According to the "Scope of National Basic Medical Insurance Diagnosis and Treatment Items", the cost of a pacemaker exceeding 20,000 yuan is one of the diagnosis and treatment items that the basic medical insurance co-ordinating fund does not pay; pacemaker (maximum payment limit 2 Ten thousand yuan) is one of the scope of diagnosis and treatment items that pays part of the expenses for the basic medical insurance fund.
Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China" that meets the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be deducted from the basic medical insurance fund in accordance with national regulations. Pay.
"Scope of Diagnosis and Treatment Items of National Basic Medical Insurance" 1. Diagnosis and treatment items that are not covered by the basic medical insurance pooling fund
(1) Service items
1. Registration fee, out-of-hospital consultation fee, medical record cost, etc.
2. Consultation fees and special medical service fees.
(2) Non-disease treatment items
1. Various beauty and bodybuilding projects as well as some non-functional plastic surgery and orthopedic surgeries (such as blepharoplasty, strabismus correction, correction of stuttering, harelips, treatment of freckles, age spots, pigmentation, armpit odor, hair loss, beauty cleansing) Teeth, dentures, orthodontics, stained tooth treatment, etc.).
2. Various weight loss, weight gain and height gain projects.
3. Various health examinations (including pre-marital examination, swimming physical examination, and exit physical examination).
4. Various preventive and health-care diagnosis and treatment items (such as various vaccines, vaccinations, disease census, follow-up, etc.).
5. Various medical consultations and medical appraisals (such as psychological consultation, health consultation, disease prediction, etc.).
(3) Diagnostic and treatment equipment and medical materials
1. Apply positron emission tomography (PET), electron beam CT, ophthalmic excimer excitation therapy equipment, human body information diagnostic equipment and other examination and treatment items.
2. Glasses, dentures, prosthetic eyes, prosthetic limbs, hearing aids and other rehabilitation equipment.
3. Various self-use health care, massage, examination and treatment equipment (such as: massagers, wheelchairs, various household testing and treatment instruments, leather steel back armor, waist circumference, steel head and neck, gastric support, kidney support, uterine support, hernia belt , knee brace belt, cremaster belt, brain strengthening device, medicated pillow, medicated pad, hot compress bag, magical energy bag, etc.).
4. The cost of a pacemaker exceeds 20,000 yuan.
5. Disposable medical materials that cannot be charged separately according to the price authority department.
"Scope of Diagnosis and Treatment Items of National Basic Medical Insurance" 2. Scope of diagnosis and treatment items for which the basic medical insurance fund pays part of the expenses and the proportion of out-of-pocket expenses
(1) Diagnostic and treatment equipment and medical materials
1. Applications of x-ray computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computerized scanning device (SPECT), single photon emission computed tomography (ECT), heart And angiography Individuals pay 15% out of pocket.
2. For extracorporeal shock wave lithotripsy, hyperbaric oxygen chamber treatment, radiofrequency treatment and other items, the individual pays 10% out of pocket.
3. For stereotactic radiotherapy devices such as X-knife (X-knife), gamma knife (γ-knife), and photon knife, 40% of the cost is paid by the individual.
4. Artificial organs for internal replacement such as pacemakers (maximum payment limit 20,000 yuan), intraocular lens, artificial joints, artificial larynx, artificial femoral head, etc. can be charged separately according to the price authority department and the individual price is more than 1500 yuan. (including 1500 yuan) of disposable medical materials (including implantable materials). The personal out-of-pocket proportions are 10% for domestic products, 15% for Sino-foreign joint venture products, and 20% for imported products.