Both CT examination and MRI examination are within the scope of basic medical insurance reimbursement. The cost of CT examination during hospitalization can be reimbursed according to a certain proportion; The reimbursement of outpatient CT examination expenses shall be subject to the specific provisions of the local social security bureau. The cost of MRI examination can also be reimbursed through basic medical insurance, and the reimbursement ratio is usually 70%, but the specific ratio needs to be determined according to the individual's medical insurance type. The calculation method of medical insurance reimbursement expenses is to multiply the balance after deducting hospitalization Qifubiaozhun, self-funded drugs and self-funded examination fees by the reimbursement ratio. These expenses are directly settled by social insurance agencies and medical institutions or pharmaceutical business units.
Medical insurance reimbursement conditions:
1. Identity of the insured: it must be the insured who has participated in medical insurance and is within the validity period;
2. Reimbursement scope: According to the local medical insurance policy, it usually includes medicine fee, diagnosis and treatment project fee, examination fee, etc.
3. Medical treatment process: the insured should follow the prescribed medical treatment process, such as going to a community hospital first and referring to a large hospital if necessary;
4. Designated medical institutions: Examination and treatment must be carried out in medical institutions designated by medical insurance, and expenses incurred by non-designated institutions are generally not reimbursed;
5. Reimbursement ratio: According to different medical insurance types and policies, the reimbursement ratio will be different;
6. Self-funded items: Some high-end medical services or over-standard treatment expenses may belong to self-funded items, which are not within the scope of reimbursement.
To sum up, CT and MRI can be reimbursed through basic medical insurance, and the reimbursement ratio is determined according to the type of individual medical insurance, and the expenses are directly settled by social insurance agencies and medical institutions or pharmaceutical business units.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.