海南省基本醫(yī)療保險按病種付費病種及醫(yī)保支付標準

1、第 1 頁，共 6 頁海海南南省省基基本本醫(yī)醫(yī)療療保保險險按按病病種種付付費費病病種種及及醫(yī)醫(yī)保保支支付付標標準準目目前前我我院院仍仍按按二二級級醫(yī)醫(yī)院院標標準準收收費費，故故報報銷銷也也按按二二級級醫(yī)醫(yī)院院標標準準執(zhí)執(zhí)行行序序號號臨臨床床專專業(yè)業(yè)病病種種主主要要操操作作/ /治治療療方方式式ICD-10ICD-10編編碼碼（醫(yī)醫(yī)保保結(jié)結(jié)算算）城城鄉(xiāng)鄉(xiāng)居居民民醫(yī)醫(yī)保保支支付付標標準準（單單位位：元元）城城鎮(zhèn)鎮(zhèn)職職工工醫(yī)醫(yī)保保支支付付標標準準（單單位位：元元）3 3級級醫(yī)醫(yī)院院2 2級級醫(yī)醫(yī)院院3 3級級醫(yī)醫(yī)院院2 2級級醫(yī)醫(yī)院院1呼呼吸吸系系統(tǒng)統(tǒng)疾疾病病支氣管擴張內(nèi)科治療J47.x004500

2、3600590042002肺部感染內(nèi)科治療J98.41448003650630043003支氣管哮喘內(nèi)科治療J45.90337003200480037004自發(fā)性氣胸內(nèi)科治療J93.00135003300460038005慢性支氣管炎內(nèi)科治療J42.x0053003600690042506支氣管肺炎內(nèi)科治療J18.00019001500250017607支原體肺炎內(nèi)科治療J15.70024001800310021008社區(qū)獲得性肺炎內(nèi)科治療J15.90349403000640035009慢性阻塞性肺疾病急性加重期內(nèi)科治療J44.101730068009500790010結(jié)核性胸膜炎內(nèi)科治療A1

3、6.500500045006500520011消消化化系系統(tǒng)統(tǒng)疾疾病病潰瘍性結(jié)腸炎內(nèi)科治療K51.900300026003950300012消化道出血內(nèi)科治療K92.210590034007700400013胃息肉內(nèi)科治療K31.700290027003800315014急性胰腺炎（水腫型，膽源性，輕癥）內(nèi)科治療K85.9005700390074504600第 2 頁，共 6 頁15慢性十二指腸球部潰瘍內(nèi)科治療K26.700380030004950350016慢性乙型病毒性肝炎 內(nèi)科治療B18.107.001270025003500290017膽囊結(jié)石經(jīng)腹腔鏡膽囊切除治療K80.2005700

4、42007400490018膽囊息肉手術(shù)治療K82.802460036006000420019膽管結(jié)石手術(shù)治療K80.500520041006800480020內(nèi)痔手術(shù)治療I84.200420038005500445021混合痔手術(shù)治療I84.201340024004400280022外痔手術(shù)治療I84.500340032004450380023肛周膿腫手術(shù)治療K61.001270023003500270024結(jié)腸息肉腫物切除術(shù)K63.500390028005100325025肛瘺手術(shù)治療K60.300320027004200320026食管內(nèi)異物食道鏡下異物取出術(shù)T18.1001700140

5、02200170027急性單純性闌尾炎闌尾切除術(shù)K35.900450036005900420028急性單純性闌尾炎經(jīng)腹腔鏡闌尾切除術(shù)K35.900.001550046007200540029急性化膿性闌尾炎闌尾切除術(shù)K35.901470040006100470030腹股溝疝腹股溝疝修補術(shù)K40.900440040005800470031腹股溝疝無張力腹股溝疝修補術(shù)K40.900.001410037005300430032下肢靜脈曲張大隱靜脈高位結(jié)扎術(shù)+剝脫術(shù)I83.900570042007450500033神神經(jīng)經(jīng)系系統(tǒng)統(tǒng)疾疾病病(重癥)帕金森病內(nèi)科治療G20.x003900360051004

6、200消消化化系系統(tǒng)統(tǒng)疾疾病病第 3 頁，共 6 頁34癲癇內(nèi)科治療G40.901360022004700260035面癱（面神經(jīng)炎）內(nèi)科治療G51.000470036006100420036血血液液系系統(tǒng)統(tǒng)疾疾病病缺鐵性貧血內(nèi)科治療D50.900380033004950390037風風濕濕性性疾疾病病類風濕關(guān)節(jié)炎內(nèi)科治療M06.900420028005500330038骨關(guān)節(jié)炎內(nèi)科治療M15.902490030006400350039痛風內(nèi)科治療M10.900460034006000400040強直性脊柱炎內(nèi)科治療M45.x00370030004800350041皮皮膚膚、皮皮下下組組織織、

7、乳乳腺腺疾疾病病和和燒燒傷傷帶狀皰疹內(nèi)科治療B02.900330025004300300042濕疹內(nèi)科治療L30.902380026004950300043蕁麻疹內(nèi)科治療L50.900160010002100120044乳腺良性腫瘤乳腺腫物切除術(shù)D24.x00750035009800410045口口腔腔、頜頜面面疾疾病病腮腺良性腫瘤腫瘤切除術(shù)D11.000540044007000510046耳耳和和乳乳突突疾疾病病分泌性中耳炎內(nèi)科治療H66.900330022004300260047突發(fā)性耳聾內(nèi)科治療H91.200340022004400260048慢性化膿性中耳炎乳突根治術(shù)H66.30142

8、0034005500400049耳前瘺管瘺管切除術(shù)Q18.102200015002600180050鼻鼻咽咽喉喉疾疾病病慢性鼻竇炎手術(shù)治療J32.900480036006300420051鼻出血止血治療R04.000230017003000200052鼻中隔偏曲經(jīng)鼻內(nèi)鏡鼻中隔偏曲矯正術(shù)J34.200460034006000400053聲帶息肉息肉切除術(shù)J38.1022900250038002900神神經(jīng)經(jīng)系系統(tǒng)統(tǒng)疾疾病病第 4 頁，共 6 頁54慢性扁桃體炎扁桃體切除術(shù)J35.000250022003200260055內(nèi)內(nèi)分分泌泌、營營養(yǎng)養(yǎng)及及代代謝謝疾疾病病結(jié)節(jié)性甲狀腺腫甲狀腺全切術(shù)E04.

9、902680055008900650056結(jié)節(jié)性甲狀腺腫甲狀腺次全切除術(shù)E04.902.001580044007600510057結(jié)節(jié)性甲狀腺腫甲狀腺部分切除術(shù)E04.902.003560042007300490058甲狀腺結(jié)節(jié)結(jié)節(jié)切除術(shù)E04.101470026006100300059眼眼和和附附器器疾疾病病老年性白內(nèi)障白內(nèi)障超聲乳化摘除術(shù)H25.900280022003600260060老年性白內(nèi)障白內(nèi)障超聲乳化吸除+人工晶狀體植入術(shù)H25.900.001390035005100410061老年性白內(nèi)障小瞳孔白內(nèi)障超聲乳化吸除+人工晶狀體植入術(shù)H25.900.002330028004300

10、380062翼狀胬肉翼狀胬肉切除術(shù)H11.000170013002200150063原發(fā)性閉角性青光眼 小梁切除術(shù)H40.200270023003500270064女女性性生生殖殖系系統(tǒng)統(tǒng)疾疾病病子宮內(nèi)膜異位癥手術(shù)治療N80.900600037007800430065子宮平滑肌瘤經(jīng)腹全子宮切除術(shù)D25.900750067009900780066子宮平滑肌瘤經(jīng)宮腔鏡黏膜下肌瘤切除術(shù)D25.900.001630055007100640067卵巢子宮內(nèi)膜異位囊腫囊腫切除術(shù)N80.100610059008000690068卵巢良性腫瘤經(jīng)腹單側(cè)卵巢囊腫剝除術(shù)D27.x006500550085006800

11、69卵巢良性腫瘤經(jīng)腹單側(cè)卵巢囊切除術(shù)D27.x00.001580050007100580070子宮內(nèi)膜息肉手術(shù)治療N84.0014700360061004200鼻鼻咽咽喉喉疾疾病病第 5 頁，共 6 頁71輸卵管妊娠經(jīng)腹單側(cè)輸卵管切除術(shù)O00.100510047006100550072輸卵管妊娠經(jīng)腹腔鏡單側(cè)輸卵管切除術(shù)O00.100640054008300630073 肌肌肉肉骨骨骼骼系系統(tǒng)統(tǒng)和和結(jié)結(jié)締締組組織織疾疾病病脛腓骨骨折切開復(fù)位內(nèi)固定術(shù)S82.2011340012600175001470074股骨干骨折切開復(fù)位內(nèi)固定術(shù)S72.30099009100129001060075肱骨髁上骨折

12、手法復(fù)位S42.401750067009800786076肱骨干骨折切開復(fù)位內(nèi)固定術(shù)S42.3008000710010400830077股骨頸骨折人工股骨頭置換術(shù)S72.0002925027000382003160078閉合性髕骨骨折切開復(fù)位內(nèi)固定術(shù)S82.00097509000127501050079半月板損傷手術(shù)治療M23.308570034007400400080腘窩囊腫囊腫切除術(shù)M71.201350025004500290081膝關(guān)節(jié)十字韌帶扭傷 手術(shù)治療S83.5009100760011900890082腰椎間盤突出癥腰椎間盤摘除術(shù)M51.2022980023400389002740

13、083腱鞘囊腫囊腫切除術(shù)M67.400260021003400240084混合型頸椎病內(nèi)科治療M47.802490032006400370085腎腎臟臟和和泌泌尿尿系系統(tǒng)統(tǒng)疾疾病病腎囊腫手術(shù)治療N28.101550042007100490086膀胱結(jié)石碎石取石術(shù)N21.000680051008800595087腎結(jié)石碎石取石術(shù)N20.000520040006800470088輸尿管結(jié)石碎石取石術(shù)N20.1005200350068004100女女性性生生殖殖系系統(tǒng)統(tǒng)疾疾病病第 6 頁，共 6 頁89急性腎盂腎炎內(nèi)科治療N10.x02400025005200290090泌尿道感染內(nèi)科治療N39.0

14、00450034005800390091男男性性生生殖殖系系統(tǒng)統(tǒng)疾疾病病良性前列腺增生經(jīng)尿道膀胱鏡前列腺電切術(shù)N40.x001200011000156001290092良性前列腺增生經(jīng)尿道前列腺激光氣化切除術(shù)N40.x00.0011540014000202001640093精索鞘膜積液手術(shù)治療N43.302230017003000200094睪丸鞘膜積液睪丸鞘膜翻轉(zhuǎn)術(shù)N43.301260021003400250095精索靜脈曲張精索靜脈曲張高位結(jié)扎術(shù)I86.101260021003400250096精索靜脈曲張經(jīng)腹腔鏡精索靜脈曲張高位結(jié)扎術(shù)I86.101.001450041005800480097妊妊娠