This study aims to investigating the implementation of environmental cost accounting during the COVID-19 pandemic in relation to medical waste management at Wangaya General Hospital, Denpasar Indonesia using qualitative approach through case studies. Data were collected through field-observation, documentation and interviews with 4 key informants. The results show that the Wangaya Hospital had implemented environmental cost accounting, but had not made an explicit disclosure of environmental costs. There is no environmental cost report, and the operational statement is only reported in the goods and services expense account. But in other hand, Wangaya General Hospital already integrated among the economic, social, and environmental sustainability. The research results also show that Wangaya General Hospital still able to manage their business in the midst of the COVID-19 pandemic.