按病种付费目录

医疗保险按病种付费病种推荐目录

序号病种名称疾病代码主要操作/治疗方式手术代码A15.0/A15.1/A15.2/A15.3/A1肺叶切除术6.0/A16.1/A16.2A15.0/A15.1/A15.2/A15.3/A1初次内科常规治疗6.0/A16.1/A16.2A15.6/A16.5内科常规治疗（含胸腔穿刺）B02C15C16C18C20C22C34C50C53C54.1C55C67C73C91.0C91.0C92.4C92.4D15.2D18D24内科常规治疗食管癌根治术胃癌根治术结肠癌根治切除术直肠癌根治术经导管肝动脉栓塞术肝癌切除术肺癌根治术单侧乳腺改良根治术双侧乳腺改良根治术根治性全子宫切除+腹膜后淋巴结切除术全子宫切除术+双侧附件切除术全子宫切除术+双侧附件切除术根治性膀胱全切术+盆腔淋巴结清扫术甲状腺癌根治术诱导缓解化疗（初治患者）强化巩固化疗（诱导治疗后完全缓解的患者）诱导缓解化疗（初治患者）强化巩固化疗（诱导治疗后完全缓解的患者）胸腔镜下纵膈病损切除术皮肤及皮下血管瘤切除术血管瘤硬化剂注射乳腺肿瘤切除术病变导管切除术1肺结核32.39/32.49234567891011121314151617181920212223肺结核结核性胸膜炎带状疱疹食管恶性肿瘤胃恶性肿瘤结肠恶性肿瘤直肠恶性肿瘤肝和肝内胆管恶性肿瘤支气管和肺恶性肿瘤乳房恶性肿瘤宫颈恶性肿瘤子宫内膜恶性肿瘤子宫恶性肿瘤膀胱恶性肿瘤甲状腺恶性肿瘤儿童急性淋巴细胞白血病（ALL）儿童急性淋巴细胞白血病（ALL）儿童急性早幼粒细胞白血病（APL）儿童急性早幼粒细胞白血病（APL）纵膈良性肿瘤血管瘤和淋巴管瘤乳房良性肿瘤非手术非手术非手术42.41/42.42/42.5/42.643.5/43.6/43.7/43.8/43.945.73/45.74/45.75/45.76/45.79/45.945.4/45.73/45.74/45.75/45.76/45.79/45.839.790350.2/50.3/50.432.28/32.29/32.30/32.39/32.41/32.49/32.50/32.5985.430185.440168.6/68.7/40.3/40.568.4901+65.5100/68.4100+65.530068.4901+65.5100/68.4100+65.530057.7100+40.591006.2/06.3/06.4非手术非手术非手术非手术34.3x0486.3x1599.290485.210085.2100x021序号24252627282930病种名称子宫平滑肌瘤卵巢良性肿瘤甲状腺良性肿瘤结节性甲状腺肿慢性泪囊炎翼状胬肉白内障疾病代码D25D27D34E04.902H04.4H11.0H25/H26主要操作/治疗方式子宫肌瘤切除术单侧卵巢切除术单侧卵巢囊肿剥除术甲状腺肿瘤切除术甲状腺部分切除术泪囊鼻腔吻合术泪囊鼻腔造口术翼状胬肉切除伴结膜移植术白内障超声乳化抽吸术+人工晶体植入术白内障超声乳化摘除术+人工晶体植入术手术代码68.290165.3900/65.310065.2901/65.250106.2/06.3/06.406.390009.810009.8100x00411.390113.4100+13.700013.1900+13.700031视网膜脱离H33玻璃体切割术+视网膜剥离术+玻璃体硅油置14.7401+14.9x02+14.7501入术巩膜环扎术巩膜外加压术小梁切开联合小梁切除术青光眼阀置入术玻璃体切除术14.490012.880112.640012.670414.740120.490119.435.2301/35.240135.020035.2101/35.220135.010036.06/36.07323334青光眼玻璃体病变慢性化脓性中耳炎H40H43H66.1/H66.2/H乳突改良根治术66.3鼓室形成术I05二尖瓣瓣膜置换术二尖瓣瓣膜切开术主动脉瓣瓣膜置换术主动脉瓣瓣膜切开术经皮冠状动脉内支架植入术35风湿性二尖瓣病变36373839404142434445464748495051风湿性主动脉瓣病变不稳定型心绞痛急性心肌梗死急性心肌梗死冠状动脉粥样硬化性心脏病房室传导阻滞室上性心动过速肾动脉狭窄胸主动脉瘤腹主动脉瘤下肢深静脉血栓下肢静脉曲张内痔混合痔混合痔外痔I06I20.0I21I21I25.1I44.303I47.1I70.101I71.2I71.4I80.207I83I84.0I84.201I84.201I84.3经皮冠状动脉内支架植入术（冠状动脉内血36.06/36.07（36.04）栓溶解药输注）内科住院溶栓治疗经皮冠状动脉内支架植入术单腔永久起搏器置入术双腔永久起搏器置入术心电生理检查+心脏射频消融术肾动脉支架置入术肾动脉成形术胸主动脉支架置入术腹主动脉支架置入术下腔静脉滤器置入术大隐静脉高位结扎术和剥脱术内痔套扎术肛周痔切除术肛周痔套扎术混合痔外剥内扎术血栓痔清除术非手术36.06/36.0737.810137.830189.5901+37.330239.901639.5900x01039.730139.710138.7x0438.590149.450049.460049.4500中医治疗49.4700序号52535455565758596061626364656667病种名称未特指的痔伴有其他并发症精索静脉曲张社区获得性肺炎支气管肺炎慢性鼻窦炎鼻息肉鼻中隔偏曲慢性扁桃体炎扁桃体肥大伴有腺体样肥大声带和喉的息肉自发性气胸纵膈囊肿胃十二指肠溃疡胃息肉急性阑尾炎慢性阑尾炎疾病代码I84.8I86.101J15.902/J15.903J18.0J32J33J34.2J35.0J35.3J38.1J93.0/J93.1J98.505K25/K26/K27K31.703K35K36.x02主要操作/治疗方式环状混合痔切除术精索静脉高位结扎术内科住院常规治疗内科住院常规治疗经鼻内镜鼻窦切开术鼻镜下鼻息肉切除术鼻中隔矫正术+下鼻甲切除术扁桃体切除术扁桃体伴腺体样切除术声带喉肿物切除术喉镜下声带喉肿物切除术胸腔闭式引流术胸腔镜下纵膈病损切除术远端胃大部切除伴胃十二指肠吻合术胃迷走神经干切断术内镜下胃息肉切除术阑尾切除术阑尾切除术腹股沟疝单侧修补术腹股沟疝双侧修补术单侧疝囊高位结扎术双侧疝囊高位结扎术手术代码中医治疗63.1x01非手术非手术22.521.310221.5+21.690228.2/28.328.3x0130.0901/30.090230.0905/30.091134.040134.3x0443.6x01/43.6x0244.0100/44.000143.410547.090147.090153.000053.100053.020253.120268腹股沟疝K406970717273747576777879808182838485肠梗阻肛裂肛瘘肛瘘肛周脓肿肛周脓肿直肠息肉直肠脱垂结肠息肉肝囊肿胆囊结石胆石症急性胆囊炎慢性胆囊炎胆囊息肉类风湿性关节炎重度膝关节骨关节炎K56.7K60.2K60.3K60.3K61.001K61.001K62.1K62.3K63.5K76.807K80.2K80K81.0K81.1K82.802M06.9M17行肠粘连松解术、小肠部分切除吻合术、肠54.59/45.62/45.91/46.01 /46.10短路吻合术、肠外置术、结肠造口术49.3901+49.5901肛裂切除术+肛门内括约肌切开术肛瘘切除术肛瘘切开挂线术高位复杂肛瘘挂线治疗直肠周围脓肿切开引流术肛周脓肿一次性根治术内镜下直肠息肉切除术经肛门直肠脱垂手术内镜下结肠息肉切除术经腹腔镜囊肿开窗术胆囊切除术胆囊切除术+胆总管切开取石术胆囊切除术胆囊切除术胆囊切除术全膝关节置换术全膝关节置换术49.120049.7301中医治疗48.8101中医治疗48.3648.7645.420150.0x0351.2251.22+51.4151.2251.2251.2281.5481.54序号病种名称疾病代码主要操作/治疗方式颈前路减压植骨固定术81.0281.03手术代码86脊髓型颈椎病M47.101颈后路减压植骨固定术颈前后联合入路减压植骨固定术腰椎髓核摘除术腰椎间盘切除术腱鞘病损切除术腱鞘囊肿切除术81.02+81.0380.510980.510783.310083.310183.390281.510081.520139.27非手术55.690198.510155.040398.510398.510255.0105/55.010660.970160.290161.490461.2x0285.0x0185.0x0271.240165.290168.3/68.4/68.565.2901/65.250168.291567.390268.390174.366.0100x006/66.010366.6200/66.6201非手术74.118.210135.5335.53/35.62/35.7235.5235.51/35.61/35.7139.7900x00838.8500x00187888990919293949596979899100101102103104105106107108109110111112113腰椎间盘突出症腱鞘囊肿腘窝囊肿股骨头坏死终末期肾脏病终末期肾脏病慢性肾衰竭肾结石输尿管结石膀胱结石肾囊肿前列腺增生睾丸鞘膜积液急性乳腺炎前庭大腺囊肿子宫内膜异位子宫腺肌病卵巢囊肿子宫内膜息肉子宫颈息肉功能障碍性子宫出血异位妊娠自然分娩剖宫产耳前瘘管室间隔缺损房间隔缺损M51.202M67.4M71.2腘窝囊肿切除术M87.002/M87.全髋关节置换术102/M87.203/M87.800x051人工股骨头置换术N18.0N18.0N18.900N20.0N20.1N21.0N28.1N40N43.301N61.x05N75.0N80N80.001N83.2N84.001N84.1N93.801O00O80O82Q18.102Q21.0Q21.1自体动静脉内瘘成形术血液透析肾移植术肾体外冲击波碎石术经皮肾镜超声碎石术输尿管体外冲击波碎石术膀胱体外冲击波碎石术肾囊肿去顶术经尿道前列腺射频消融术经尿道前列腺气化电切术睾丸鞘膜翻转术睾丸鞘膜切除术乳房浅表脓肿切开引流术乳房深部脓肿切开引流术前庭大腺囊肿切除术卵巢肿瘤剥除术子宫切除术卵巢囊肿剥除术宫腔镜子宫内膜病损切除术宫腔镜宫颈管息肉切除术子宫次全切术输卵管外异位妊娠清除术输卵管切开妊娠产物去除术输卵管切除伴输卵管妊娠产物去除术单胎顺产子宫下段剖宫产术耳前瘘管切除术心室间隔缺损缝合术心室间隔缺损修补术心房间隔缺损缝合术心房间隔缺损修补术经皮动脉导管未闭封堵术动脉导管结扎术114动脉导管未闭Q25.0序号病种名称114动脉导管未闭疾病代码Q25.0主要操作/治疗方式动脉导管未闭切断缝合术手术代码38.8500x01279.390479.2901非手术79.3101中医治疗79.320278.5301中医治疗79.330281.5100/81.520081.520179.350179.350179.150079.350179.150079.360479.360179.160179.3603非手术83.8800x001115116117118119120121122123锁骨骨折锁骨骨折肱骨干骨折肱骨干骨折尺骨干骨折桡骨远端骨折闭合性桡骨远端骨折掌骨骨折（单发）股骨颈骨折S42.0S42.0S42.3S42.3S52.2S52.5S52.501S62.3S72.0锁骨骨折切开复位内固定术锁骨骨折切开复位术保守治疗；非手术治疗（含中医）肱骨干骨折切开复位内固定术骨折手法整复术+骨折夹板外固定术尺骨干骨折切开复位内固定术桡骨钢板内固定术骨折手法整复术+骨折夹板外固定术掌骨骨折切开复位内固定术髋关节置换术人工股骨头置换术股骨颈骨折切开复位内固定术股骨粗隆间骨折切开复位内固定术股骨粗隆间骨折闭合复位内固定术股骨干骨折切开复位内固定术股骨干骨折闭合性复位术伴内固定髌骨骨折切开复位内固定术胫骨骨折切开复位内固定术胫骨骨折闭合复位内固定术踝关节骨折切开复位内固定术保守治疗；非手术治疗（含中医）跟腱修补术124125126127128129130股骨粗隆间骨折股骨干骨折髌骨骨折胫骨骨干骨折踝关节骨折踝关节骨折跟腱断裂S72.1S72.3S82.0S82.2S82.5/S82.6S82.5/S82.6S86.001