Is stenting reimbursable by Medicare

Stents are covered by Medicare and are usually reimbursable.

Stents are used to treat myocardial ischemia caused by narrowing of the coronary arteries. Stents are covered by Medicare, but the reimbursement rates vary. The difference is usually in the geographic area. Different regions have different reimbursement rates, and there are also differences between urban and rural health insurance. As for the reimbursement rate, it depends on the reimbursement program set by the medical insurance bureau in the patient's location. If it is a reimbursable domestic cardiac stent medical insurance, it is generally included in the medical insurance reimbursement scope at 50%. But imported cardiac stents, social security is not reimbursed. There is also reimbursement from the state for off-site cardiac stent surgery. The reimbursement rate is different for different levels of hospitals. County hospitals are reimbursed 40%, city hospitals 35% and provincial hospitals 30%.

1. At present, domestic drug stents belong to the cost of materials and are generally included in the medical insurance reimbursement at 50%.

2. Other expenses, such as hospitalization surgery and medicine, are reimbursed at 85%-90% according to the regulations of medical insurance.

3. Off-site stenting is generally reimbursed at 40% for county hospitals, 35% for municipal hospitals, and 30% for provincial hospitals. In addition, how many stents can be reimbursed is based on about four times the average salary of the city's workers in the previous year.

Medicare First of all, the difference between medicare and non-medicare drugs, the reimbursement starting line is also different according to the hospital level

Generally, Class A drugs can enjoy full reimbursement, Class C will need to pay all the out-of-pocket expenses, while Class B reimbursement of 80%, 20% out-of-pocket rate.

Village health insurance reimbursement

1, outpatient reimbursement:

(1) 60% reimbursement for village health clinics and village center health clinics, with a limit of 10 yuan per visit for prescription drugs, and a limit of 50 yuan per visit for temporary rehydration prescriptions by health center doctors.

(2) Township health centers will be reimbursed 40% of the cost for each visit, with a limit of 50 yuan for each examination and surgery, and a limit of 100 yuan for prescription drugs.

(3) Secondary hospitals will be reimbursed 30% of the cost, with a limit of 50 yuan for each examination and operation and 200 yuan for prescription drugs.

(4) Tertiary hospitals will reimburse 20% of the cost, with a limit of RMB 50 for each examination and operation and RMB 200 for prescription drugs.

(5) Chinese medicine invoices with prescription attached are limited to RMB 1 yuan per sticker.

(6) The annual limit of outpatient compensation for township-level cooperative medical care is 5,000 yuan.

2, hospitalization compensation

(1) reimbursement scope:

A, medicine: auxiliary examination: EEG, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other examination fees limit of 200 yuan; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement according to 1,000 yuan).

B, the elderly over 60 years of age hospitalized in Xingta Township Health Center, treatment and care costs are compensated 10 yuan per day, limit 200 yuan.

(2) Reimbursement rate:

The town health center reimburses 60%; secondary hospitals reimburse 40%; tertiary hospitals reimburse 30%.

3, compensation for major illnesses

(1) town risk fund compensation: where the rural cooperative medical insurance hospitalized patients with a one-time or annual cumulative reportable medical expenses exceeding 5,000 yuan segmented compensation, i.e., 5,001-10,000 yuan compensation of 65%, 10,001-18,000 yuan compensation of 70%.

(2) The annual limit of compensation for inpatient hospitalization and outpatient hemodialysis for uremia, outpatient radiotherapy and chemotherapy for oncology is 11,000 yuan at the township level cooperative medical care.

The following are not covered by the Rural Cooperative Medical Insurance:

1, self-medical treatment (without designated hospitals or referral orders), self-purchased medicines, medicines that cannot be reimbursed by the public medical care regulations, and medical expenses that do not conform to family planning;

2, outpatient treatment fees, consultation fees, hospitalization fees, meals, companion fees, nutritional costs, blood transfusion fees (except for those with family blood storage, which are subject to the relevant regulations), and blood transfusion fees. Blood transfusion (except for those with family blood storage, which will be reimbursed in accordance with the relevant regulations), heating and cooling costs, ambulance fees, special care fees and other expenses;

3. Medical expenses for car accidents, fights, suicides, alcoholism, workplace accidents, and medical malpractice;

4. Orthopedics, cosmetic surgery, dental implants, prosthetic limbs, organ transplants, named surgery fees, and consultation fees;

5. Reimbursement of expenses within the scope of reimbursement, and the portion of reimbursement that is outside of the limit.

Legal basis

The People's Republic of China*** and the State Social Insurance Law

Article 26 The standard of treatment of basic medical insurance for employees, the new type of rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28 Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with the state regulations.

Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly by the social insurance administrative organization with the medical institutions and drug business units. The social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses for medical treatment in other places to facilitate the enjoyment of basic medical insurance by insured persons.