

The Ministry of Health notes that the code of the patient coming for medical examination and treatment is determined by the medical examination and treatment facility after the medical examination or treatment is completed for the patient to send electronic XML data to the Social Insurance Agency's reception portal.

In case a patient comes for medical examination and treatment and can apply more than 1 subject code, the medical examination and treatment facility will select the subject code in order from top to bottom.