건강보험요양급여 책자란?
건강보험심사평가원에서는 매년 요양급여 책자를 펴내고 있습니다. 해당 책자는 건강보험에 관련된 업무를 하는 분들에게 교과서와 같은 업무편람 기준이 될 수 있기에 매년 개정되는 책자를 곁에두고 업무를 하시길 추천합니다. 2023년도에도 그동안 개정된 고시사항을 반영하여 책자를 새로 펴냈습니다. 의료수가개발부에서 펴냈네요. 병원에서 심사 업무를 하는 분들이나 진료를 보는 의료진, 원무과나 원무팀에서 관련 업무를 하시는 분들 그리고 병원 기획과 경영을 하는 분들에게도 필수 책입니다. 우리가 잘 모르는 기준이 모두 망라되어 있기 때문입니다.
특히 병원관련 업무를 시작하는 분들이나 대학생 보건행정, 간호, 의대에서 공부하는 분들에게도 꼭 추천드립니다.
일러두기(책 발췌)
본 책자는 보건복지부 고시인 ｢건강보험요양급여 비용의 내역｣ 및 ｢건강보험 행위 급여·비급여 목록표 및 급여 상대가치점수｣를 수록하였으며, 2023년 2월 중 고시사항을 반영하였습니다.
아울러, ｢건강보험 행위 급여·비급여 목록표 및 급여 상대가치점수｣ 제1편 제2부 제2장 검사료 및 제3장 제3절 양전자방출단층촬영에 대한 이해를 돕고자 검사별 세부항목을 [별첨1]로, 방사성 동위원소를 [별첨2]로 수록하였으며, 급여·비급여 등재행위 중 신의료기술평가 위원회의 안전성 및 유효성 평가를 거친 항목에 대한 이해를 돕고자 사용목적, 대상 및 방법을 [별첨3]로 수록하였으니 업무에 참고하시기 바랍니다.
※ [별첨3]의 신의료기술 평가항목은 ｢건강보험 행위 급여·비급여 목록표 및 급여 상대가치점수｣ 및 [별첨1], [별첨2]에도 (＊)로 표시함. 2023년 2월 의료수가개발부
건강보험요양급여비용 책 목차
● 건강보험요양급여비용의 내역
(보건복지부 고시 제2022－276호) ······································································ 3
● 건강보험 행위 급여·비급여 목록표 및 급여 상대가치점수
(보건복지부 고시 제2023-16호) ········································································· 9
제 1 편 행위 급여·비급여 목록 및 급여 상대가치점수
제1부 행위 급여 일반원칙 ······················································ 53
Ⅰ. 일반기준 ··················································································· 53
Ⅱ. 요양기관 종별가산율 ······························································· 55
Ⅲ. 차등수가 ··················································································· 57
Ⅳ. 예외규정 ··················································································· 58
제2부 행위 급여 목록·상대가치점수 및 산정지침 ················ 59
제1장 기본진료료 ··········································································· 59
제2장 검사료 ················································································ 115
(별 표) ································································································· 117
제1절 검체 검사료 ············································································· 119
일반진단검사 ······································································· 121
혈액질환검사 ······································································· 125
수혈검사 ·············································································· 133
일반화학검사 ······································································· 135
내분비진단검사 ··································································· 141
심뇌혈관질환검사 ································································ 147
종양검사 ·············································································· 149
대사검사 ·············································································· 153
약물·중독검사 ······································································ 157
임신관련 검사 ····································································· 161
감염검사 ·············································································· 162
면역검사 ·············································································· 179
제2절 병리 검사료 ·············································································· 188
조직병리검사 ······································································· 188
세포병리검사 ······································································· 191
특수병리검사 ······································································· 193
사람유전자 분자유전검사 ··················································· 195
제3절 기능 검사료 ·············································································· 200
호흡기 기능검사 ································································· 200
신경계 기능검사 ································································· 202
평형기능검사 ······································································· 214
청각기능검사 ······································································· 216
신장 및 비뇨기 검사 ·························································· 219
외피, 근골 기능 검사 ························································· 221
시기능검사 ··········································································· 223
내분비 기능 검사 ································································ 228
소화기 기능 검사 ································································ 233
알레르기 검사 ····································································· 235
순환기 기능 검사 ································································ 238
생식, 임신 및 분만 ····························································· 247
핵의학 기능 검사 ································································ 250
치아 검사 ············································································ 251
(별 표 1) 신경인지기능검사 ··················································· 252
(별 표 2) 증상 및 행동 평가 척도 ······································· 258
제4절 내시경, 천자 및 생검료 ·························································· 262
내시경 ·················································································· 262
천자 ····················································································· 267
일반생검 ·············································································· 269
제5절 초음파 검사료 ·········································································· 273
기본초음파 ·········································································· 273
진단초음파 ·········································································· 274
유도 초음파 ········································································ 279
특수 초음파 ········································································ 280
제3장 영상진단 및 방사선치료료 ··············································· 281
제1절 방사선단순영상진단료 ····························································· 282
제2절 방사선특수영상진단료 ····························································· 297
소화기계 ·············································································· 299
중추신경계 ·········································································· 300
비뇨생식기계 ······································································· 301
기타부위 ·············································································· 302
전산화단층영상진단 ···························································· 303
자기공명영상진단 ······························································· 310
혈관조영촬영 ······································································· 336
제3절 핵의학영상진단 및 골밀도검사료 ··········································· 341
제4절 방사선치료료 ············································································ 351
방사선 모의치료 및 치료계획 ············································ 351
방사선 치료 ········································································ 356
제4장 투약 및 조제료 ·································································· 361
제5장 주사료 ················································································ 369
제1절 주사료 ······················································································· 370
제2절 채혈 및 수혈료 ········································································ 374
제6장 마취료 ················································································ 379
제1절 마취료 ······················································································· 381
제2절 치과마취료 ··············································································· 384
제3절 신경차단술료 ············································································ 385
제4절 신경파괴술료 ············································································ 389
제7장 이학요법료 ········································································· 391
제1절 기본물리치료료 ········································································ 391
제2절 단순재활치료료 ········································································ 393
제3절 전문재활치료료 ········································································ 396
제4절 기타 이학요법료 ······································································ 401
제8장 정신요법료 ········································································· 405
제9장 처치 및 수술료 등 ···························································· 409
제1절 처치 및 수술료 ········································································ 409
(별 표) ······················································································ 413
기본 처치 ············································································ 443
피부 및 연부조직 ······························································· 450
근 골 ··················································································· 460
코 ························································································· 488
후 두 ··················································································· 494
기관, 기관지 및 폐 ···························································· 497
흉 곽 ··················································································· 501
순 환 기 ·············································································· 504
비장 및 림프절 ··································································· 523
입, 이하선 ··········································································· 525
인두 및 편도 ······································································· 528
식 도 ··················································································· 530
복막 및 후복막 ··································································· 533
위 ························································································· 534
장, 장간막, 허니아 ····························································· 537
직장 및 항문 ······································································· 542
비 뇨 기 ·············································································· 547
남성 생식기 ········································································· 557
여성 생식기, 임신과 분만 ·················································· 561
보조생식술 ··········································································· 577
내분비기 ·············································································· 581
신 경 ··················································································· 583
감 각 기 ·············································································· 595
응급처치 ·············································································· 606
중재적 방사선시술 ······························································ 611
투 석 ··················································································· 627
유 방 ··················································································· 632
간 ························································································· 635
담낭 및 담도 ······································································· 637
췌 장 ··················································································· 639
소화기 내시경하 시술 ························································ 641
장기이식 ·············································································· 646
기타 ····················································································· 649
제2절 캐스트료 ··················································································· 650
제10장 치과 처치·수술료 ····························································· 655
(별 표) ······························································································· 657
제1절 치아질환 처치 ········································································ 659
제2절 수술 후 처치, 치주조직의 처치 등 ······································· 665
제3절 구강악안면 수술 ····································································· 669
제4절 치주질환 수술 ········································································ 677
제5절 보철물의 유지관리 ································································· 679
제11장 조산료 ·············································································· 681
제12장 보건기관의 진료수가 ························································ 683
제13장 한방 검사료(檢査料) ······················································· 687
제14장 한방 시술(施術) 및 처치료(處置料) ······························ 689
제1절 시술료(施術料) ······································································· 690
제2절 처치료(處置料) ······································································· 693
제3절 한방 정신요법료(精神療法料) ··············································· 694
제15장 약국 약제비 ····································································· 697
제16장 전혈 및 혈액성분제제료 ················································· 703
제17장 입원환자 식대 ································································· 707
제18장 치과의 보철료 ································································· 709
제19장 응급의료수가 ··································································· 721
제1절 응급 기본진료료 ····································································· 721
제2절 응급의료행위 ·········································································· 729
제3절 권역외상센터 응급의료행위 ··················································· 730
제20장 치과의 교정치료료 ·························································· 781
제3부 행위 비급여 목록 ······················································· 787
제 2편 질병군 급여·비급여 목록 및 급여 상대가치점수
제1부 질병군 급여 일반원칙 ················································ 819
제2부 질병군 급여 목록·상대가치 점수표 및 적용지침 ····· 829
제1장 안과 ···················································································· 829
제2장 이비인후과 ·········································································· 832
제3장 외과 ···················································································· 833
제4장 산부인과 ············································································· 841
제3부 질병군 분류번호 결정요령 ········································· 867
제4부 질병군 비급여 일반원칙 및 비급여 목록 ················· 903
제 3편 요양병원 급여 목록 및 상대가치점수
제1부 요양병원 급여 일반원칙 ············································· 909
제2부 요양병원 환자군 급여목록·상대가치점수 및 산정지침 ········· 911
제3부 요양병원 행위 급여목록·상대가치점수 및 산정지침 ··········· 917
제 4편 호스피스, 연명의료중단등결정 급여·비급여 목록 및 급여 상대가치점수
제1부 호스피스, 연명의료중단등결정 급여 일반원칙 ········· 993
제2부 입원형 호스피스 ························································· 995
제1장 호스피스 급여 목록·상대가치점수 및 산정지침 ·············· 995
제1절 호스피스 입원일당 정액Ⅰ ···················································· 1000
제2절 호스피스 입원일당 정액Ⅱ ···················································· 1001
제2장 호스피스 급여 별도산정 목록·상대가치점수 및 산정지침 ······ 1003
제3장 호스피스 비급여 일반원칙 및 비급여 목록 ·················· 1007
제3부 가정형 호스피스 ······················································· 1009
제1장 호스피스 급여 목록·상대가치점수 및 산정지침 ············ 1009
제1절 가정형 호스피스 행위 급여 목록 및 상대가치점수 ············ 1010
제4부 자문형 호스피스 ······················································· 1013
제1장 호스피스 급여 목록·상대가치점수 및 산정지침 ············ 1013
제1절 자문형 호스피스 행위 급여 목록 및 상대가치점수 ············ 1014
제5부 연명의료중단등결정 ·················································· 1017
제1장 연명의료중단등결정 급여 목록·상대가치점수 및 산정지침······ 1017
제1절 연명의료중단등결정 행위 급여 목록 및 상대가치점수 ······· 1019
제 5편 혁신의료기술 급여‧비급여 목록 및 급여 상대가치점수
제1부 혁신의료기술 급여목록 및 급여 상대가치점수 ········ 1025
제2부 혁신의료기술 비급여 목록 ······································· 1029
● (부록) 검체검사 위탁에 관한 기준 ································· 1033
● [별첨1] 검사료 항목별 세부내용
1-1. 검체검사료의 각 분류항목별 세부 검사항목 ······························· 1045
1-2. 병리검사료의 항목별 세부내용 ···················································· 1146
1-3. 유전성/비유전성 유전자검사 항목별 유전자 종류 ····················· 1154
● [별첨2] 각 분류항목별 방사성 동위원소 ······················ 1173
● [별첨3] 신의료기술 안전성·유효성 평가결과 ·············· 1177
건강보험요양급여비용 출처와 원문
건강보험심사평가원 - 의료정보 - Hira e-book
https://www.hira.or.kr/ra/ebook/list.do?pgmid=HIRAA030402000000
HIRA e-Book < 의료정보 < 건강보험심사평가원
홈 의료정보 HIRA e-Book 전체 : 381건 [1/43페이지] 2023 지자체 맞춤형 보건의료현황 분석 보고서(대전) 심사평가연구실 의료보장연구부 2023-03-16 15:19:16 다운로드 건강보험요양급여비용 2023년 2월판
www.hira.or.kr
위 사이트에 가면 2023년 건강보험요양급여비용으로 다운로드 버튼이 있습니다. 원문자료는 해당 사이트를 찾아 보시기 바라며, 제가 첨부드린 pdf파일도 이곳에서 받음을 밝힙니다.
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