Chile Reimbursement for AI Echocardiography
How echocardiography is coded and paid in Chile: one national arancel, two FONASA modalities, ISAPRE plans priced off the same code set, and GES guarantees on top.
How is echocardiography reimbursed in Chile?
Through the national arancel that MINSAL approves each year, where echocardiography sits in Grupo 17, Subgrupo 01. FONASA pays it two ways: Modalidad de Atención Institucional inside the public network, and Modalidad Libre Elección, where the patient picks a registered private provider and FONASA contributes a fixed amount per code. ISAPRE plans quote cover as a percentage of the same codes, and GES caps the copayment on listed conditions. The standard full study is 17-01-045, at a 2026 base value of CLP 76.030. There is no Chilean code for AI analysis, so AI-assisted reporting is billed inside the existing echo codes.
Reimbursement Landscape in Chile
Chile runs two insurers over one price list. FONASA covers roughly four fifths of the population, the ISAPREs the rest, and both price procedures off the arancel MINSAL approves each year. What changes between them is the discount, not the code.
FONASA: MAI and MLE
The Fondo Nacional de Salud pays two ways. Modalidad de Atención Institucional (MAI) covers care inside the public network, where hospitals are financed by budget and, increasingly, by GRD case-mix coding. Modalidad Libre Elección (MLE) lets the patient pick a registered private provider and pays a fixed contribution per procedure, with the patient covering the rest.
ISAPREs
The thirteen-odd open and closed ISAPREs sell plans priced as a multiple of the same arancel codes. Cover is typically quoted as a percentage of the arancel value with an annual cap per procedure, so the code that identifies an echo is identical to the FONASA one.
GES on top
Garantías Explícitas en Salud binds both FONASA and the ISAPREs to guaranteed access, waiting times, quality and a capped copayment for a listed set of conditions. The 2025-2028 decree took the list to 90 health problems from 1 December 2025 and includes several cardiac ones.
Relevant Coding
Echocardiography sits in Grupo 17, Subgrupo 01 (Cardiología) of the national arancel. Values below are the 2026 Modalidad Libre Elección schedule at Grupo 1 of the Rol. Providers registered in Grupo 2 charge the base plus 30% and Grupo 3 the base plus 60%, and because echo carries no recargo exemption the whole uplift lands on the patient: FONASA pays the same amount at every level.
Doppler Color TTE
Ecocardiograma bidimensional Doppler color. The standard full transthoracic study with colour flow, and the code most Chilean echo labs bill.
Base value CLP 76.030 at Grupo 1. FONASA contributes a flat CLP 38.020; the beneficiary pays CLP 38.010 at Grupo 1, CLP 60.820 at Grupo 2 and CLP 83.630 at Grupo 3. AI-assisted measurement and reporting supports the cardiologist interpretation billed under this code.
Doppler Echo with Recording
Ecocardiograma Doppler, con registro. Explicitly includes code 17-01-008, so the two are not billed together.
Base value CLP 72.190 at Grupo 1, with a flat FONASA contribution of CLP 36.100 and a copayment of CLP 36.090 to CLP 79.400 depending on the provider group. Read the bundling note carefully: 17-01-007 already contains the 2D study, and pairing it with 17-01-008 on one claim is a rejection.
2D TTE (Base Study)
Ecocardiograma bidimensional, incluye registro modo M, papel fotosensible y fotografía, en adultos o niños. Flagged as a procedimiento autónomo.
Base value CLP 45.130 at Grupo 1, FONASA contribution CLP 22.570, copayment CLP 22.560 to CLP 49.640. This is the floor of the echo group and the code that survives when no Doppler is performed or recorded.
Transesophageal Echo
Ecocardiograma bidimensional Doppler color transesofágico. Carries an anaesthesia equivalence, so the pabellón and sedation codes apply alongside it.
Base value CLP 87.590 at Grupo 1, FONASA contribution CLP 43.800, copayment CLP 43.790 to CLP 96.340. There is no stress-echo code in Subgrupo 01: exercise testing is billed as 17-01-003, Electrocardiograma de esfuerzo, which limits how a stress protocol can be captured on a Chilean claim.
Values are the 2026 Modalidad Libre Elección schedule as reajusted by Resolución Exenta 347 of 3 March 2026 (Diario Oficial 44.400, 14 March 2026), which modifies Resolución Exenta 176 of 1999 and applied an inflactor of 1,77% to MLE and 0,93% to MAI. MAI values differ and public-network activity is increasingly settled through GRD case-mix rather than per-procedure. ISAPRE cover is a plan-specific percentage of the arancel with its own caps. Verify against the current FONASA arancel and the specific ISAPRE plan before relying on a figure.
Model the impact on your service
Enter your annual echo volume across FONASA and ISAPRE streams to model the capacity an AI-assisted workflow releases.
Reimbursement by Care Setting
The same four codes behave differently depending on who is paying and where the study is done. Per-study revenue is highest in the private clinics and effectively zero at the margin inside a budget-funded public hospital.
Public Network (MAI)
Servicios de Salud hospitals and consultorios. Activity is recorded against the arancel but financed by budget allocation and, in the hospitals inside the GRD programme, by case-mix weight.
Where the marginal study earns no marginal revenue, the value case is throughput against the waiting list rather than billing. This is the setting where automated measurement moves the most.
Private Provider on MLE
Clinics and private hospitals registered in the Rol de la Modalidad Libre Elección. The patient brings a bono, FONASA pays its fixed share and the provider collects the copayment.
Because the FONASA contribution is fixed, moving up a Rol group raises the patient copayment rather than the public subsidy. Report quality and turnaround are what justify the higher group.
ISAPRE and Particular
ISAPRE-contracted providers and self-paying patients. Plans quote cover as a percentage of the arancel code value, with annual caps; particular patients pay the clinic list price.
Per-study revenue is the highest of the three settings, and demand is elastic to reporting turnaround. Both halves of the AI value case apply here.
Chilean Procurement & Regulatory Context
A Chilean hospital reviewing AI echocardiography will ask how the device is regulated, how patient data is handled under the new data-protection law, and how a public buyer contracts for it.
Device Regulation and the ISP
Medical devices in Chile sit under article 111 of the Código Sanitario and DS 825/1998, administered by the Instituto de Salud Pública. Decreto Exento 25 (MINSAL, March 2026) revised the scope of that framework on a phased timetable, with ISP technical guidance due within 12 months of publication. Us2.ai is FDA 510(k) cleared and CE marked as a Class IIb medical device, and is available for clinical use in Chile.
Ley 21.719 and Health Data
Chile replaces Ley 19.628 with Ley 21.719 on 1 December 2026, creating an Agencia de Protección de Datos Personales with power to fine up to 20.000 UTM or 4% of annual revenue. Health data is a special category. Clinical records are already sensitive data under Ley 20.584, and Ley 21.541 gave telemedicine a statutory basis in 2023.
Public Buying and Hosting
Public providers contract through Mercado Público under Ley 19.886, so a Chilean deployment usually needs a licitación or convenio marco route. Us2.ai supports regional cloud hosting and on-premise deployment, with ISO 27001:2022 and SOC 2 Type II in place for the security review.
Frequently Asked Questions
Common questions about echocardiography coding and reimbursement in Chile.
What is the difference between FONASA MAI and MLE?
Which FONASA code covers a standard echocardiogram?
Why does the value change between Grupo 1, 2 and 3?
Is there a Chilean code for AI-assisted echocardiography?
How is Us2.ai regulated for use in Chile?
Does GES cover echocardiography?
How is health data handled under Ley 21.719?
Where can I get Chile-specific reimbursement guidance?
Important Information
Information is provided for general informational purposes only and is not a guarantee of coverage or reimbursement. FONASA arancel values are reajusted annually by MINSAL resolution and MAI values differ from the MLE figures shown here. ISAPRE cover is plan-specific. Chilean medical device regulation is changing on a phased timetable under Decreto Exento 25 of 2026, and this page will be re-checked when ISP technical guidance is issued. Providers should verify against the current arancel and their own contracts.
Coding and fee information last reviewed:
Questions about Chile Reimbursement?
Our team can support business cases for Servicios de Salud hospitals, MLE-registered clinics and ISAPRE-contracted providers with current arancel values, the ISP regulatory position and peer-reviewed clinical evidence.
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