6/7-
附表一:手術項目給付比率表
手術名稱 給付百分比
A、腹部和消化系統
剖腹探查術、結腸切開術 ··································· 65%
腹膜腔膿瘍引流術 ········································· 68%
闌尾膿瘍切開引流術 ······································· 45%
闌尾切除術 ··············································· 58%
總膽管切開或總膽管造口術,伴有無合併膽囊切開 ············ 101%
膽囊切除術 ··············································· 82%
膽囊切開術或膽囊切開引流術 ······························· 74%
內視鏡:
肛門鏡,合併組織切片 ····································· 10%
食道鏡,合併組織切片 ····································· 23%
胃鏡,合併組織切片 ······································· 22%
食道鏡及胃鏡,合併組織切片 ······························· 27%
經皮下穿刺,肝組織之病理檢查 ····························· 10%
單純外傷性,肝臟傷口縫合 ································· 92%
胰病變割除 ·············································· 110%
胰切除,伴胰管空腸造口術 ································ 140%
胰切除,Whipple 氏手術··································· 222%
扁桃腺切除術,合併增殖腺切除術 ··························· 27%
深部提肛肌、直腸附近或後直腸膿瘍切開引流術 ··············· 31%
小腸或大腸單一或多發病灶的單一剖腸切除術 ················· 92%
經由腹部與會陰的全直腸肛門切除術 ························ 155%
迷走神經切斷和幽門整形,併有無胃造口術 ·················· 110%
剖腹探查術合併胃造口術及移除異物 ························· 78%
全胃切除術,伴小腸移殖修復 ······························ 200%
B、截肢和關節切斷
手指或大姆指任何單一關節截除術 ··························· 25%
趾、蹠骨、跗骨關節截除術 ································· 20%
踝關節截除術 ············································· 73%
腕部截除術 ··············································· 53%
前臂截除術 ··············································· 60%
小腿截除術 ··············································· 80%
股骨截除術 ··············································· 87%
肱骨截除術 ··············································· 60%
臗部、骨盤腹部間截除術 ·································· 330%
C、大腦、神經系統
顱骨鑽孔術,無合併其他後續手術 ··························· 48%
顱骨鑽孔術合併顱內膿瘍救囊腫引流術 ······················ 135%
開顱探查術,併有無合併顱骨整復 ·························· 195%
開顱術,合併小腦天幕上或天幕下探查 ······················ 230%
天幕上腦瘤切除術 ········································ 230%
天幕下或後顱窩的腦瘤切除術 ······························ 240%
頸椎或胸椎板切開合併筥管探查術 ·························· 180%
椎板切開術:
因單側頸椎椎間盤突出壓迫神經根而行 ······················ 145%
因雙側頸椎椎間盤突出壓迫神經根而行 ······················ 180%
因單側腰椎椎間盤突出壓迫神經根而行 ······················ 135%
因雙側腰椎椎間盤突出壓迫神經根而行 ······················ 170%
D、脫臼
踝關節復位術 ············································· 17%
肘關節復位術 ············································· 17%
指骨、掌復位術 ··········································· 17%
顳、下頷關節復位術 ······································· 12%
膝蓋骨復位術 ············································· 17%
胸、鎖骨復位術 ··········································· 18%
距骨、跗骨、蹠骨復位術 ··································· 13%
腕關節復位術 ············································· 17%
E、耳
針刺式鼓膜穿刺術 ········································· 10%
鼓室整形術合併乳突切除術 ································ 155%
鼓室整形術合併三個聽小骨重建術 ·························· 175%
割除耳息肉 ··············································· 10%
F、內分泌系統
甲狀腺舌咽部囊腫,切開和引流 ····························· 10%
甲狀腺全部切除術 ········································· 97%
甲狀腺全或次全切除術合併頸部根除術 ······················ 185%
G、眼部
眼眶內容物全剜除術、合併義眼植入 ························· 62%
表淺性結膜異物移除 ······································· 10%
深理性、或結膜下、或鞏胯上異物移除 ······················· 10%
眼外肌創口修復 ··········································· 22%
因青光眼而行鞏膜造瘻術及虹膜切除術 ······················· 78%
手術名稱 給付百分比
抽吸式水晶體摘除術·······································110%
白內障或膜性白內障後水晶體摘除術··························78%
H、骨折
顯微鏡手術················································35%
指骨······················································11%
掌骨······················································16%
蹠骨······················································15%
跗骨······················································13%
橈骨······················································29%
尺骨······················································27%
尺骨和橈骨················································40%
腓骨······················································25%
脛骨······················································40%
脛骨和腓骨················································58%
肱骨······················································33%
股骨······················································53%
鎖骨······················································18%
肩胛骨····················································19%
膝蓋骨····················································27%
肋骨······················································10%
I、生殖系統
男性:
睪丸切除術················································35%
複雜性攝護腺切除,膿傷外部引流術··························80%
女性:
陰道黏膜活體組織切片病理檢查······························10%
子宮頸切開、子宮頸切除、子宮頸截除························35%
診斷性子宮內膜擴刮術······································27%
經腹腔子宮全體切除手術···································100%
經腹腔單一或多個子宮肌瘤摘除術····························87%
單側或雙側輸卵管截斷······································56%
單側、雙側、部份、全部輸卵管、卵巢切除術··················71%
卵巢切除術,合併全網膜切除術······························83%
經由腹腔行子宮切開移除葡萄胎······························83%
以擴張和刮除術移除葡萄胎··································37%
輸卵管性子宮外孕,由腹腔或陰道切進························83%
J、血液和淋巴系統
脾臟切除術···············································100%
K、心臟和循環系統
心臟切開術和異物移除·····································200%
心肌切除術···············································250%
心肌梗塞後造成心窒中隔損修補術···························300%
單一瓣膜置換術···········································290%
二個瓣膜置換術···········································330%
三個瓣膜置換術···········································500%
L、呼吸系統
肺切除,伴胸廓整形術,或切除重建胸壁·····················180%
氣胸······················································10%
鼻息肉切除················································10%
部份或完全鼻甲切除········································13%
鼻竇切開··················································26%
聲帶切除術···············································105%
氣管和支氣管切開造口術····································31%
M、皮膚、被膜、乳部
膿傷:癰或節切開和引流或穿刺術····························10%
皮膚及皮下組織惡性病灶,組織切片病理檢查合併初縫合於 0.5
公分以下··················································11%
0.5~1 公分以下 ············································16%
1~2 公分 ··················································23%
囊腫第一次發炎或非發炎性病變切開和引流····················10%
乳房切除:
單側完全切除··············································52%
雙側完全切除··············································65%
單側部份切除··············································39%
乳房根除術,含乳房組統、胸肌及腋窩下淋巴節摘除···········120%
N、泌尿系統
腎周圍或腎膿瘍引流········································83%
腎截石術(結石移除)·····································103%
腎切除含部份尿管切除·····································115%
腎固定術:腎的固定或懸掛··································92%
膀胱切開或膀胱造口術伴電療燒法····························83%
膀胱切開伴隨尿道導管插入··································63%
註:如手術項目未包括於上表時,本公司將參照上表及依該項手術之相對比例,核付合理之補償金。