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發布時間:2020-06-16      作者: 亞博網頁登陸

臨汾地區城鎮職工基本醫療保險

診療項目管理范圍和目錄管理暫行辦法

〖臨地勞字(2000)102號〗

yi、genjuguojia、shengyouguanguidingyiji《linfendiquchengzhenzhigongjibenyiliaobaoxianshishifangan》,zhidingbenbanfa。

er、jibenyiliaobaoxianzhenliaoxiangmushizhifuheyixiatiaojiandegezhongyiliaojishulaowuxiangmuhecaiyongyiliaoyiqi、shebeiyuyiyongcailiaojinxingdezhenduan、zhiliaoxiangmu:

(yi)linchuangzhiliaobixuanquanyouxiao、feiyongshiyidezhenliaoxiangmu;

(er)youshengwujiabumenhuitongweishengbumenzhidingleshoufeibiaozhundezhenliaoxiangmu;

(san)youdingdianyiliaojigouweicanbaorenyuantigongdedingdianyiliaofuwufanweineidezhenliaoxiangmu。

san、jibenyiliaobaoxianzhenliaoxiangmufanweihemulugenjulinchuangzhenduan、zhiliaodejibenxuyao、jianguwoqujingjizhuangkuangheyiliaojishushuipingdechayideyuanze,zuodaokexueheli,fangbianguanli。

si、jibenyiliaobaoxianbuyuzhifufeiyongdezhenliaoxiangmufanwei;

(yi)fuwuxiangmulei:

1、weilieru《linfendiquchengzhenzhigongjibenyiliaobaoxianzhuyuanbingzhongmulu》ji《teshubingzhongfanweiguanlizanxingguiding》dejibingzhenliaofeiyong;

2、guahaofei、yuanwaihuizhenfei、bingligongbenfei、chuzhenfei、ziqingtebiehushidengtexuyiliaofuwufei;

3、feiyizhutejihulifei、jianchazhiliaojiajifei、dianmingshoushufujiafei、youzhiyoujiafei。

(er)feijibingzhiliaoxiangmulei:

1、gezhongmeirong、jianmeixiangmu、feigongnengxingzhengrong、jiaoxingjishengliquexiandejiancha、sheji、shoushu,zhiliaochuzhifeiyong(ru:zhiliaofenci、zuochuang、bahen、sesuchenzhu、queban、heiban、laorenban、tuozhi、hufu、pingyou、mianmo、kouchi、dahan<huxijiongpozhengshoushuchuwai>、tuchun、longbi、duiyan、xieshijiaozheng、danyanpigaishuangyanpi、chuaner、yechou、zhifa、duomaozheng、ranfa、jiafa、jieya、yaliebuqijiaozhi、sebanya、longru、pingzu、geliuzhi、jianshenanmodefeiyongdeng);

2、gezhongjianfei、zengpang、zenggao、jiedu、jieyandengfeiyong;

3、gezhongjiankangtijian(ru:hunqianyixuejiancha、youyongtijian、chujingtijian、ruxuetijiandengfeiyong);

4、gezhongyufang、baojianxingdezhenliaoxiangmu(ru:gezhongyimiao、yufangfuyao、yufangjiezhong、jibingpucha、jibinggenzongsuifangfeideng);

5、gezhongyiliaozixun、yiliaojianding(ru:xinlizixun、baojianzixun、yingyangzixun、hunyuzixun、xingzixun、jibingyuce、rentixinxizhenduanyijianchafeideng);

6、dajiadouou、xujiu、zisha、zican、jiaotongzhaoshi、yiliaoshigudengdeyiliaofei;

7、yinziranzaihai、shiwu、jiulei、yaopinzhongdudengyinsuzaochengdeji、wei、zhongbingrenqiangjiufashengdeyiliaofeiyong。

(san)zhenliaoshebeijiyiyongcailiaolei:

1、yingyongzhengdianzifasheduancengsaomiaozhuangzhi(pet)、dianzishuct、yankezhunfenzijiguangzhiliaoyidengdaxingyiliaoshebeijinxingdejiancha、zhiliaoxiangmu;

2、yanjing、yichi(ru:zhuangguan、taoguan、zhongzhiyadeng)yiyan、yizhi、zhutingqidengkangfuxingqiju;

3、gezhongziyongdebaojian、anmo、jianchahezhiliaoqixie(ru:gezhonganmoqi、liliaoqiju、ciliaoxiongzhao、ciliaoku、ciliaoru、ciliaobeixin、ciliaoxie、ciliaoxianglian、jiangyashoubiao、yaozhen、yaodian、yaowubeixin、gezhongqianyindai、guaizhang、gangtoujing、huxidai、tigaodai、weituo、futuo、shentuo、zigongtuo、rengonggangmendai、yicixingdaoniaodai〈qi〉);

4、chuzhusheqi、shuyeqi、shuxueqi、guochanputongdaoguanyiwaideyicixingcailiaofeiyijisheng、diwujiabumenguidingbukedandushoufeideyicixingyiyongcailiao。

5、shanzizengjiadezhenliaoxiangmuheshanzitigaoshoufeibiaozhunsuofashengdeyiqiefeiyong。

(si)zhiliaoxiangmulei:

1、gezhongqiguanhuozuzhiyizhideqiguanhuozuzhiyuan;

2、chushenzang、xinzangbanmo、jiaomo、pifu、xueguan、gu、gusuiyizhiwaideqitaqiguanhuozuzhiyizhi;

3、jinshiyanjiaoxingshu,gezhongshengliquexiandeshoushu,jieya、xiangya、yaliebuzhengjiaoxing、sebanyazhiliao、yakezhengji、yakekaoci;

4、qigongliaofa、yinleliaofa、baojianxingdeyingyangliaofa、ciliaodengfuzhuxingdezhiliaoxiangmu。

(wu)qita

1、gezhongbuyu(yun)zheng、xinggongnengzhangaidezhenliaoxiangmu;

2、gezhongkeyanxing、linchuangyanzhengxingdezhenliaoxiangmu;

3、chuguoyijigang、ao、taidiqu(hangongpairenyuan)tanqin、kaihui、qiatan、kaocha、jiangxue、gongzuoqijiansuofashengdeyiliaofei;

4、yingchuyuanerjubuchuyuanzhe,congyuanfangkaichuchuyuanzhiriqisuofashengdeyiqiefeiyong。guamingzhuyuan、bingzhongmuluwaizhuyuanhebufuheruyuanbiaozhundebingrensuofashengdezhuyuanyiliaofeiyong;

5、zhiliaoqijianyuhuanzhebingqingwuguandeyiliaofei,chufangyuzhenduanbufuhedeyaopinfei;

6、weijingwujia、laodong、weishengzhuguanbumenpizhunde,yiyuanzidingxiangmuhezizhiyaopin,yijiyiyuan、yaodianshanzitigaoshoufeibiaozhun,chaochuguojiadingjiadebufen;

7、danweicanbaoqiantuoqiandeyiliaofei,zhongduanjiaofeierweibu,qijianfashengdeyiliaofei,tingbaohoufashengdeyiliaofei;

8、canbaorenyuanzixingdaofeidingdianyiyuan、yaodianjiuyigouyaofeiyong,zixingzhuanzhen、zhuanyuanfeiyong;

9、mouqudierzhiyedezaizhirenyuan,beiwaidanweipinrendelituixiurenyuanyinshoushanghuogongzuolaoleisuozhijibingdeyiliaofei;

10、chaoguoguidingbiaozhundezhuyuanchuangweifei;

11、weilieruquyuweishengguihuadedaxingyiliaoshebei,zaishixingjibenyiliaobaoxianzhidugaigezhiqian,weijingweishengxingzhengbumenpizhunde,shixingjibenyiliaobaoxianzhidugaigezhihou,weijingweishengxingzhengbumenhelaodongxingzhengbumenpizhunde,budenarujibenyiliaobaoxianzhifufanwei。

12、zhuyuanqijianjiashoudeyiqiebaoxianfei。

wu、jibenyiliaobaoxianzhifubufenfeiyongdezhenliaoxiangmufanwei:

(yi)zhenliaoshebeijiyiyongcailiaolei

1、yingyongx-shexianjisuanjiticengsheyingzhuangzhi(ct)、litidingxiangfashezhuangzhi(γ-dao、x-dao、chaoshengdao、huojiguangdao、jiguangdao)、xinzangjixueguanzaoyingxxianji(hanshuzijianyingshebei)、hecigongzhenchengxiangzhuangzhi(mri)、danguangzifashedianzijisuanjisaomiaozhuangzhi(spect)、caiseduopuleyi、yiliaozhixianjiasuqidengfeiyongchaoguo100yuanyishangdedaxingyiliaoshebeijinxingdejiancha、zhiliaoxiangmu,qifeiyongyougerenfudan30%,tongchoujijinfudan70%;duiteshujianchajieguoshixingyangxinglvzhibiaokongzhi,bingdingqigongbu。weidabiaodeteshujianchafeiyong,yiliaobaoxiantongchoujijinbuyuzhifu(yangxinglv:ct≥75%、ect≥75%、mri≥70%)。

2、tiwaizhenbosuishiyugaoyayangcangzhiliaodengfeiyonggaoyuchangguizhiliao50%yishengdezhiliaoxiangmu,qifeiyongyougerenfudan30%、tongchoujijinfudan70%;changguizhiliaojishunenggouyizhi,danbenrenyaoqiucaiyonggaoxinjishushebeide,qizhiliaofeiyongyoubenrenfudan。

3、anzhuangguochanpujixingrengongqiguan(xinzangbanmo、rengongjingti、rengonghouherengonggukuanguanjie)、xueguanzhijia、tineizhifangcailiao、xinzangqiboqi、gouzhiqiguanjicailiaodefeiyong,youbenrenfudan30%、tongchoujijinfudan70%;shixingrentiqiguan、zuzhiyizhidengshoushudefeiyong,yougerenfudan30%。tongchoujijinfudan70%。

4、sheng、diwujiabumenguidingdekedandushoufeideyicixingyiyongcailiao,(lieqingmingdan),qifeiyongyougerenfudan30%,tongchoujijinfudan70%。

5、shiyongjinkouyiyongcailiaoshi,bizhaoguochantongleicailiaojiagezhifu。

(er)zhiliaoxiangmulei:

1、xueyetouxi、fumotouxi;

2、shenzang、xinzangbanmo、jiaomo、xueguan、gusuiyizhi;

3、xinzangjiguangdakong、kangzhongliuxibaomianyiliaofahekuaizhongzizhiliaoxiangmu;

4、xindaoguanjianchazhiliaoxiangmu(ru:shepinxiaorongshu、xinbanmoqiunangkuozhang、zuoyouxinshizaoying、piaofudaoguanjiancha、ptca、zuoyouxindaoguanjianchazhiliaodexiangmu)。

shangshuxiangmudezhiliaofeiyong,yougerenfudan30%、tongchoujijinfudan70%。

(san)shenglaodongtingguidingdejiageangguideyiliaoyiqiyushebeidejiancha、zhiliaoxiangmudeyiyongcailiaodengxiangmuhefeiyong,gerenzifubilijuncanzhaoshangshutongleixiangmudezifubilizhixing。

liu、canbaorenyuanfashengdezhenliaoxiangmufeiyong,shuyujibenyiliaobaoxianbuyuzhifufeiyongzhenliaoxiangmumuluyineide,jibenyiliaobaoxianjijinbuyuzhifu;shuyujibenyiliaobaoxianzhifubufenfeiyongzhenliaoxiangmumuluyineide,xianyoucanbaorenyuananguidingbilizifuhou,zaianjibenyiliaobaoxiandeguidingzhifu;jibenyiliaobaoxianbuyuzhifufeiyonghezhifubufenfeiyongzhenliaoxiangmumuluyiwaide,anjibenyiliaobaoxiandeguidingzhifu。

qi、ben《banfa》zifabuzhiriqishixing。

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