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["附件2"]
["2024年  月耗材目录品种维护审核结果申诉表"]
["申诉单位（盖章）："]
["公示序号","基础信息",{"$nulls":3},"医保支付信息",null,"单独收费依据",{"$nulls":3},"公示情况",null,null,"申诉事项",null,null,"申诉理由简述","备注"]
[null,"医保耗材国家代码(27位国家代码)","单件产品名称","注册证号","对应医保通用名","对应医保属性","对应医保支付标准","医疗服务项目编码","医疗服务项目名称","医疗服务项目内涵","医疗服务项目除外内容（耗材名称）","审核结果","未通过理由","公示批次","可单独收费审核结论","对应医保属性/医保支付标准","产品相关信息",null,"申诉单位","联系人","联系电话","申报医疗机构","联系人","联系电话"]
["示例1：XXX","C01060802100000074330000001","阻抗控制子宫内膜切除系统-一次性双极消融器","国械注准20173033051","电极","丙类","","331303027"," 子宫内膜去除术 ","包括热球、射频消融、电凝","消融连接管、热球","通过",null,"202X年4月",null,null,"单件产品名称“阻抗控制子宫内膜切除系统-一次性双极消融器”变更为“阻抗控制子宫内膜消融设备-一次性双极消融器”。","单件产品名称与重庆市药品和医用耗材招采管理系统及国家医保信息业务编码标准数据库中的产品名称不一致","***公司","张**","188*****630","***医院","李**","187*****630"]
["示例2：XXX","C02070100400000004460001880","造影导管","国械注准20173033051","导管","甲类","960","320200009"," 经皮动脉内球囊扩张术 ","不含脑血管及冠状动脉","导管","通过",null,"202X年4月",null,null,"将数据退回，我司将重新维护提交。所申报的医疗服务项目填报有误，拟申报医疗服务目编码-32，医疗服务项目名称-（二）经血管（内、外）介入诊疗","所申报的医疗服务项目填报有误","***公司","李**","188*****620","***医院","张**","187*****620"]
["示例3：XXX","C08070310600000088610000204","眼科手术刀","国械注进20152163093","手术刀","甲类","317","330406"," 晶状体手术 ",null,"乳化专用刀","不通过","从申报产品的规格和注册证信息判断，并非超声乳化刀，与除外内容不符","202X年4月","应予以通过",null,null,"1.《医疗器械产品分类界定结果汇总》，明确一次性眼科手术刀用于白内障超声乳化手术中切割角膜或巩膜，符合乳化专用刀的描述。2.眼科手术学书中有提到：白内障超声乳化吸除术使用一次性的15°穿刺刀、2.0-3.2mm的一次性穿刺刀和一次性隧道分离刀，与我司产品注册证中规格名称相同“附件3”","***公司","汪**","188*****660","***医院","孙**","187*****660"]
["示例4：XXX","C02010900400001090980000001","磁定位可调弯标测导管","国械注进20193070344","导管","甲类","2200","31"," (一)临床各系统诊疗 ","1.本类包括神经系统、内分泌系统、眼、耳鼻咽喉、口腔颌面、呼吸系统、心脏及血管系统、血液及淋巴系统、消化系统、。。。。。。","导管","通过",null,"202X年4月",null,"医保属性应为甲类，支付上限为2200元。",null,"集采产品的医保属性应为甲类，而公示为丙类。","***公司","汪**","188*****660","***医院","孙**","187*****660"]
["说明：1.本申诉表随申诉单位的其他申诉材料一并提供。如申诉提及非申诉单位申报产品的，一并填报申诉产品信息和在库信息或公示信息。"]
["     2.申报单位须签章。本表中备注栏6列次不得为空，相关信息需准确填报，以便在复审中联系沟通和了解相关情况及作好解释工作。"]