10 BESAR TINDAKAN 2022 BPJS

JML KASUS
NO ICD 10 DIAGNOSA INACBGS 2022 KLS 1 KLS 2 KLS 3
D21.0 - D21.9 SOFT TISSUE TUMOR PROSEDUR PADA KULIT,
JA(RINGAN) BAWAH KULIT DAN
PAYUDARA (RINGAN)
1 26 5,069,400 4,440,500 3,811,600
PROSEDUR PADA PAYUDARA
2 D24 Benign neoplasm of breast (RINGAN) 12 6,105,600 5,348,100 4,590,700

PERADANGAN
KULIT/CELLULITIS (RINGAN)
3 L03.9 Cellulitis, unspecified 2 1,433,000 1,669,400 1,905,800
Acute appendicitis with
4 K35.3 localized peritonitis
PROSEDUR SISTEM PENCERNAAN LAIN-LAIN (RINGAN)
3 7,279,600 6,376,500 5,473,400

PROSEDUR PADA DARAH DAN

ORGAN PEMBENTUK DARAH
Acute lymphadenitis of face, LAIN-LAIN (RINGAN)
5 L04.9 head and neck 5 4,824,700 4,226,200 3,627,600
PROSEDUR PADA KULIT,
JA(RINGAN) BAWAH KULIT
6 M67.4 Ganglion DAN PAYUDARA (RINGAN) 3 5,069,400 4,440,500 3,811,600
7 O82.9 SC OPERASI PEMBEDAHAN CAESAR (RINGAN)35 6,193,500 5,425,100 4,656,700

Spontaneous abortion,
incomplete, without
8 O03.4 complication
PROSEDUR DILATASI, KURET, INTRAUTERIN & SERVIK 2(RINGAN) 3,022,900 2,647,900 2,272,900

TARIF MOW TERBARU

KELAS 1 KELAS 2 KELAS 3
O34.2 MOW PROSEDUR PADA TUBA FALOPII 3,115,400 2,728,900 2,342,400
BPJS INA CBG'S Rp 3,811,600 Rp 4,440,500
SOFT TISSUE TUMOR/GANGLION/LIMPA 2 hr 1 mlm 2 hr 1 mlm
KELAS 3 2
KAMAR (2 Hari 1 Mlm) Rp 195,000 Rp 300,000
SEWA OK Rp 750,000 Rp 750,000
DR. OPERATOR (NETT)+VISIT Rp 780,000 Rp 880,000
DR. ANASTESI ASA 1/2/3 (NETT) Rp 390,000 Rp 440,000
OBAT & DISPO Rp 850,000 Rp 850,000
LAB Rp 150,000 Rp 150,000
GAS MEDIK
TINDAKAN
RAJAL POLI Rp 175,000 Rp 175,000
ADM
SEWA ALAT
TOTAL Rp 3,290,000 Rp 3,545,000
SELISIH Rp 521,600 Rp 895,500

KOMPONEN DR BEDAH KLS 3 KLS 2

drSp (NETT) Rp 680,000 Rp 755,000
VISIT 1X (NETT) Rp 100,000 Rp 125,000
TOTAL (NETT) Rp 780,000 Rp 880,000

* Belum termasuk biaya PA

Rp 5,069,400
2 hr 1 mlm
1
Rp 400,000 5
Rp 750,000 20
Rp 980,000 20
Rp 490,000 10
Rp 850,000 25
Rp 150,000 5

Rp 175,000 10

Rp 3,795,000
Rp 1,274,400

KLS 1
Rp 830,000
Rp 150,000
Rp 980,000
BPJS INA CBG'S Rp 4,590,700 Rp 5,348,100
TUMOR MAMMAE 2 hr 1 mlm 2 hr 1 mlm
KELAS 3 2
KAMAR (2 Hari 1 Mlm) Rp 195,000 Rp 300,000
SEWA OK Rp 750,000 Rp 750,000
DR. OPERATOR (NETT)+VISIT Rp 950,000 Rp 1,100,000
DR. ANASTESI ASA 1/2/3 (NETT) Rp 475,000 Rp 550,000
OBAT & DISPO Rp 850,000 Rp 850,000
LAB Rp 150,000 Rp 150,000
GAS MEDIK
TINDAKAN
RAJAL POLI Rp 175,000 Rp 175,000
ADM
SEWA ALAT
TOTAL Rp 3,545,000 Rp 3,875,000
SELISIH Rp 1,045,700 Rp 1,473,100

KOMPONEN DR BEDAH KLS 3 KLS 2

drSp (NETT) Rp 850,000 Rp 975,000
VISIT 1X (NETT) Rp 100,000 Rp 125,000
TOTAL (NETT) Rp 950,000 Rp 1,100,000

* Belum termasuk biaya PA

Rp 6,105,600
2 hr 1 mlm
1
Rp 400,000 5
Rp 750,000 20
Rp 1,300,000 20
Rp 650,000 10
Rp 850,000 25
Rp 150,000 5

Rp 175,000 10

Rp 4,275,000
Rp 1,830,600

KLS 1
Rp 1,150,000
Rp 150,000
Rp 1,300,000
BPJS INA CBG'S Rp 2,272,900 Rp 2,647,900 Rp 3,022,900
KURET 2 hr 1 mlm 2 hr 1 mlm 2 hr 1 mlm
KELAS 3 2 1
KAMAR (2 Hari 1 Mlm) Rp 195,000 Rp 300,000 Rp 400,000 5
SEWA OK Rp 500,000 Rp 500,000 Rp 500,000 20
DR. OPERATOR (NETT)+VISIT Rp 450,000 Rp 500,000 Rp 600,000 20
DR. ANASTESI ASA 1/2/3 (NETT) Rp 225,000 Rp 250,000 Rp 300,000 10
OBAT & DISPO Rp 568,225 Rp 661,975 Rp 755,725 25
LAB Rp 150,000 Rp 150,000 Rp 150,000 5
GAS MEDIK
TINDAKAN
RAJAL POLI Rp 150,000 Rp 150,000 Rp 150,000 10
ADM
SEWA ALAT
SEWA VK Rp - Rp - Rp -
TOTAL Rp 2,238,225 Rp 2,511,975 Rp 2,855,725
SELISIH Rp 34,675 Rp 135,925 Rp 167,175

KOMPONEN DR BEDAH KLS 3 KLS 2 KLS 1

drSp (NETT) Rp 350,000 Rp 375,000 Rp 450,000
VISIT 1X (NETT) Rp 100,000 Rp 125,000 Rp 150,000
TOTAL (NETT) Rp 450,000 Rp 500,000 Rp 600,000
BPJS INA CBG'S Rp 5,473,400 Rp 6,376,500 Rp 7,279,600
APENDIK 3 hr 2 mlm 3 hr 2 mlm 3 hr 2 mlm
KELAS 3 2 1
KAMAR (3 Hari 2 Mlm) Rp 390,000 Rp 600,000 Rp 800,000
SEWA OK Rp 750,000 Rp 750,000 Rp 750,000
DR. OPERATOR (NETT)+VISIT Rp 1,100,000 Rp 1,300,000 Rp 1,500,000
DR. ANASTESI ASA 1/2/3 (NETT) Rp 550,000 Rp 650,000 Rp 750,000
OBAT & DISPO Rp 1,200,000 Rp 1,200,000 Rp 1,200,000
LAB Rp 580,000 Rp 580,000 Rp 580,000
GAS MEDIK
TINDAKAN
RAJAL POLI Rp 325,000 Rp 325,000 Rp 325,000
ADM
SEWA ALAT
TOTAL Rp 4,895,000 Rp 5,405,000 Rp 5,905,000
SELISIH Rp 578,400 Rp 971,500 Rp 1,374,600

KOMPONEN DR BEDAH KLS 3 KLS 2 KLS 1

drSp (NETT) Rp 900,000 Rp 1,050,000 Rp 1,200,000
VISIT 2X (NETT) Rp 200,000 Rp 250,000 Rp 300,000
TOTAL (NETT) Rp 1,100,000 Rp 1,300,000 Rp 1,500,000
 5
20
20
10
25
5 *termasuk USG Abdomen

10
BPJS INA CBG'S Rp 4,283,800 Rp 4,990,600 Rp 5,697,400
HERNIA 3 hr 2 mlm 3 hr 2 mlm 3 hr 2 mlm
KELAS 3 2 1
KAMAR (3 Hari 2 Mlm) Rp 390,000 Rp 600,000 Rp 800,000 5
SEWA OK Rp 750,000 Rp 750,000 Rp 750,000 20
DR. OPERATOR (NETT)+VISIT Rp 850,000 Rp 950,000 Rp 1,050,000 20
DR. ANASTESI ASA 1/2/3 (NETT) Rp 425,000 Rp 475,000 Rp 525,000 10
OBAT & DISPO Rp 1,000,000 Rp 1,000,000 Rp 1,000,000 25
LAB Rp 450,000 Rp 450,000 Rp 450,000 5
GAS MEDIK
TINDAKAN
RAJAL POLI Rp 325,000 Rp 325,000 Rp 325,000 10
ADM
SEWA ALAT
TOTAL Rp 4,190,000 Rp 4,550,000 Rp 4,900,000
SELISIH Rp 93,800 Rp 440,600 Rp 797,400

KOMPONEN DR BEDAH KLS 3 KLS 2 KLS 1

drSp (NETT) Rp 650,000 Rp 700,000 Rp 750,000
VISIT 2X (NETT) Rp 200,000 Rp 250,000 Rp 300,000
TOTAL (NETT) Rp 850,000 Rp 950,000 Rp 1,050,000
*termasuk USG Abdomen