On the approval of the nomenclature of medical services nag. How are additional paid medical services provided according to the Nomenclature of Medical Services? On approval of the range of medical services

Ministry of Health Russian Federation
(Ministry of Health of Russia)

On approval of the range of medical services

Article 14 federal law dated November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, item 6724; 2012, N 26, item 3442, 3446; 2013, N 27 3459, 3477; N 30, item 4038; N 39, item 4883; N 48, item 6165; N 52, item 6951; 2014, N 23, item 2930; N 30, item 4106 , 4244, 4247, 4257; N 43, item 5798; N 49, item 6927, 6928; 2015, N 1, item 72, 85; N 10, item 1403, 1425; N 14, item 2018; No. 27, article 3951; No. 29, article 4339, 4356, 4359, 4397; No. 51, article 7245; 2016, No. 1, article 9, 28; No. 18, article 2488; No. 27, article 4219) order:

1. Approve the attached nomenclature medical services.

2. Recognize as invalid:

order of the Ministry of Health of the Russian Federation dated October 28, 2013 N 794n "On amendments to the order of the Ministry of Health and social development of the Russian Federation dated December 27, 2011 N 1664n "On approval of the range of medical services" (registered by the Ministry of Justice of the Russian Federation on December 31, 2013, registration N 30977);

order of the Ministry of Health of the Russian Federation of December 10, 2014 N 813n "On amendments to the range of medical services approved by order of the Ministry of Health and Social Development of the Russian Federation of December 27, 2011 N 1664n" (registered by the Ministry of Justice of the Russian Federation on January 19, 2015 ., registration N 35569);

order of the Ministry of Health of the Russian Federation of September 29, 2016 N 751n "On amendments to the range of medical services approved by order of the Ministry of Health and Social Development of the Russian Federation of December 27, 2011 N 1664n" (registered by the Ministry of Justice of the Russian Federation on October 25, 2016 ., registration N 44131);

order of the Ministry of Health of the Russian Federation of August 24, 2017 N 548n "On amendments to the range of medical services approved by order of the Ministry of Health and Social Development of the Russian Federation of December 27, 2011 N 1664n" (registered by the Ministry of Justice of the Russian Federation on September 13, 2017 ., registration N 48161).

Approved
order of the Ministry of Health
Russian Federation
dated October 13, 2017 N 804n

Nomenclature of medical services

I. General provisions

1. Nomenclature of medical services(hereinafter - the Nomenclature) is a systematic list of codes and names of medical services in healthcare.

2. Medical service coding algorithm in the Nomenclature is presented in the diagram:

The service code consists of an alphanumeric code from 8 to 11 (12<*>) signs. The first character indicates the section of the service, the second and third characters indicate the type of medical service, the fourth and fifth (sixth<*>) signs - a class of medical service (anatomical and functional area and / or a list medical specialties), from the sixth to the eleventh characters (from the seventh to the twelfth<*>) – type, subtype of service.
––––––––––––––––––––––––––––––––
<*>For section "B".

3. The list of medical services is divided into two sections: "A" and "B" built on a hierarchical basis.

Section "A" includes medical services, which are certain types of medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and having an independent complete value.

Section "B" includes medical services, which are a complex of medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and having an independent complete value.

4. Section "A":

4.1. In section "A" indicate a specific type of medical service:

4.2. Section class "A" (from 01 to 31) designate the anatomical and functional area:

01 - skin, subcutaneous fat, skin appendages

02 - muscular system

03 - skeletal system

04 - joints

05 - hematopoietic system and blood

06 - immune system

07 - oral cavity and teeth

08 - upper respiratory tract

09 - lower respiratory tract and lung tissue

10 - heart and pericardium

11 - mediastinum

12 - large blood vessels

13 - microcirculation system

14 - liver and bile ducts

15 - pancreas

16 - esophagus, stomach, duodenum

17 - small intestine

18 - large intestine

19 - sigmoid and rectum

20 - female genital organs

21 - male genital organs

22 - glands internal secretion

23 - central nervous system and brain

24 - peripheral nervous system

25 - hearing organ

26 - organ of vision

27 - organ of smell

28 - kidneys and urinary system

29 - mental sphere

30 - others.

The class of medical service is identical in all standard sections. If a specific service is not allocated for a class in a certain type section, then this class is not prescribed, while its sequence number is retained for it.

The class "Other" includes medical services that cannot be classified in the corresponding anatomical and functional subsection (for example, performed during pregnancy, childbirth, newborn, diagnostic laparoscopy, plain picture of the abdominal organs).

4.3. Type of medical service(001 to 999) denotes medical services that have a complete diagnostic or therapeutic value.

5. Section "B":

5.1. In section "B" indicate a specific type of medical service:

5.2. Section "B" classes (from 001 to 070) indicate a list of medical specialties:

001 - obstetrics and gynecology

002 - allergology and immunology

003 - anesthesiology and resuscitation

004 - gastroenterology

005 - hematology

006 - genetics

007 - geriatrics

008 - dermatovenereology and cosmetology

009 - pediatric oncology

010 - pediatric surgery

011 - pediatric endocrinology

012 – diabetology

013 - dietetics

014 - infectious diseases

015 – cardiology, pediatric cardiology

016 - clinical laboratory diagnostics

017 - clinical pharmacology

018 – Coloproctology

019 - laboratory genetics

020 - exercise therapy and sports medicine

021 - social hygiene, sanitation and epidemiology

022 - manual therapy

023 - neurology

024 – neurosurgery

025 - Nephrology

026 - general practice (family medicine)

027 - oncology

028 – otorhinolaryngology

029 – ophthalmology

030 - pathological anatomy

031 - pediatrics

032 - neonatology

033 - occupational pathology

034 - psychotherapy

035 - psychiatry and forensic psychiatric examination

036 - psychiatry-narcology

037 - pulmonology

038 - radiology and radiotherapy

039 – radiology

040 – rheumatology

041 – reflexology

042 - sexology

043 – Cardiovascular surgery, X-ray endovascular diagnostics and treatment

044 - ambulance

045 - forensic medical examination

046 – audiology-otorhinolaryngology

047 - therapy

048 – toxicology

049 - thoracic surgery

050 - Traumatology and Orthopedics

051 - transfusiology

052 – ultrasound diagnostics

053 - urology, pediatric urology-andrology

054 – physiotherapy

055 - Phthisiology

056 - functional diagnostics

057 - surgery, surgery (transplantation of organs and tissues) and combustiology

058 – endocrinology

059 - endoscopy

060 - bacteriology

061 - virology

062 - epidemiology

063 – orthodontics

064 - pediatric dentistry

065 - therapeutic dentistry and general practice dentistry

066 – orthopedic dentistry

067 - surgical dentistry

068 – maxillofacial surgery

069 – osteopathy

070 - others.

The class of medical service is identical in all standard sections. If a specific service is not allocated for a class in a certain typical section, then this class is not prescribed, while its sequence number is retained for it.

The class "Other" includes medical services that cannot be classified in the appropriate division (for example: services of a medical psychologist).

5.3. Type of medical service(001 to 099) denotes medical services that have a complete diagnostic or therapeutic value.

The subtype of medical service (from 001 to 999) denotes medical services depending on the methods (methods) of their implementation.

Part of medical services may not contain subtypes of services.

November 2017 On the official Internet portal of legal information pravo.gov.ru, the Order of the Ministry of Health of Russia No. 804n of October 13, 2017 was published. and the Nomenclature of medical services approved by this order. The nomenclature entered into force on 01/01/2018, thereby canceling the previously existing (since 2011) old nomenclature of medical services. What has changed in the work of the clinic - we understand.

Why do you need a nomenclature of medical services

Finishing the discussion of the appointment of the Nomenclature, it should be said that the absence of any medical service in the Nomenclature does not cancel the possibility of its provision in the conditions of a medical organization. Such legal feature, however, complicates the definition legal status service, although it does not prohibit its provision.

Innovations in the nomenclature of medical services

Without dwelling on the general provisions of the old and new Nomenclature, let's talk about the changes reflected in the new Nomenclature of Medical Services 2018.

The new Nomenclature of Medical Services eliminated a number of contradictions that took place in the old one. Thus, in the old Nomenclature in class "A" of the General Provisions there were medical services with type 25, designated as "microbiological research on major infectious diseases", while the services themselves, presented in this section, related to treatment. The microbiological studies themselves were of type 26, which is absent in the General Provisions of the old Nomenclature.

The old Nomenclature reflects several medical services for genetic research. They were divided into two types of services: morphological examination of tissues (08) and examination of the functions of organs and tissues using special procedures, devices and techniques (12). In the new Nomenclature, firstly, the list of genetic studies is significantly expanded, and, secondly, they are combined into a separate type (28). Also in the new Nomenclature, class "A" is supplemented by expanding the type of service 21, which includes osteopathy.

The changes also affected section "B". For example, dispensary observation services, medical sports and recreational activities, were excluded from type 04, and medical prevention services proper were expanded through preventive examinations by a specialist and preventive counseling.

Also, a new medical specialty 069 - “osteopathy” has been added to section “B”, while in the old Nomenclature, the appointment of an osteopathic doctor was classified as “other medical specialties”. Since the specialty “osteopathy” was added to the list of specialties requiring higher medical or pharmaceutical education in 2015 and, in this regard, were approved qualification requirements to these specialists, a large number of medical services of this particular profile have been added to the New Nomenclature of Medical Services 2018, including a hardware examination of patients in various options and treatment using simple physical influences (for example, manual therapy).

IMPORTANT!
In addition to the above, the new Nomenclature includes interventional methods of pain treatment, such as continuous injection of medication into the epidural space and implantation of an intrathecal pump.

Also, the new Nomenclature of Medical Services reflects such a popular and socially significant service as the provision of palliative care. It should be noted, however, that at present there is a certain legislative vacuum: there is a service, but there is no corresponding medical specialty. Despite the fact that the palliative care physician in the Procedures for the provision of palliative care and the Nomenclature of positions medical workers and pharmaceutical workers are present, there are no qualification requirements for this specialty. She is not marked in any qualification handbook, none of professional standards doctors, nor in the List of specialties and areas of higher education.

Despite this, the new nomenclature for 2018 includes medical services for the appointment of a doctor for palliative care, and the service for prescribing dietary nutrition in the provision of palliative care has also appeared in the Nomenclature.

Of the controversial points of the new Nomenclature, it is interesting to highlight the services of a pathologist for intravital examinations, which were included in it in connection with the adoption in 2016 of the Rules for Post-mortem Examinations. The list of such services has been significantly expanded in the new Nomenclature. At the same time, such a service as a consultation (examination) of a pathologist (В01.030.001) has been retained in the new Nomenclature. As you can see, the medical joke “the pathologist was invited to consult the patient” found its embodiment in the old Nomenclature and consolidated its position in the new one.

However, although a pathologist may participate in examinations of a patient in accordance with the Nomenclature of Medical Services, such a function is not indicated either in the Rules for Post-mortem Examinations or in the Unified Qualification Guide. And in general, a lifetime consultation of a patient by a pathologist looks, to put it mildly, strange.

Of course, it is difficult to describe all the changes in the new Nomenclature of Medical Services in a short review. Nevertheless, it should be said that further improvement of the list of medical services will certainly simplify the interaction and understanding between all participants in this market. However, it should be noted that it is extremely important for the legislator here to maintain a certain parity, so that, on the one hand, the list of services does not grow to cosmic proportions, and on the other hand, doctors would not rack their brains over how to name the perfect manipulation so that it finds its legitimate place in the Nomenclature and reporting cards.

Order of the Ministry of Health and Social Development of Russia No. 1664n dated December 27, 2011
On approval of the range of medical services

In accordance with Article 14 of the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2011, No. 48, Art. 6724) and yu:

Approve the nomenclature of medical services according to the appendix.

Minister T.A. Golikova
www.minzdravsoc. ru/docs/mzsr/spa/117 (date of access: 01/30/2012)

Appendix to the order
Ministry of Health
and social development
Russian Federation
dated ___________ 2011 No. ___

Nomenclature of medical services

I. General provisions

1. Nomenclature of medical services(hereinafter - the Nomenclature) is a list of medical services.

In the Nomenclature is presented in the diagram:

The service code consists of an alphanumeric code from 8 to 11 (12*) characters. The first character indicates the class of service, the second and third characters - the section (type of medical service), the fourth and fifth (sixth*) characters - the subsection (anatomical and functional area and / or the list of medical specialties), from the sixth to the eleventh characters (from the seventh to twelfth*) - serial number (groups, subgroups).

* - for class "B"

3. The list of medical services is divided into two classes: "A" and "B" built on a hierarchical basis.

Class "A" includes medical services that are certain types of medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and having an independent complete value.

Class "B" includes medical services, which are a complex of medical interventions aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and have an independent complete value.

4. Class "A":

4.1. Sections of class "A" designate a specific type of medical service:

4.2. Subsections of class "A" (from 01 to 31) designate the anatomical and functional area:

01 Skin, subcutaneous fat, skin appendages
02 Muscular system
03 Skeletal system
04 Joints
05 Hematopoietic system and blood
06 Immune system
07 Oral cavity and teeth
08 Upper respiratory tract
09 Lower airways and lung tissue
10 Heart and pericardium
11 Mediastinum
12 Large blood vessels
13 Microcirculation system
14 Liver and bile ducts
15 Pancreas
16 Esophagus, stomach, duodenum
17 Small intestine
18 Large intestine
19 Sigmoid and rectum
20 Female reproductive organs
21 Male reproductive organs
22 Endocrine glands
23 Central nervous system and brain
24 Peripheral nervous system
25 Organ of hearing
26 Organ of vision
27 Organ of smell
28 Kidneys and urinary system
29 Psychic Realm
30 Other.

The subsection is identical in all sections. If a specific service is not allocated for a subsection in a particular section, then this subsection is not prescribed, while its serial number is retained for it.

The “Other” subsection includes medical services that cannot be classified in the corresponding anatomical and functional subsection (for example, performed during pregnancy, childbirth, newborn, diagnostic laparoscopy, abdominal imaging, etc.).

4.3. Group number(001 to 999) denotes medical services that have a complete diagnostic or therapeutic value.

Some groups may not contain subgroups.

5. Class "B":

5.1. Sections of class "B" designate a specific type of medical service:

5.2. Subsections of class "B" (from 001 to 069) designate a list of medical specialties:

001 - obstetrics and gynecology
002 - allergology and immunology
003 - anesthesiology and resuscitation
004 - gastroenterology
005 - hematology
006 - genetics
007 - geriatrics
008 - dermatovenereology and cosmetology
009 - pediatric oncology
010 - pediatric surgery
011 - pediatric endocrinology
012 - diabetology
013 - dietetics
014 - infectious diseases
015 - cardiology, pediatric cardiology
016 - clinical laboratory diagnostics
017 - clinical pharmacology
018 - Coloproctology
019 - laboratory genetics
020 - exercise therapy and sports medicine
021 - social hygiene, sanitation and epidemiology
022 - manual therapy
023 - neurology
024 - neurosurgery
025 - nephrology
026 - general medical practice (family medicine)
027 - oncology
028 - otorhinolaryngology
029 - ophthalmology
030 - pathological anatomy
031 - pediatrics
032 - neonatology
033 - occupational pathology
034 - psychotherapy
035 - psychiatry and forensic psychiatric examination
036 - psychiatry-narcology
037 - pulmonology
038 - radiology and radiotherapy
039 - radiology
040 - rheumatology
041 - reflexology
042 - sexology
043 - cardiovascular surgery, endovascular diagnostics and treatment
044 - ambulance
045 - forensic medical examination
046 - audiology-otorhinolaryngology
047 - therapy
048 - toxicology
049 - thoracic surgery
050 - traumatology and orthopedics
051 - transfusiology
052 - ultrasound diagnostics
053 - urology, pediatric urology-andrology
054 - physiotherapy
055 - Phthisiology
056 - functional diagnostics
057 - surgery, surgery (transplantation of organs and tissues) and combustiology
058 - endocrinology
059 - endoscopy
060 - bacteriology
061 - virology
062 - epidemiology
063 - orthodontics
064 - dentistry and pediatric dentistry
065 - therapeutic dentistry
066 - orthopedic dentistry
067 - surgical dentistry
068 - maxillofacial surgery
069 - others.

The subsection is identical in all sections. If a specific service is not allocated for a subsection in a certain section, then this subsection is not prescribed, while its serial number is retained for it.

The subsection "Other" includes medical services that cannot be classified in the corresponding subsection (for example: services of a medical psychologist).

5.3. Group number(001 to 099) denotes medical services that have a complete diagnostic or therapeutic value.

The subgroup serial number (from 001 to 999) designates medical services depending on how they are performed.

Some groups may not contain subgroups.

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Is it possible to provide paid medical services that are not listed in the Nomenclature of Medical Services approved by the Order of the Ministry of Health of October 13, 2017 No. 804? The Ministry of Health provides clarifications on this issue in its Letter dated July 4, 2018 No. 17-2/10/2-4323 "On the rules for the provision of paid medical services by medical organizations."

The information is relevant for course participants professional retraining and advanced training in the following areas:

Paid medical services must comply with the Nomenclature and the List of Medical Services

Today, there are a number of fundamental legal acts that regulate the provision of medical services. These primarily include the Federal Law of May 4, 2011 No. 99-FZ “On Licensing certain types activities”, which clearly states that medical activities must be licensed. According to this requirement, there are 2 main legal act: Regulations on licensing with the List of services and the Nomenclature of medical services.

• In the Decree of the Government of the Russian Federation of April 16, 2012 No. 291 "On licensing medical activities» the Regulation on Licensing was approved, where the List of works (services) that make up medical activities is given.
• In the departmental order dated October 13, 2017 No. 804, the Nomenclature of medical services was approved.

Respectively , medical organizations When forming a list of paid medical services, they should be guided by these documents.

At the same time, the Ministry of Health indicates in its Letter that the Nomenclature contains generalized names of medical services, and the provided list of medical services is not exhaustive.

How to navigate the nomenclature of medical services?

The nomenclature of medical services is a system of lists of codes and names of medical services provided in the healthcare system. The list itself is divided into two main sections:

• Section A
• Section B.

Each of them is built on a hierarchical principle.

What does Section "A" of the Nomenclature of Medical Services include?

Section "A" includes medical services in the form of certain medical interventions that are aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation. Such services have an independent finished value.

• The numbers from 01 to 27 indicate the types of medical services.
• Classes denoting the anatomical and functional area - numbers from 01 to 30.

Classes of medical services may not provide for a specific service

The fourth, fifth digits indicate the class of medical services. The class of medical service is identical in all standard sections. If a specific service is not allocated for a class in a certain typical section, then this class is not prescribed, while its serial number is retained for it.

Medical services that cannot be attributed to any particular class

The “other” class includes such medical services that cannot be classified in the corresponding anatomical and functional subsection (for example, performed during pregnancy, childbirth, newborn, diagnostic laparoscopy, panoramic X-ray of the abdominal organs).

Types and subtypes of medical services in section "A" of the Nomenclature

Numbers from 001 to 999 indicate the type of medical service. These services are of complete diagnostic or therapeutic value.

The last numbers from 001 to 999 indicate the subtype of the medical service. They are determined depending on the methods (methods) of performing a particular service.

It is important to note that a part of medical services may not contain subtypes of services.

What does Section "B" of the Nomenclature of Medical Services include?

This includes medical services, which are complex medical interventions. They are also aimed at the prevention, diagnosis and treatment of diseases, medical rehabilitation and those having an independent complete value.

Here, unlike section A, after the code “Type of service”, there is a code value from 001 to 070, which indicates not an anatomical and functional area, as in the first section, but a medical specialty.

Classes in section "B" Nomenclature

It is also possible for this section to have no assigned class. This is possible if a specific service is not allocated to a class in a particular type section. It is important to take into account that the serial number is stored behind the class. There are also services classified as “other”, for example, the service of a medical psychologist. These services, as in section "A", cannot be classified in one or another subsection.

The absence of subspecies in section "B"

It is important to note that a certain part of medical services may not contain subtypes of services.

We note that the Nomenclature contains generalized names of medical services, and the provided list of medical services is not exhaustive.

What is the place of paid medical services in the list?

Paid medical services can be an addition to the legally guaranteed volume of free medical care citizens within the framework of the program of state guarantees of free provision of medical care to citizens and the relevant territorial programs approved on its basis in the constituent entities of the Russian Federation.

The Rules for the provision of paid medical services by medical organizations (according to Decree of the Government of the Russian Federation of 04.10.2012 No. 1006) states that medical organizations can provide paid medical services based on the list of works (services) that make up medical activities and specified in the license for medical activities issued in the prescribed manner.

At the same time, it is important that it is necessary to provide paid medical services in compliance with the procedure for the provision of medical care, which was approved by the Ministry of Health. This is stated in parts 3 and 4 of Article 84 of Federal Law No. 323-FZ and paragraphs 9 and 10 of the Rules for the provision of paid medical services.

Compliance with the standards of medical care in the provision of paid medical services

The Ministry of Health in the Letter indicated that paid medical services can be provided in full of the standard of medical care or, at the request of the patient, in part:

• in the form of separate consultations
• individual medical interventions.

It is also possible to provide medical services in an amount exceeding the scope of the standard of medical care being fulfilled.

Paid services in the list of services of medical organizations participating in the implementation of the program of free provision of medical care to citizens are possible.

In accordance with paragraph 7 of the Rules (Decree of the Government of the Russian Federation of 04.10.2012 No. 1006), such medical organizations can provide paid medical services in 4 cases:

A) on other terms than provided by the program, territorial programs and (or) target programs, at the request of the consumer (customer), including but not limited to:

• establishment of an individual post of medical observation during treatment in a hospital;
• the use of drugs that are not included in the list of vital and essential drugs, if their appointment and use is not due to vital indications or replacement due to individual intolerance to drugs included in the specified list, as well as the use of medical devices, medical nutrition, including the number of specialized health food products that are not provided for by the standards of medical care;

B) when providing medical services anonymously, with the exception of cases provided for by the legislation of the Russian Federation;

C) citizens of foreign states, stateless persons, with the exception of persons insured under compulsory health insurance, and citizens of the Russian Federation who do not permanently reside on its territory and are not insured under compulsory health insurance, unless otherwise provided by international treaties of the Russian Federation;

D) when applying for medical services on your own, except for the cases and procedure provided for in Article 21 of Federal Law No. 323-FZ, and for the provision of emergency, including emergency specialized, medical care and medical care provided in an emergency or emergency form.

Additional types of medical care

According to Part 3 of Article 81 of Federal Law No. 323-FZ, territorial programs of state guarantees of free provision of medical care to citizens, subject to the fulfillment of financial standards established by the program of state guarantees of free provision of medical care to citizens, may contain additional types and conditions for the provision of medical care, as well as additional volumes of medical care, including those providing for the possibility of exceeding the average indicators established by the standards of medical care.

How to create a list of paid and additional medical services?

The Ministry of Health believes that after specifying the medical service in accordance with the Nomenclature, it is possible to further specify the service depending on the features of its execution.

Since the law allows for the possibility of providing paid medical services in excess of the scope of the standard of medical care, medical organizations can expand the list of medical services as provided by the Nomenclature when providing medical services not included in the Nomenclature.

In view of the foregoing, it follows that when providing paid medical services in without fail the procedures for the provision of medical care must be observed, while at the request of the consumer (customer) these services can be provided in full of the standard of medical care or in the form of individual consultations or medical interventions, including in an amount exceeding the scope of the performed standard of medical care And.