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건강보험 심사청구(제6판)
 
· 시중가격 : · 고객선호도 :
· 판매가격 : · 출판사 : 에듀팩토리
· 페이지 : 416 · ISBN : 979-11-5823-528-4
· 저자 : 송혜숙 외 · 발행 : 2022.02.28
· 제본 : 210*280(2색) · 포 인 트 :
· 수 량 :
       
도서소개 목 차 배송관련정보 상품평 교환/반품정보 ▲ TOP

우리나라는 1989년 7월 1일부터 전국민 의료보험이 도입되어 지난 30여 년간 국민건강 향상과 더 불어 의료산업의 비약적인 발전을 이루었다. 이에 건강보험청구심사업무 또한 양적으로나 질적으로 발전하는 계기가 되었다. 현재 많은 의료기관에서 보험심사청구 인력이 종사하면서 중요성을 인식하고 있으나 그동안 전문화 된 교재개발은 미약하였다. 이에 저자는 우리나라 건강보험 수가에 대한 설명 및 심사기준을 한 권에 정리하여 보험심사청구를 공부하는 학생들과 현장에서 심사청구 업무를 담당하고 있는 실무자에게 도 움이 되고자 하였다. 책의 구성은 건강보험요양급여비용 제1편 행위 급여⋅비급여 목록 및 급여 상대가치점수 제1부 행 위 급여 일반원칙과 제2부 행위 급여 목록⋅상대가치점수 및 산정지침 제1장~제5장(기본진료료, 검 사료, 영상진단 및 방사선치료료, 투약 및 조제료, 주사료), 제6장~제17장(마취료, 이학요법료, 정신 요법료, 처치 및 수술료 등, 치과 처치⋅수술료, 조산료, 보건기관의 진료수가, 한방 검사료, 한방 시 술 및 처치료, 약국약제비, 전혈 및 혈액성분제제료, 입원환자 식대)과 부록으로 구성하였다. 

 


목  차 ▲ TOP

건강보험요양급여비용의 내역 ·······················································································1 

보건복지부 고시 제2021-276호 ···················································································1 

 제 1 편 행위급여·비급여목록 및 급여 상대가치점수 

제1부 행위 급여 일반원칙 ······································································································5 

I. 일반기준 ······················································································································5 

II. 요양기관 종별가산율 ·································································································7 

III. 차등수가 ····················································································································9 

IV. 예외규정 ··················································································································10 

제2부 행위 급여 목록·상대 가치점수 및 산정지침 ····················································12

제1장 기본진료료 ········································································································12 

산정지침 ············································································································12 

제2장 검사료 ···············································································································58 

산정지침 ············································································································58 

해당검사 분류항목 ···························································································59 

제1절 검체 검사료 ··························································································60

[일반진단검사] ·····················································································61 

[혈액질환검사] ·····················································································62 

[수혈검사] ····························································································64 

[일반화학검사] ·····················································································64 

[내분비진단검사] ·················································································66 

[심뇌혈관질환검사] ··············································································67 

[종양검사] ····························································································68 

[대사검사] ····························································································68 

[약물⋅중독검사] ·················································································69 

[임신관련 검사] ···················································································70 

[감염검사] ····························································································70 

[면역검사] ····························································································76 

제2절 병리 검사료 ·····················································································77 

[조직병리검사] ················································································77 

[세포병리검사] ················································································81 

[특수병리검사] ················································································82 

제3절 기능 검사료 ··························································································82 

[호흡기 기능검사] ···············································································82 

[사람유전자 분자유전검사] ·····························································82 

[신경계 기능검사] ···········································································83 

[평형 및 청각 기능검사] ·································································85 

[신장 및 비뇨기검사] ······································································86 

[외피, 근골 기능검사] ·····································································86 

[시기능검사] ····················································································87 

[내분비 기능검사] ···········································································89 

[소화기 기능검사] ···········································································89 

[알레르기 기능검사] ········································································89 

[순환기 기능검사] ···········································································90 

[생식, 임신 및 분만] ······································································90 

[핵의학 기능검사] ···········································································91 

[치아 검사] ······················································································91 

제4절 내시경, 천자 및 생검료 ··································································92

[내시경] ···························································································92

[천자] ······························································································93 

[일반생검] ·······················································································94

제5절 초음파 검사료 ·················································································94 

[기본 초음파] ··················································································95

[진단 초음파] ··················································································95

[유도 초음파] ··················································································97

[특수 초음파] ··················································································98 

제3장 영상진단 ····································································································101 

산정지침 ····································································································101 

기본원칙 ····································································································102 

전산화단층영상진단(CT)의 급여기준 ························································103 

자기공명영상진단(MRI)의 급여기준 ··························································106

F-18 FDG 양전자방출단층촬영(F-18 FDG-PETI)의 급여기준 ···············108 

I-123 FP-CIT & FP-CIT 뇌 단일광자단층촬영의 급여기준 ··················109 

제1절 방사선단순영상진단료 ···································································110 

제2절 방사선특수영상진단료 ···································································116

[소화기계] ·····················································································117 

[중추신경계] ··················································································117

[비뇨생식기계] ··············································································117 

[기타 부위] ····················································································118

[전산화 단층영상진단] ··································································118

[자기공명영상진단] ·······································································118

[혈관조영촬영] ··············································································120 

제3절 핵의학영상진단 및 골밀도검사료 ··················································120

제4절 방사선 치료료 ···············································································123

[방사선 모의치료 및 치료계획] ····················································123 

[방사선 치료] ················································································124

제4장 투약 및 조제료 ·························································································127 

산정지침 ····································································································127

[조제료] ·························································································127 

제5장 주사료 ·······································································································132

산정지침 ····································································································132

제1절 주사료 ·····························································································132 

제2절 채혈 및 수혈료 ···············································································136 

제6장 마취료 ·······································································································142 

산정지침 ····································································································142 

제1절 마취료 ···························································································143 

제2절 치과마취료 ····················································································146 

제3절 신경차단술료 ·················································································146 

제4절 신경파괴술료 ·················································································148 

제7장 이학요법료 ································································································151 

제1절 기본물리치료 ·················································································151 

제2절 단순재활치료료 ·············································································152

제3절 전문재활치료료 ·············································································153

제4절 기타 이학요법료 ············································································155 

제8장 정신요법료 ································································································ 156

산정지침 ···································································································· 156 

제9장 처치 및 수술료 등 ····················································································160 

제1절 처치 및 수술료 ·············································································160 

산정지침 ····································································································160 

[기본 처치] ····················································································174

[피부 및 연부조직] ·······································································177 

[근골] ····························································································179 

[코] ································································································185 

[후두] ····························································································186

[기관, 기관지 및 폐] ····································································186 

[흉곽] ····························································································186 

[순환기] ·························································································186 

[비장 및 림프절] ···········································································187 

[입, 이하선] ··················································································187 

[인두 및 편도] ··············································································188 

[식도] ····························································································189

[복막 및 후복막] ···········································································189 

[위] ································································································189 

[장, 장간막, 허니아] ·····································································191

[직장 및 항문] ··············································································193 

[비뇨기] ·························································································193 

[남성 생식기] ················································································195 

[여성 생식기, 임신과 분만] ··························································196

[내분비기] ·····················································································201 

[신경] ····························································································201 

[감각기] ·························································································203 

[응급처치] ·····················································································208

[중재적 방사선시술] ······································································211

[투석] ····························································································212 

[유방] ····························································································213 

[간] ································································································214 

[담낭 및 담도] ··············································································214 

[췌장] ····························································································214

[소화기 내시경하 시술] ································································215

[장기이식] ·····················································································215

[기타] ····························································································217 

제2절 캐스트료 ························································································219 

산정지침 ····································································································219

[캐스트 기술료] ·············································································219

부위별 석고붕대 사용기준 ········································································221 

부위별 합성 캐스트 사용기준 ··································································221 

제10장 치과 처치⋅수술료 ····················································································223 

산정지침 ··································································································223 

제1절 치아질환 처치 ···············································································225

제2절 수술 후 처치, 치주조직의 처치 등 ··············································229 

제3절 구강악안면 수술 ············································································233 

제4절 치주질환 수술 ···············································································239 

제11장 조산료 ·······································································································243

산정지침 ··································································································243

제12장 보건기관의 진료수가 ················································································244 

산정지침 ··································································································244

제13장 한방 검사료(檢査料) ·················································································247 

산정지침 ··································································································247 

제14장 한방 시술(施術) 및 처치료(處置料) ··························································248 

산정지침 ··································································································248 

제1절 시술료(施術料) ··············································································249

제2절 처치료(處置料) ··············································································252 

제3절 한방 정신요법료(精神療法料) ························································253 

제15장 약국 약제비 ······························································································255

산정지침 ··································································································255 

제16장 전혈 및 혈액성분제제료 ···········································································258

산정지침 ··································································································258

제17장 입원환자 식대 ···························································································261 

산정지침 ··································································································261 

제18장 치과의 보철료 ···························································································266 

산정지침 ··································································································266 

제19장 응급의료수가 ·····························································································271 

제1절 응급 기본진료료 ············································································271 

제2절 응급의료행위 ·················································································275 

제3절 권역외상센터 응급의료행위 ··························································276

제20장 치과의 교정치료료 ····················································································300 

산정지침 ··································································································300 

제3부 행위 비급여 목록 ································································································302 

제1장 기본진료료 ································································································302

제2장 검사료 ·······································································································306 

제1절 검체 검사료 ···················································································306

제2절 병리 검사료 ···················································································308

제3절 기능 검사료 ···················································································309 

제4절 내시경, 천자 및 생검료 ································································311 

제5절 초음파 검사료 ···············································································311 

제3장 영상진단 및 방사선 치료료 ······································································312 

제5장 주사료 ·······································································································313

제7장 이학요법료 ································································································313 

제8장 정신요법료 ································································································313 

제9장 처치 및 수수료 등 ····················································································314 

제10장 치과처치⋅수술료 ······················································································316

제13장 한방검사료(檢査料) ···················································································317

제14장 한방 시술 및 처치료 ················································································317

제 2 편 질병군 급여⋅비급여 목록 및 급여 상대가치점수 

제1부 질병군 급여 일반원칙 ························································································321 

제2부 질병군 급여 목록 ································································································326 

제1장 안 과 ·········································································································326

제2장 이비인후과 ································································································327 

제3장 외 과 ·········································································································328

제4장 산부인과 ····································································································332 

제3부 질병군 급여 목록 ································································································343 

제4부 질병군 비급여 일반원칙 및 비급여 목록 ·························································344 

 부 록 |비용의 본인부담| ·······························································································349 

|요양급여비용 청구방법, 심사청구⋅명세서서식 및 작성요령| ·····················361

|요양기관종별 요양급여비용 청구체계| ····························································374

|별지서식| ············································································································376 

|별첨| ···················································································································382


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