Acuan Jasa Medik Dokter Tahun 2013

1. 1
ACUAN (TARIF)
JASA MEDIK DOKTER
Pengurus Besar Ikatan Dokter Indonesia
Jakarta, Oktober 2013

2. Kata Pengantar
Puji Syukur kita panjatkan Kehadirat Tuhan Yang Maha Esa kita diberikan kesehatan dan kekuatan
dalam melaksanakan tugas sebagai insan profesi maupun melakukan aktifitas sehari-hari di
masyarakat. Sebagai Organisasi Profesi,Ikatan Dokter Indonesia berperan menghasilkan kebijakan
dalam rangka memberikan pelayanan kesehatan kepada Masyarakat. Peran dokter sebagai Profesi
tidak terlepas dari Sistem yang berlaku di Indonesia.
Pemerintah telah menerbitkan UU No.40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional (SJSN)
yang mengamanatkan bahwa setiap orang atau warga negara berhak atas jaminan sosial untuk
dapat memenuhi kebutuhan dasar hidup yang layak dan meningkatkan martabatnya menuju
terwujudnya masyarakat Indonesia yang sejahtera, adil dan makmur. Program jaminan sosial
menurut Undang-Undang tersebut meliputi: jaminan kesehatan, jaminan kecelakaan kerja, jaminan
hari tua, jaminan pensiun dan jaminan kematian.
Sehubungan dengan jaminan kesehatan, Dokter sebagai salah satu pemberi pelayanan kesehatan,
mempunyai arti penting dalam pelaksanaan SJSN. Kinerja dan perilaku dokter berpengaruh besar
pada seluruh biaya pelayanan kesehatan. Terkait hal ini Ikatan Dokter Indonesia telah Menyusun
Acuan (Tarif) Jasa Medis Dokter. Acuan ini diharapkan menjadi salah satu dasar perhitungan dalam
menetapkan tarif keseluruhan jasa pelayanan sebagaimana yang dirancang dalam pembiayaan BPJS
– Ina CBG’s. Acuan ini merupakan dasar perhitungan dalam mencapai kesepakatan besaran jasa
medis yang akan diterima dan atau diberikan antara Para Dokter dengan Direksi Rumah Sakit; di
masing-masing Rumah Sakit dan Fasilitas Kesehatan Lainnya
Kami menyadari bahwa acuan (tarif) jasa medis ini masih belum sempurna, oleh karena itu kami
mengharapkan kritik dan saran dari Bapak/Ibu/Saudara untuk perbaikan yang akan datang.
Terima kasih kepada seluruh pihak yang telah berkontribusi sehingga tersusunnya Acuan (Tarif) Jasa
Medis Ini. Semoga acuan (tarif) ini memberikan bermanfaat demi peningkatan pelayanan kesehatan
bagi masyarakat.
Ketua Tim Pokja Harmonisasi Tarif Jasa Medis
Dr. H. N Nazar, Sp.B, M.H.Kes

3. Kata Sambutan
Ketua Umum Pengurus Besar Ikatan Dokter Indonesia
Salam Sehat Indonesia,
Dalam mewujudkan sistem kesehatan yang baik tidak lepas dari dua sistem yaitu sistem pelayanan dan
sistem pembiayaan kesehatan. Dalam sistem pelayanan, selain sarana prasarana pelayanan, standar
pelayanan dari tenaga kesehatan harus tetap diperhatikan. Standar pelayanan merupakan bagian dari
standar profesi yang merupakan kewenangan organisasi profesi untuk menyusunnya. Begitupun dengan
standar pembiayaan, diperlukan suatu kendali agar masyarakat dapat merasakan pelayanan kesehatan
yang bermutu.
Kedua sistem di atas, yaitu sistem pelayanan dan sistem pembiayaan mengharuskan IDI sebagai
organisasi profesi kedokteran untuk terlibat di dalamnya. Hal ini disebabkan IDI memiliki peran yang
diamanahkan oleh Undang-undang Nomor 29 tahun 2004 tentang Praktik Kedokteran yaitu Kendali
Mutu dan Kendali Biaya. Atas amanah ini, IDI diharuskan mengeluarkan aturan dan kebijakan organisasi
yang dijadikan acuan bagi seluruh dokter yang melakukan praktik di Indonesia agar tercipta sistem
kesehatan yang baik.
Terkait dengan kendali biaya, selain fokus pada pembiayaan di layanan primer, IDI dengan segenap
Perhimpunan Dokter Spesialis (PDSp) bersama menyusun acuan tarif dokter spesialis, dimana
diharapkan menjadi acuan bagi penetapan standar tarif dalam pelayanan kesehatan di masa
mendatang. Apalagi, menjelang pelaksanaan Sistem Jaminan Sosial Nasional di bidang kesehatan,
permasalahan terkait pembiayaan harus tuntas berdasarkan usulan IDI. Hal ini untuk menjaga agar tidak
terjadi disharmoni antar spesialisasi, serta dapat meminimalisir potensi moral hazard di dalam
pembiayaan.
Semoga dengan buku acuan (tarif) jasa dokter spesialis ini dapat memberikan kontribusi besar terhadap
perbaikan mutu pelayanan dokter Indonesia pada khususnya serta sistem kesehatan di Indonesia pada
umumnya. Terima kasih yang sebesar-besarnya kepada tim penyusun dan segenap pengurus
perhimpunan yang terlibat dalam penyusunan acuan ini. Semoga Tuhan Yang Maha Kuasa meridhoi
upaya kita semua. Amin
Billahit Taufiq Walhidayah,
Ketua Umum
Pengurus Besar Ikatan Dokter Indonesia
Dr.Zaenal Abidin,M.H.

4. DAFTAR ISI
Kata Sambutan……………………………………………………………………………………………………………………………..i
Kata Pengantar................................................................................................................................. ii
Daftar Isi........................................................................................................................................... iii-iv
Pendahuluan.................................................................................................................................... v-viii
Lingkup Bedah.................................................................................................................................. 1
Tarif Jasa Medis Tindakan Pembedahan Dokter Spesialis Bedah Umum......................................... 2-13
Tarif Jasa Medis Tindakan Pembedahan Dokter Spesialis Bedah Anak............................................ 14-18
Tarif Jasa Medis Tindakan Pembedahan Dokter Spesialis BedahOrthopaedi&Traumatologi…..... 19-27
Tarif Jasa Medis Tindakan Pembedahan Dokter Spesialis Bedah PlastikRekonstruksi&Estetik..... 28-40
Tarif Jasa Medis Tindakan Pembedahan Dokter Spesialis Bedah Saraf............................................ 41-45
Tarif Jasa Medis Tindakan Pembedahan Dokter Spesialis Bedah Toraks Kardiovaskular................ 46-52
Tarif Jasa Medis Tindakan Pembedahan Dokter Spesialis BedahUrologi........................................ 53-58
Tarif Jasa Medis Tindakan Pembedahan Dokter Spesialis Obstetri&Ginekologi............................ 59-63
Tarif Jasa Medis Tindakan Pembedahan Dokter Spesialis THT…..……………………………...................... 64-71
Tarif Jasa Medis Tindakan Pembedahan Dokter Spesialis Mata...................................................... 72-77
Lingkup Non-Bedah.......................................................................................................................... 78
Tarif Jasa Medis Tindakan Dokter Spesialis Penyakit Dalam........................................................... 79-84
Tarif Jasa Medis Tindakan Dokter Spesialis Jantung&PembuluhDarah........................................ 85-88
Tarif Jasa Medis Tindakan Dokter Spesialis Anak............................................................................ 89-90
Tarif Jasa Medis Tindakan Dokter Spesialis Saraf (Neurologi)......................................................... 91-95
Tarif Jasa Medis Tindakan Dokter Spesialis Kulit&Kelamin............................................................ 96-98
Tarif Jasa Medis Tindakan Dokter Spesialis KedokteranJiwa.......................................................... 99-100
Tarif Jasa Medis Tindakan Dokter Spesialis OnkologiRadiasi......................................................... 101-102
Tarif Jasa Medis Tindakan Dokter Spesialis KedokteranNuklir....................................................... 103-106
Tarif Jasa Medis Tindakan Dokter Spesialis Kedokteran Olahraga.................................................. 107

5. Tarif Jasa Medis Tindakan Dokter Spesialis Okupasi…………….......................................................... 108-110
Tarif Jasa Medis Tindakan Dokter Spesialis Akupuntur.................................................................... 111-115
Lingkup Penunjang Medis................................................................................................................ 116
Tarif Jasa Medis Tindakan Dokter Spesialis FarmakologiKlinik….................................................... 117
Tarif Jasa Medis Tindakan Dokter Spesialis Gizi Klinis..................................................................... 118
Tarif Jasa Medis Tindakan Dokter Spesialis Mikrobiologi Klinik....................................................... 119-121
Tarif Jasa Medis Tindakan Dokter Spesialis Parasitologi Klinik........................................................ 122
Tarif Jasa Medis Tindakan Dokter Spesialis Patologi Anatomi......................................................... 123-124
Tarif Jasa Medis Tindakan Dokter Spesialis Patologi Klinik.............................................................. 125
Tarif Jasa Medis Tindakan Dokter Spesialis Radiologi...................................................................... 126-159
Tarif Jasa Medis Tindakan Dokter Spesialis Rehabilitasi Medik....................................................... 160-164
Lingkup Anestesi,Terapi Intensif di ICU, dan Pengelolaan Nyeri...................................................... 165
Tarif Jasa Medis Tindakan Dokter Spesialis Anestesi....................................................................... 166-243
Lampiran……………………………………………………………………………………………………………………………………….244-246
Referensi.......................................................................................................................................... 247-249

6. v
Pendahuluan
Perkembangan sosio kultural dan kemajuan Ilmu Kedokteran saat ini menuntut hubungan
dokter – pasien bukan lagi merupakan hubungan yang bersifat paternalistik tetapi menjadi
hubungan yang didasari pada kedudukan yang seimbang. Ketika dalam hubungan itu disertai dengan
hak dokter untuk mendapatkan imbalan jasa dari pasien dan pasien bersedia memenuhinya maka
hubungan itu menjadi hubungan kontraktual. Hubungan kontraktual terjadi karena para pihak yaitu
dokter dan pasien masing-masing diyakini mempunyai kebebasan dan mempunyai kedudukan yang
setara. Kedua belah pihak mengadakan suatu perikatan atau perjanjian di mana masing-masing
pihak harus melaksanakan peranan atau fungsinya satu terhadap yang lain. Peranan tersebut bisa
berupa hak dan kewajiban. Seluruh proses tersebut diatas berlangsung dan berlaku dalam lingkup
Rumah Sakit.
Hubungan dokter-pasien sangat dipengaruhi oleh etika profesi kedokteran, sebagai bentuk
konsekuensi kewajiban profesi yang merupakan batasan atau rambu-rambu hubungan tersebut.
Kewajiban tersebut tertuang di dalam prinsip moral profesi, yaitu autonomy (menghormati hak-hak
pasien), beneficence (berorientasi kepada kebaikan pasien), non maleficence (tidak mencelakakan
atau memperburuk keadaan pasien) dan justice (keadilan distribusi, meniadakan diskriminasi)
sebagai prinsip utama profesionalisme seorang dokter.
Sebagai salah satu konsekuensi dari hubungan profesionalisme tersebut maka secara tidak
langsung menyangkut masalah pembiayaan Jasa Medis, merupakan hal yang sangat sensitif.
Dengan adanya perkembangan aturan pemerintah tentang pelaksanaan BPJS, ditenggarai
bahwa perhitungan komponen jasa medis yang tidak proporsional berpotensi terjadinya
kecenderungan penurunan profesionalisme seorang dokter hingga kemungkinan menimbulkan
“moral hazard”.
Mengingat penting dan sangat mendasarnya hal tersebut di atas, maka PB-IDI kembali membentuk
Pokja Harmonisasi (Tarif) Jasa Medis Dokter (SK No 474/PB/A.4/06/2013 tanggal 19 Juni 2013)
tentang Tim Kelompok Kerja Harmonisasi Tarif Jasa Medis Ikatan Dokter Indonesia .Tugas utama
Pokja adalah menyusun Acuan (Tarif) Jasa Medis Dokter untuk semua tingkat pelayanan (primer,
sekunder & tertier). Acuan Jasa Medis ini diharapkan menjadi salah satu dasar perhitungan dalam
menetapkan tarif keseluruhan jasa pelayanan sebagaimana yang dirancang dalam pembiayaan BPJS
– Ina CBG’s. Tidak kurang pentingnya pula bahwa Acuan Jasa Medis ini merupakan dasar
perhitungan dalam mencapai kesepakatan besaran jasa medis yang akan diterima dan atau
diberikan antara Para Dokter dengan Direksi Rumah Sakit; di masing-masing Rumah Sakit.

7. vi
Esensi dari acuan jasa medis ini adalah pernyataan sikap para dokter anggota IDI bagaimana
selayaknya penghargaan terhadap tindak profesi yang dikonversi dalam bentuk nominal, sekaligus
menunjukan bagaimana besarnya kontribusi profesi dokter untuk program BPJS ini.
Oleh karena itu sebagai representative dari seluruh dokter Indonesia, IDI telah membuat
suatu ketetapan bersama tentang tata cara pembiayaan imbalan jasa (dikenal dengan jasa medis)
yang bersumber dari masukan seluruh Perhimpunan Dokter-Dokter dilingkungan IDI, MPPK;
narasumber dari bidang terkait; seluruhnya terhimpun dalam Pokja Harmonisasi Acuan Tarif Jasa
Medis. Sebagai perbandingan kami juga melakukan bench marking jasa medis / take home pay para
dokter di negara-negara tetangga seperti Malaysia, Thailand, Filipina, Myanmar, Australia, dan
Jerman.
Setelah melalui proses interaktif dan sangat partisipatif dari seluruh peserta pokja dihasilkan
tarif jasa medis yang cukup berkeadilan, bukan hanya bagi dokter atau tenaga medis tetapi juga bagi
semua pihak terkait; termasuk Rumah Sakit.
Disepakati dan ditetapkan bahwa Acuan Tarif Jasa Medis menyesuaikan dan selaras dengan
masa transisi periode awal era BPJS - Ina CBG’s, yaitu berdasarkan:
1. Kinerja atau upaya yang diperlukan untuk menegakkan diagnosa sampai tindakan/prosedur
medis yang diperlukan termasuk rehabilitasi. ini diformulasikan dalam scoring system.
2. Nilai nominal aplikatif yang merupakan bagian dari komponen tarif pelayanan yaitu Relative
Value Unit.
Scoring system merupakan kumpulan dari 5 (lima) variabel, yang bersifat konstan, yaitu:
1. Kualifikasi SDM ( F.1 )
2. Pencapaian Kompetensi ( F.2.1 )
3. Tindakan atau prosedur yang memerlukan bantuan, misalnya anestesi ( F.2.2 )
4. Faktor tanggung jawab atau risiko ( F.3 )
5. Faktor waktu, yang diperlukan melakukan tindakan (F.4 )
Relative Value Unit merupakan komponen harga satuan setiap tindakan; bersifat fleksibel
baik terhadap masing-masing spesialisasi, maupun terhadap sebagian/sekelompok spesialis yang
akan mengalami penyesuaian mengikuti kesepakatan dan kondisi masing-masing pemangku
kepentingan di masing-masing Rumah Sakit.
Oleh karena itu sangat penting bahwa terteranya dengan jelas posisi Jasa Medis setiap
dokter / setiap tindakan dalam hal ini Regulasi dari Kemenkes sebagai “pengadil” sangat dibutuhkan,

8. vii
untuk menghindari sak-wasangka terhadap Direksi Rumah Sakit sebagai pembagi Jasa Medis
tersebut.
Berdasarkan kesepakatan dan wacana selama pembahasan dalam Pokja Harmonisasi Acuan
Tarif Jasa Medis melalui pertemuan diskusi berkelanjutan yang komprehensif, diyakini bahwa cara
pembayaran-penghasilan profesi yang paling ideal adalah sistem remunerasi. Namun untuk
menyusun sistem remunerasi tersebut memerlukan referensi dan penelaahan akademis yang lebih
sempurna serta dibutuhkan waktu yang cukup panjang; sehingga disepakati dalam masa transisi ini
cara pembayaran-penghasilan profesi dokter mengacu pada:
1. Penghasilan jasa tetap ( basic salary )
2. Penghasilan jasa Profesi ( fee for service )
Penghasilan jasa tetap yang selanjutnya disebut sebagai basic salary merupakan penghasilan
dasar setiap dokter yang besarannya bersifat tetap dalam kurun waktu tertentu sesuai dengan
kesepakatan bersama antara dokter dan Rumah Sakit. Penghasilan dasar ini meliputi / terdiri dari
antara lain: gaji pokok, tunjangan fungsional, tunjangan keluarga, tunjangan natura, dan lain-lain
sejenisnya selain penghasilan dari Jasa Medis. Dikenal juga sebagai fee for position.
Acuan Basic salary yang ideal antara lain :
1. Acuan basic salary Dokter Pelayanan Primer : Rp 12.500.000,00 sampai Rp 15.000.000,00 / bulan
2. Acuan basic salary Dokter Spesialis : Rp 22.500.000,00 sampai Rp 42.500.000,00 / bulan
Penghasilan jasa Profesi yang selanjutnya disebut sebagai fee for service besarannya
tergantung dari kinerja / produktivitas dokter yang bersangkutan; merupakan tambahan penghasilan
positif terhadap basic salary. Diperhitungkan dari hasil kinerja, performance, atau produktifitas
dokter yang bersangkutan yang telah melebihi nilai nominal basic salary. dikenal juga sebagai Fee for
performance dan fee for person.
Khusus mengenai basic salary Dokter Pelayanan Primer, acuan tersebut di atas diajukan
kalau Panduan Cara Pembayaran Dokter Pelayanan Primer belum terformulasi.
Selain kedua hal di atas dinilai perlu “keseragaman” tarif konsultasi di poliklinik, ruang rawat,
perawatan khusus, emergensi/UGD, dll. Sebagai berikut:
Untuk BPJS/PBI/Kelas III:
a. Konsultasi poliklinik dokter umum : Rp 25.000,00 - Rp 50.000,00
b. Konsultasi poliklinik dokter spesialis/ : Rp 75.000,00 - Rp 100.000,00
UGD dan perawatan khusus
c. Visite/ruang rawat inap : Rp 50.000,00 - Rp 75.000,00

9. viii
Acuan Tarif Jasa Medis tersebut di atas merupakan tarif dasar ( tarif sosial ) bagi perawatan
kelas III; untuk perhitungan tarif profesional dianjurkan menggunakan faktor pengali yang
ditetapkan berdasarkan gradasi kelas perawatan, yaitu:
Kelas II - Faktor pengali (1.10 - 1.15)
Kelas I - Faktor pengali (1.20 - 1.25)
VIP - Faktor pengali (1.30 - 1.40)
Seyogyanya komponen tarif jasa medis wajib tertabulasi atau tertulis dengan jelas disamping
tarif pelayanan yang ditentukan oleh setiap Rumah Sakit.
Pokja Harmonisasi Acuan Tarif Jasa Medis akan terus bekerja, tidak saja hanya memantau
dan mengevaluasi pelaksanaan acuan tarif jasa medis ini; namun yang lebih penting lagi adalah
realisasi tarif lanjutan (dengan melakukan survey, study banding, perhitungan real cost) sehingga
terwujud tarif rasional, berkeadilan dengan referensi akademik yang dapat dipertanggungjawabkan;
serta kesepahaman implementasi clinical pathway yang mempengaruhi biaya pelayanan secara
keseluruhan.
Kami menyadari bahwa acuan (tarif) jasa medis ini masih belum sempurna, masih belum
sesuai benar dengan apa yang kita harapkan, namun ini adalah tahap awal dari salah satu
pernyataan eksistensi para dokter anggota IDI. Koreksi, kritik dan saran para sejawat akan sangat
bermakna bagi perbaikan-perbaikan dikemudian hari.
Terima kasih dan maaf yang sebesar-besarnya kepada seluruh teman sejawat yang sejak
semula dikeluarkannya SK Pokja ini yaitu dari MPPK, unsur pimpinan PB IDI, perwakilan-perwakilan
seluruh perhimpunan, para konsultan dan tim ahli serta seluruh anggota Pokja; yang hampir tidak
pernah absen dalam setiap rapat pembahasan sampai tahap akhir rapat pleno dengan penuh
semangat dan keikhlasan berkontribusi demi terwujudnya acuan (tarif) jasa medis ini. Kiranya Yang
Maha Kuasa jualah yang akan membalas semuanya ini.
Kepada institusi pembuat regulasi dan pemangku kebijakan di negeri ini, kami nyatakan
inilah kontribusi IDI dalam menyokong program “Universal Health Coverage” dengan tetap
mengutamakan “Patient Safety”.

10. 1
LINGKUP
BEDAH

11. 1AffArchBarr24.82545155595200001,900,000
2AffArchBarrdansuspensimaksila24.825454555125200002,500,000
3AmputasiAboveKnee84.172545451525155200003,100,000
4AmputasiBelowKnee84.152545451525155200003,100,000
5AmputasiJari(Phalangs-Traumatik)84.012515155565200001,300,000
6Amputationofdigitisingle**84.01204515515100200002,000,000
7Analfistulectomy49.12254545525145200002,900,000
8Analfistulotomy49.11254545515135200002,700,000
9AneurismaA.Brachialis(diluargraft)39.522545451525155200003,100,000
10AneurismaA.Femoralis(diluargraft)39.522545451545175200003,500,000
11Appendicostomy47.912545454525185200003,700,000
12Arterialpungsi,kanulasi,sectie38.91251515151585200001,700,000
13Arteriovenousshunt(AVShunt)brakiosefalika39.27254545515135200002,700,000
14Arteriovenousshunt(AVShunt)radiosefalika39.27254545515135200002,700,000
15AV – Shunt (Lokal Anestesi)39.27254515515105200002,100,000
16Axillarydissection40.512545451525155200003,100,000
17Babcock38.592545451520150200003,000,000
18BatuSaluranKemih*56.2/56.0204545520135200002,700,000
19Bilateralexcisionofectopicbreasttissue(mammaaberans)85.242545451525155200003,100,000
20Bilateralinguinalherniarepairwithgraftorprosthesis,nototherwisespecified53.172545451515145200002,900,000
21Bilateralmultipelexcisionoflesionofbreastwithnarcose85.22545451525155200003,100,000
22BilateralOvariectomy65.512545454530190200003,800,000
23Bilateralradicalmastectomy85.462590454545250200005,000,000
24Bilateralrepairofdirectinguinalhernia53.112545451515145200002,900,000
25Bilateralrepairofdirectinguinalherniawithgraftorprosthetis53.142545451515145200002,900,000
26Bilateralrepairoffemoralherniawith/withoutgraftofprosthesis53.312545451515145200002,900,000
27Bilateralrepairofindirectinguinalhernia53.122545451515145200002,900,000
RVUNO
TARIFJASAMEDISTINDAKANPEMBEDAHANDOKTERSPESIALISBEDAHUMUM
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
2

12. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
28Bilateralrepairofindirectinguinalherniawithgraftorprosthesis53.152545451515145200002,900,000
29Bilateralrepairofinguinalhernia,nototherwisespecified53.102545451515145200002,900,000
30Bilateralrepairofinguinalhernia,onedirectandoneindirect53.132545451515145200002,900,000
31
Bilateralrepairofinguinalhernia,onedirectandoneindirect,withgraftor
prosthesis
53.162545451515145200002,900,000
32Bilateralsimplemastectomy85.422545451535165200003,300,000
33Biopsipembuluhdarah(perifer)*38.2120151551570200001,400,000
34BiopsiPerikardium*37.242045454525180200003,600,000
35Biopsiterbukabronkhus*33.252045451525150200003,000,000
36Biopsiterbukadiafragma*34.272015451525120200002,400,000
37Biopsiterbukamediastinum*34.262045451525150200003,000,000
38Biopsiterbukaparu*33.282045451525150200003,000,000
39Biopsiterbukapleura*34.242045451525150200003,000,000
40BiopsiterbukapleuradenganVATS*34.242045451525150200003,000,000
41Biopsiterbukatumordindingthoraks*34.2320154551095200001,900,000
42Biopsyinsisionaldengananastesilokal83.212515155565200001,300,000
43Biopsyofanus49.232515155565200001,300,000
44Biopsyofperianaltissue49.222515155565200001,300,000
45Caecostomy45.722545451545175200003,500,000
46Cholecystectomy51.222545454525185200003,700,000
47Choledochoplasty51.722590451540215200004,300,000
48ClippingCostae(diluarplate)79.392545451525155200003,100,000
49Closedreductionoftemporomandibulardislocation76.93251545515105200002,100,000
50Closureofanalfistula49.732545151515115200002,300,000
51Closureofappendicealfistula47.922545451520150200003,000,000
52Closureofcholecystostomy51.922545451520150200003,000,000
53Closureoffistulaoflargeintestine46.762545451520150200003,000,000
54Closureoffistulaofsmallintestine,exceptduodenum46.742545451520150200003,000,000
55Closureofintestinalstoma46.512545451520150200003,000,000
56Closureoflecerationofliver50.612545454545205200004,100,000
57Colostomy,nototherwisespecified46.102545451525155200003,100,000
3

13. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
58Combustio(LukaBakar)*86.282015451515110200002,200,000
59Commonductexplorationforremovalofcalculus51.412590451520195200003,900,000
60Compartementexcision83.142590451520195200003,900,000
61completeglossectomy25.32590454540245200004,900,000
62Completethyroidectomy06.42545454525185200003,700,000
63Controlofhemorrhageofanus49.952515451515115200002,300,000
64Debridementmediastinum(Sternotomi)*77.312045451530155200003,100,000
65Debridement-nekrotomilukagangren86.22251515151585200001,700,000
66Deseksisubmandibula40.212545454525185200003,700,000
67Disartikulasisendiekstremitas84.062545151515115200002,300,000
68Diseksileherradikal/radikalneckdissection*40.42090451520190200003,800,000
69Dislokasibahu*81.8220151551570200001,400,000
70Drainageofappedicealabscess47.22545451520150200003,000,000
71Drainageofpancreaticcystbycatheter52.012545451545175200003,500,000
72EksisiBiopsiTumorpembuluhdarah38.21254545510130200002,600,000
73Eksisigldsubmandibula26.32545451525155200003,100,000
74Eksisihigromaleher*40.292045451535160200003,200,000
75Eksisikistatiroglosus06.72545451525155200003,100,000
76Eksisiluastumorganasbibirdenganrekonstruksiflaplokal27.42+27.572545451545175200003,500,000
77Eksisiluastumorganasdenganrekonstruksiflapjauh86.4+86.742590451540215200004,300,000
78Eksisiluastumorganaskulittanparekonstruksi86.42545451525155200003,100,000
79Eksisiluastumorganasronggamulutdenganrekonstruksiflaplokal27.49+27.572590451540215200004,300,000
80Eksisipadabronkhus322590451540215200004,300,000
81Eksisiparsial+marsupialisasiRanula26.21254545515135200002,700,000
82EksisiPseudoaneurisma39.522545451525155200003,100,000
83EksisiTumorDindingdada*34.792015451525120200002,400,000
84Eksisitumorganaskulitdenganflaplocalataugraftkulit86.4+86.72545451545175200003,500,000
85Eksisitumorjinakdengananastesilokal86.22015155560200001,200,000
86EksisiTumorPembuluhDarahPerifer**38.602015451525120200002,400,000
87Eksisitumorpembuluhdarahperifer(hemangioma)**38.602015451525120200002,400,000
88Ekskokleasiepulis24.3254515515105200002,100,000
4

14. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
89Ekskokleasikistafolikuler86.225454555125200002,500,000
90Ekskokleasikistaradikuler86.225454555125200002,500,000
91Eksplorasivaskular(Trauma/NonTrauma)39.992545451545175200003,500,000
92Ekstirpasi/eksisitumorjinakjaringanlunakukuran<2cm**86.220154551095200001,900,000
93Ekstirpasikistadermoid*83.3920151551570200001,400,000
94EkstraksiCorpusAlienumdiRegioToraks*86.052045451525150200003,000,000
95EkstraksiCorpusAlienumdiRegioToraksdenganVATS*34.992090451520190200003,800,000
96Embolektomi(diluaralat)38.02545451510140200002,800,000
97Embolektomi/trombektomiaorta38.042090451530200200004,000,000
98Embolektomi/trombektomipembuluhdaraharteriekstremitasbawah*38.082015451525120200002,400,000
99Embolektomi/trombektomipembuluhdaraharteriabdominal*38.062045451525150200003,000,000
100Embolektomi/trombektomipembuluhdarahekstremitasatas(diluaralat)*38.032015451525120200002,400,000
101Embolektomi/trombektomipembuluhdarahekstremitasbawah(diluaralat)*38.092015451525120200002,400,000
102
Embolektomi/trombektomipembuluhdarahregioservikal(karotis,jugular)
(diluaralat)*
38.022015451525120200002,400,000
103Endoscopicpolypectomyofrectum48.36254515515105200002,100,000
104Endoscopicthyroidectomy06.32590451530205200004,100,000
105EvakuasiHematom(pascapungsi)86.012515155565200001,300,000
106Evakuasihematomdiekstremitas(pascapungsiHD/traumatik)86.012515455595200001,900,000
107Excisionofectopicbreasttissue85.2425454555125200002,500,000
108Excisionofhemorrhoids49.462545151515115200002,300,000
109excisionoflesionofbreastwithnarcose85.22545451510140200002,800,000
110Excisionofotherbileduct51.692590451540215200004,300,000
111Excisionofperianalskintags49.0254515510100200002,000,000
112Excisionofthyroglossalductortrac06.72545451525155200003,100,000
113Explorationofcommonduct51.512590451520195200003,900,000
114Exploratorylaparotomy54.112545454525185200003,700,000
115Exteriorizationoflargeintestine46.032545451545175200003,500,000
116Exteriorizationofsmallintestine46.012545451545175200003,500,000
117Fasciotomy*83.142015451525120200002,400,000
118Fiksasiinternafrakturmaksilofasial1-2tempatpatahan*76.742045451525150200003,000,000
5

15. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
119Fiksasiinternafrakturnasal21.72545451525155200003,100,000
120FiksasiinternaFrakturPanfacial76.792590454550255200005,100,000
121FiksasiSternum(Wire,Plate)(diluarwire/plate)*78.592045451545170200003,400,000
122FrakturAntebrachi79.322545451515145200002,900,000
123FrakturColles&Pergelangantanganlainnya79.322545451515145200002,900,000
124FrakturCruris79.362545451545175200003,500,000
125FrakturFemur*79.352015451545140200002,800,000
126FrakturHumerus*79.312015451525120200002,400,000
127Frakturklavikula78.51254545155135200002,700,000
128FrakturOlekranon79.322545451525155200003,100,000
129FrakturPatela79.392545451525155200003,100,000
130FrakturSuprakondilerHumerus79.312545451545175200003,500,000
131Freeskingraft86.60254545510130200002,600,000
132Full-thicknessskingrafttohand86.61254545510130200002,600,000
133Full-thicknessskingrafttoothersites*86.632015451525120200002,400,000
134Gastrostomi*43.120154551095200001,900,000
135Groindissection40.542545451545175200003,500,000
136Hemiglosektomi25.22545451545175200003,500,000
137HidrokelTestis/Funikuli**61.22015451525120200002,400,000
138HipertropiProstatBeningna(BPH)*60.32015451540135200002,700,000
139Ileostomy,nototherwisespecified*46.202015451545140200002,800,000
140Incisionofperianalabscess49.0125151551575200001,500,000
141Incisionalherniarepair53.512545451525155200003,100,000
142Incisionalherniarepairwithprosthesis53.612545451525155200003,100,000
143insertionofsyntheticimplantinfacialbone76.922545451545175200003,500,000
144Insisiabsesdengananastesilokal86.032515155565200001,300,000
145Insisiflegmondasarmulut27.02545451515145200002,900,000
146Internaldrainageofpancreaticcyst52.42545451545175200003,500,000
147InternalFiksasifrakturcondylusmandibula76.762590451520195200003,900,000
148Internalfiksasifrakturmaksilofasial5tempatpatahan/lebih76.742590451520195200003,900,000
149InternalFiksasifrakturMandibulasegmental76.762590451520195200003,900,000
6

16. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
150Intra-abdominalmanipulationofintestine,nototherwisespecified46.802545454525185200003,700,000
151Intra-abdominalmanipulationoflargeintestine46.822545454525185200003,700,000
152Intra-abdominalmanipulationofsmallintestine46.812545454525185200003,700,000
153Labioshisis*27.5420154551095200001,900,000
154Laparoscopicappendectomy47.012545451525155200003,100,000
155Laparoscopicappendectomy(elective)47.012545451525155200003,100,000
156Laparoscopiccholecystectomy51.232545451525155200003,100,000
157Laparoscopicincidentalappendectomy47.112545451525155200003,100,000
158Laparoscopiclysisofperitonealadhesions54.512545454545205200004,100,000
159Laparoscopy54.212545451525155200003,100,000
160Large-to-largeintestinalanastomosis45.942545454530190200003,800,000
161Laringectomi*30.32090451540210200004,200,000
162Laringectomidengandiseksileher*30.42090451540210200004,200,000
163Lefthemicolectomy45.752545454535195200003,900,000
164Leftlateralanalsphincterotomy49.512545451525155200003,100,000
165Ligasivaskularekstremitas38.825151551575200001,500,000
166Ligationofhemorrhoids49.452545151515115200002,300,000
167Lobektomiparsial(reseksiparusegmental)*32.32090451540210200004,200,000
168Localexcisionoflesionofbreast85.21254515510100200002,000,000
169Localexcisionofrectallesionortissue49.3254515515105200002,100,000
170Maksilektomitotal+Rekonstruksi*76.45+76.912090451520190200003,800,000
171Mediastinostomy34.12590451540215200004,300,000
172ModifikasiRND/functionalneckdissection40.42590454540245200004,900,000
173Multipelexcisionoflesionofbreastwithnarcose85.22545451530160200003,200,000
174Muscleflapgrafttobreast85.852590451520195200003,900,000
175Muscleflapgrafttobreast(TRAMflap/LDflap)85.852590451520195200003,900,000
176Mutilasidigitiekstremitas(Multiple)85.012545451510140200002,800,000
177Openbiopsiofbreast85.1254545155135200002,700,000
178Openbiopsyofgallbladderorbileducts51.132545451525155200003,100,000
179Openbiopsyofliver50.122545451525155200003,100,000
180Openbiopsyofpancreas52.122545451525155200003,100,000
7

17. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
181Openbiopsyofrectum48.252545155595200001,900,000
182openbiopsyofsalivaryglandorduct26.1225454555125200002,500,000
183openreductionofalveolarfracture*76.772015451525120200002,400,000
184openreductionofmalarandzygomaticfracture76.722545451545175200003,500,000
185Openreductionofmandibularfractur76.762545451545175200003,500,000
186openreductionofmaxillaryfracture76.742545451545175200003,500,000
187OperasiCommando25.42590454550255200005,100,000
188Osteotomieksisitulangmaksilofasial76.392545451535165200003,300,000
189Otherappendectomy(elective)*47.02015451520115200002,300,000
190Otherbilateralfemoralherniorraphy53.292545451515145200002,900,000
191Otherdestructionoflesionofliver50.292545454545205200004,100,000
192Otherdiagnosticproceduresofabdominalregion54251545155105200002,100,000
193Otherexcisionofperianaltissue49.3251515151585200001,700,000
194Otherherniarepair53.92545451510140200002,800,000
195Otherincidentalappendectomy*47.192015451520115200002,300,000
196Otherincisionofanus49.93251545515105200002,100,000
197Otherincisionofskinandsubcutaneoustissue86.092515455595200001,900,000
198Otherlaparotomy54.192545454545205200004,100,000
199
Otherlocalexcisionordestructionoflesionortissueofskinandsubcutaneous
tissue
86.22515455595200001,900,000
200Otherlysisofperitonealadhesions54.52515451545145200002,900,000
201Otheroperationsonanus49.9251545515105200002,100,000
202Otheroperationsonintestines46.92545454525185200003,700,000
203Otheroperationsonpancreas52.92590454540245200004,900,000
204Otheroperationsonthebreast/Reconstructionofthebreast85.92590451540215200004,300,000
205Otheroperationsontrachea31.992515451525125200002,500,000
206Otherpancreatotomy52.092590454550255200005,100,000
207Otherpartialexcisionoflargeintestine45.792545454535195200003,900,000
208Otherpartialthyroidectomy06.32545454525185200003,700,000
209Otherproceduresonhemorrhoids49.42515454515145200002,900,000
210Otherreconstructionofotherfacialbone76.462590451520195200003,900,000
8

18. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
211Otherreconstructionofmandible76.432590451520195200003,900,000
212Otherrepairandplasticoperationoftongue25.592590451520195200003,900,000
213Otherrepairofabdominalwall54.722515451525125200002,500,000
214Otherrepairofanalsphincter49.792515451525125200002,500,000
215Otherrepairofintestine46.72545451545175200003,500,000
216Otherrepairofmesentery54.752545451545175200003,500,000
217Otherskingrafttohand86.62251545510100200002,000,000
218Otherskingrafttoothersites86.692515451525125200002,500,000
219Othersmall-to-largeintestinalanastomosis45.932545454535195200003,900,000
220Othersutureofabdominalwall54.632545451545175200003,500,000
221Otherumbilicalherniorraphy*53.492045451525150200003,000,000
222Otherunilateralfemoralherniorraphy53.292545451510140200002,800,000
223Palatoshisis**27.62015451525120200002,400,000
224Parathyroidectomysubtotal06.892590454520225200004,500,000
225Parathyroidectomytotal06.812590454520225200004,500,000
226Parotidektomisuperfisial*26.22015451545140200002,800,000
227Parotidektomitotal26.322590454545250200005,000,000
228PartialGastrectomy43.52590454550255200005,100,000
229partialglossectomy25.22545451545175200003,500,000
230Partialhepatectomy50.222590454550255200005,100,000
231partialmandibulectomyhemimandibulectomy76.312590454520225200004,500,000
232Partialsplenectomy41.432545454545205200004,100,000
233PasangDoubleLumenHemodialysis(HD)(diluaralat)39.952515451515115200002,300,000
234PasangImplantableCentralVenousAccess(diluaralat:port-a-cath®,celsite®)*38.9320154551095200001,900,000
235PasangThoraksDrain/WSD(diluaralat)*34.04201545515100200002,000,000
236Pedicleorflapsgraft,nototherwisespecified86.752590451520195200003,900,000
237Pelepasanplat&skrupmaksilofasial3tempatataulebih76.9725454555125200002,500,000
238Pelepasanplat&skruptulangmaksilofasial1-2tempat76.9725454555125200002,500,000
239PemasanganCentralVenousCatheter(CVC)(diluaralat)38.932515155565200001,300,000
240Pemasanganinterdentalwiring/archbar24.72545151515115200002,300,000
9

19. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
241PemasanganPeritonealDialysis(PD)Catheter(diluaralat)54.982545151515115200002,300,000
242Pembedahanteleangiectasis38.62545454525185200003,700,000
243PembuatanThoracicwindow34.092545451525155200003,100,000
244Pericardiocentesis*37.002015451510105200002,100,000
245Perikardiektomi*37.312045451545170200003,400,000
246Perikardiotomi/Pericardialwindow*37.122045451525150200003,000,000
247Permanentcolostomy46.132545451545175200003,500,000
248Permanentileostomy46.232545451545175200003,500,000
249Pionephrosis55.012545454525185200003,700,000
250Pleuralwindow(EloeserFlap)*34.092015451525120200002,400,000
251Pleurektomi*34.52090451530200200004,000,000
252Pleurodesis(pleurosklerosis)*34.62015155560200001,200,000
253PlikasiBulae/BlebEmfisematous32.212545451525155200003,100,000
254Plikasidiafragma*53.812090451520190200003,800,000
255Pneumonectomy*32.52090451540210200004,200,000
256ProsedurSistrunkkistaduktustiroglosus06.72545451525155200003,100,000
257Pulmonarydecortication*34.512045451545170200003,400,000
258Pungsihematom/seroma86.012515155565200001,300,000
259Radicalexcisionofskinlesion86.42545451525155200003,100,000
260Reclosureofpostoperativedisruptionofabdominalwall54.612515451545145200002,900,000
261RedoTorakotomi*34.032090451520190200003,800,000
262Reductionofanalprolapse49.942515454525155200003,100,000
263RekonstruksiarteriekstremitasdenganBypassGraftsynthetic(diluarprotesa)39.52590454550255200005,100,000
264Rekonstruksifrakturblow-out74.462590454540245200004,900,000
265Rekonstruksimenggunakanflapbebas86.742590454550255200005,100,000
266Rekonstruksisternum&dindingdada34.792590454540245200004,900,000
267
Rekonstruksivaskularekstremitasinferior(Arterifemoralis&poplitea)(diluar
graft)
39.52590451540215200004,300,000
268
Rekonstruksivaskularekstremitassuperior(Arteribrakialis,radialis&ulnaris)
(diluargraft)
39.52590451540215200004,300,000
10

20. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
269ReleaseKontrakturmandibula86.842545151530130200002,600,000
270Releasetongtie*25.91201545515100200002,000,000
271Releasetortikolis83.852545451545175200003,500,000
272Removalofforeignbodyfromretro-peritonealcavity54.922545451545175200003,500,000
273Removalofforeignbodyfromperitonealcavity54.922545451545175200003,500,000
274Reopeningofrecentlaparotomysite54.122545451545175200003,500,000
275RepairaneurismaAortaAbdominalis(diluarprotesa)*38.342090454550250200005,000,000
276RepairAr.Poplitea&Femoralis(diluargraft)39.312545454545205200004,100,000
277RepairLaserasiDiafragma*34.822045451525150200003,000,000
278Repairofdiaphragmatichernia,abdominalapproach53.72545451545175200003,500,000
279Repairofdirectinguinalhernia53.012545451510140200002,800,000
280Repairofdirectinguinalherniawithgraftorprosthesis53.032545451510140200002,800,000
281Repairofgastroschisis54.712590454530235200004,700,000
282Repairofindirectinguinalhernia53.022545451510140200002,800,000
283Repairofindirectinguinalherniawithgraftorprosthesis53.042545451510140200002,800,000
284Repairoflacerationofgallbladder51.912545454545205200004,100,000
285Repairofotherbileducts51.792590454540245200004,900,000
286Repairofotherherniaofanteriorabdominalwall53.52515451525125200002,500,000
287Repairofotherherniaofanteriorabdominalwallwithprosthesis53.62515454525155200003,100,000
288Repairofumbilicalherniawithprosthesis*53.412015451525120200002,400,000
289Repairpembuluhdarahregioservikal(karotis,jugular)*39.322090451530200200004,000,000
290ReposisiDislokasisendirahangdenganPembiusan(TMJ)*76.932015451515110200002,200,000
291ReposisiDislokasiTMJtanpapembiusan76.9325151515575200001,500,000
292ReposisitertutupFrakturCondilusMandibula76.75251515151585200001,700,000
293Reposisitertutupfrakturnasal21.7251515151585200001,700,000
294Resectionoftransversecolon45.742545454535195200003,900,000
295Reseksimaksilainfrastuktural76.392545454545205200004,100,000
296Reseksimaksilasuprastuktural76.392545454555215200004,300,000
297Reseksimandibuladenganrekonstruksigrafttulang/K-wire**76.3+76.912090451520190200003,800,000
298Reseksimandibulatanparekonstruksi76.422545454545205200004,100,000
299RevisiArteriovenousshunt*39.422015451525120200002,400,000
11

21. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
300RevisiThoraksdrain/WaterSealedDrainage(WSD)(diluaralat)34.04251545515105200002,100,000
301Revisionofanastomosisoflargeintestine46.932545451545175200003,500,000
302Revisionofanastomosisofsmallintestine46.932545451545175200003,500,000
303Revisionofstomaoflargeintestine46.432515451525125200002,500,000
304Revisionofstomaofsmallintestine46.412515451525125200002,500,000
305Revisionoftracheostomy31.742515451515115200002,300,000
306Righthemicolectomy45.732545454535195200003,900,000
307RuptureBuli-buli*57.812015451555150200003,000,000
308RupturetendonAchiles83.732545451525155200003,100,000
309Scleroterapidan/atauligasihemangioma39.92251545515105200002,100,000
310Sigmoidectomy45.762545454535195200003,900,000
311Simplesutureofcommonbileduct51.712545454545205200004,100,000
312Sirkumsisi***642051551055200001,100,000
313Skleroterapivena(Varises,Hemangioma)*39.922015155560200001,200,000
314Small-to-smallintestinalanastomosis45.912545454535195200003,900,000
315Split-thicknessgrafttobreast85.822545451535165200003,300,000
316Strippingvarisesekstremitasinferior38.52515454525155200003,100,000
317Subtotalmastectomy85.232545454545205200004,100,000
318Sutureoflacerationofanus49.92545451515145200002,900,000
319Sutureoflacerationoflargeintestine46.752545451525155200003,100,000
320Sutureoflacerationofsmallintestine,exceptduodenum46.732545451525155200003,100,000
321Sutureofperitoneum54.642545451545175200003,500,000
322Temporarycolostomy46.112545451525155200003,100,000
323Temporaryileostomy*46.212045451545170200003,400,000
324
ThoracalSymphatectomydenganVideoAssisstedThoracoscopicSurgery
(VATS)
05.2+32.252545454545205200004,100,000
325Thoracocentesis*34.912015451510105200002,100,000
326ThymectomydenganVATS07.82590454520225200004,500,000
327Tiroidektomisubtotal/totalnodultiroid**06.32015451525120200002,400,000
328TiroidektomitotaldenganBerryPicking06.42590454520225200004,500,000
329Tiroidektomitotaldengandiseksileherfungsional06.4+40.212590454520225200004,500,000
12

22. RVUNO
TOTAL
SKOR
NAMATINDAKANICDIX-CMF1F2.1F2.2F3F4JASA
330Torakotomi/SternotomiEksplorasi*34.022045451545170200003,400,000
331Torsiotestis**62.52045451535160200003,200,000
332TotalGastrectomy43.92590904550300200006,000,000
333Totalsplenectomy*41.52045451545170200003,400,000
334Trakeostomidenganpenyulittumorpadaaksestrakea***31.12045451515140200002,800,000
335Trakeostomitemporary**31.120151515570200001,400,000
336TumorJinakKulit&TumorNonNeoplastikKulit*86.22015155560200001,200,000
337Unilateralexcisionofectopicbreasttissue(mammaaberans)85.24254545155135200002,700,000
338Unilateralradicalmastectomy85.452545454545205200004,100,000
339Unilateralrepairoffemoral/inguinalherniawith/withoutgraftorprosthesis53.02545451510140200002,800,000
340Unilateralsimplemastectomy85.412545451515145200002,900,000
341Unilateralthyroidlobectomy06.22545454525185200003,700,000
342Vascularshunting(Splenorenalshunt,Depalmashunt)39.12590459050300200006,000,000
343Venapunctie,kanulasi,sectie*38.942015155560200001,200,000
344WhippleProcedure52.72590459050300200006,000,000
345WideexcisionofSofttissuetumor86.42545451520150200003,000,000
Keterangan:
*
**
***
Tumpangtindihkompetensidenganduaspesialislain(Tindakantumpangtindihpadatigadokterspesialis)
Tumpangtindihkompetensidengantigaspesialislain(Tindakantumpangtindihpadaempatdokterspesialis)
Tumpangtindihkompetensidengansatuspesialislain(Tindakantumpangtindihpadaduadokterspesialis)
13

23. 1AbdominoperinealPullThrough(MalformasiAnorectal)48.892518090901455302000010,600,000
2AbdominorectalPullThrough(SwensonProcedure)48.892518090901455302000010,600,000
3AmputasiEksisiKistaBronchiogenik32.025180451530295200005,900,000
4Appendektomi*47.02515451515115200002,300,000
5BedahLaparoskopiAnak54.2125180454520315200006,300,000
6BillrothI&li/ReseksiGasterParsial43.625180901801456202000012,400,000
7BiopsiRektum"FullThickness"48.252545451510140200002,800,000
8BiopsiEksisionalDalamNarkose76.11254545510130200002,600,000
9BiopsiInsisionalDalamNarkose76.11254545510130200002,600,000
10BiopsiPerlaparatomi54.192545909020270200005,400,000
11Biopsi/EksisiKGB,Lipoma.Ateroma,Ganglion82.2125454555125200002,500,000
12CDH(Paediatrik)2518090180755502000011,000,000
13Chordektomi30.222545451520150200003,000,000
14Cystojejenostomi57.125180909060445200008,900,000
15Debulking25180909060445200008,900,000
16DetorsiTestis+Orcidopexy**62.52545451530160200003,200,000
17Duodenoduodenostomi/Duodenojejunostomi45.912518090180755502000011,000,000
18EksisiBakerCyst83.39254545510130200002,600,000
19EksisiGranulomaUmbilikal86.3259045510175200003,500,000
20EksisiHemangiomaBesar/Multiple38.62590909080375200007,500,000
21EksisiHemangiomaDenganSkinGraftSTSG/FTSG38.625180909080465200009,300,000
22EksisiHemangiomaKecil38.62590451510185200003,700,000
23EksisiHigromaColli/LimfangiomaSimple*40.292545451530160200003,200,000
24EksisiHigromaColli/AxillaPadaNeonatus40.2325180909020405200008,100,000
25EksisiKelenjarGetahBening40.3254545510130200002,600,000
26EksisiKelenjarLiurSubmandibula26.3254545510130200002,600,000
27EksisiKistaBrachial32.62590904520270200005,400,000
TARIFJASAMEDISTINDAKANPEMBEDAHANDOKTERSPESIALISBEDAHANAK
RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
14

24. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
28EksisiKistaDuktusTiroglosus06.72545454530190200003,800,000
29EksisiKistaSaluranEmpedu512518090180605352000010,700,000
30EksisiKistaUrachus54.32545454520180200003,600,000
31EksisiNeuroblastoma04.072518090180755502000011,000,000
32EksisiTeratomaRetroperitoneal54.9925180909030415200008,300,000
33EksisiTeratomaSacrococcygeal54.992590909020315200006,300,000
34EksisiTumorJaringanLunakUkuranKecil(MarginalMarginExcisi)86.2254545155135200002,700,000
35EkstirpasiTumorJinakKulit<3Cm**86.22515455595200001,900,000
36EkstirpasiTumorJinakKulit>3Cm86.2254545155135200002,700,000
37EndorectalPullThrough(Soave-BolleyProcedure)48.4125180909075460200009,200,000
38Esofagomyotomi(OperasiHeller)42.725180909050435200008,700,000
39Esofagostomi+Gastrostomi(AtresiaEsofagus)42.852590454530235200004,700,000
40EsophagusReplacementProcedure42.82518090180755502000011,000,000
41FistulektomiKompleks48.732545454510170200003,400,000
42FundoplikasiGaster44.6625180459030370200007,400,000
43GastrostomiAnak*43.12515455595200001,900,000
44GastrostomiNeonatus43.02590459020270200005,400,000
45Genitoplasty(Clitoroplasty,Vaginoplasty,Phalioplasty)70.792590459020270200005,400,000
46GlosektomiTotalis25.32590459020270200005,400,000
47Hemiglosektomi25.22590459020270200005,400,000
48Hemimandibulektomi76.312590459030280200005,600,000
49Herniotomi532545451510140200002,800,000
50HerniotomiBilateral53.12545451515145200002,900,000
51HerniotomiPadaHerniaStrangulata53+46.032545459015220200004,400,000
52HerniotomiResidif532545451515145200002,900,000
53HerniotomiUmbilikalis*53.42515451520120200002,400,000
54Herniotomy+Laparotomy+Reseksi+Anastomosis54.12545459025230200004,600,000
55LigasiTinggiKelasII(Narkose)**63.12545451510140200002,800,000
56Ileostomi*46.22545451510140200002,800,000
57InsisiAbsesPerianal49.02545451510140200002,800,000
58InsisiDrainase/DebridementAbses86.01254545155135200002,700,000
15

25. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
59InsisiTongueTie*25.1251545510100200002,000,000
60Jari,Polydactyly,AmputasiWithRekonstruksi86.262545451510140200002,800,000
61Jari,RingConstriction(Multiple),Koreksi86.842590451510185200003,700,000
62Jarj,RingConstriction(Single),Koreksi86.84254545155135200002,700,000
63Jari,Syndactyly(Multiple)86.852545454515175200003,500,000
64Jari,Syndactyly(Single)Koreksi86.852545454510170200003,400,000
65KelainanUmbilikus54.32545454510170200003,400,000
66Kolesistektomi51.22545459025230200004,600,000
67KolostomiAnak46.12545454520180200003,600,000
68KolostomiNeonatus46.12545459020225200004,500,000
69Ladd2590459040290200005,800,000
70LaparaskopikAppendektomi47.012590454510215200004,300,000
71LaparaskopikDiagnostik/Biopsi54.212590454510215200004,300,000
72LaparaskopikGastrektomi44.952590909040335200006,700,000
73LaparaskopikLobektomi50.252590909085380200007,600,000
74Laparatomi+AppendektomiPadaAppPerforasi54.1+47.02545459040245200004,900,000
75Laparatomi+Milking/ReseksiPadaInvaginasi54.12545459040245200004,900,000
76Laparatomi+ReseksiAnasm54.12545454530190200003,800,000
77Laparatomi+ReseksiUsusHalus/Kolon54.12545459045250200005,000,000
78LaparatomiAdhesiolisis54.12545459040245200004,900,000
79LaparatomiEksplorasi/Biopsi54.12545459020225200004,500,000
80LaparatomiPadaPerforsiUsus54.12545459050255200005,100,000
81LaparatomiPadaTraumaAbdomen54.125459018075415200008,300,000
82LaparatomiPadaPeritonitisNeonatus54.125909018075460200009,200,000
83Limpoma,Atheroma,dll86.212515455595200001,900,000
84LobektomiSubTotalis(Tiroid)06.22545454530190200003,800,000
85MarsupialisasidenganRanula(Kelas2)26.212545454510170200003,400,000
86Minimal/LimitedPSARP49.992590454530235200004,700,000
87NearTotalTiroidektomi06.42545454530190200003,800,000
88NefrektomiParsial*55.42545454530190200003,800,000
89NefrouretektomiTumorWilms55.512545454550210200004,200,000
16

26. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
90Orchidektomi62.32545454520180200003,600,000
91OrchidektomiBilateral62.42545454520180200003,600,000
92OrchidektomySubKabsuler62.32545454520180200003,600,000
93ParotidektomiRadikal26.322590459060310200006,200,000
94ParotidektomiSuperfisialis26.312590459050300200006,000,000
95ParotidektomiTotalis26.322590459060310200006,200,000
96PasangAksesPortCeisite*38.932515455595200001,900,000
97PasangPEG43.112545454515175200003,500,000
98PemasanganDoubleLumenKateterDenganLokalAnestesi39.952545451515145200002,900,000
99PlikasiDiafragma53.812545459020225200004,500,000
100Polipektomi48.352545451515145200002,900,000
101PolipektomiRektum48.352545451515145200002,900,000
102Portoenterostomi(Operas!Kassai)51.3725180901801656402000012,800,000
103PosteroSagitalAnorectoplaty/PSARP49.992590909085380200007,600,000
104PosterosagitalAnorectovaginourethroplasty/PSARVUP49.992518090901655502000011,000,000
105PotongStump8.432545451510140200002,800,000
106ProsedurTierschPadaProlapRekti48.992590454520225200004,500,000
107PSARP+Laparotomy49.99+54.1125909090100395200007,900,000
108Pyeloplasty55.872590459020270200005,400,000
109Pyloromyotomi(OperasiFredetRamstedt)43.32590459020270200005,400,000
110ReleaseSinekhiaVulva71.02545454510170200003,400,000
111RepairBladderExtrophy57.8625180901801656402000012,800,000
112RepairCloacalExtrophy48.9925180901801656402000012,800,000
113RepairDefekDindingPerut(Omphalocele/Gastroschizis)53.4925909018085470200009,400,000
114RepairDefekHerniaUmbilikalis*53.42515451520120200002,400,000
115RepairFistelRectovaginal70.7325901359030370200007,400,000
116RepairRupturaPerineumLama71.752590459030280200005,600,000
117RepairVesikaUrinaria57.812590459020270200005,400,000
118Reseksi+AnastomosisEsofagus42.625909018040425200008,500,000
119ReseksiAnastomosisPadaAtresiaUsus,Duplikasi46.992590459050300200006,000,000
120ReseksiEsofagus&Rekonstruksi42.625180901801656402000012,800,000
17

27. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
121ReseksiGaster43,52590909040335200006,700,000
122ReseksiHepar(Tumor,Trauma)50.2225180901801656402000012,800,000
123ReseksiSigmoid45.762545454530190200003,800,000
124ReseksiUrachus57.512545454520180200003,600,000
125RetrorectalPullThrough(DuhamelProcedure)48,652590909040335200006,700,000
126SalpingoOophorektomiBilateral65.,62545454520180200003,600,000
127Sirkumsisi(Narkose)***64.02515451510110200002,200,000
128Sistostomi57.172545451510140200002,800,000
129SkleroterapiDenganAnestesi49.422545451510140200002,800,000
130Sphincterotomy49.52545454510170200003,400,000
131SplenectomiPadaTrauma*41.52545451540170200003,400,000
132SplenektomiEc.HipertensiPortal/KelainanHematologiLain41.52545459030235200004,700,000
133SuntikSclerotingAgentMalformasiVaskular39.922545451510140200002,800,000
134Thoracotomi+AnastomosisEsofagus34.02+42.625180909085470200009,400,000
135TiroidektomiSubtotalis**06.32515451520120200002,400,000
136TotalGastrektomiDanRekonstruksi43.92518090901655502000011,000,000
137Tracheostomi**31.12545451510140200002,800,000
138TransanalMucosektomy49.99259090180100485200009,700,000
139UreteroNeosistostomi56.742590909040335200006,700,000
140Uretroplasty(Hipopadia)*58.452545454540200200004,000,000
141VenaSeksiDanPasangAksesVaskuler38.392545451510140200002,800,000
142Yeyunostomi46.322545454520180200003,600,000
Keterangan:
*
**
***
Tumpangtindihkompetensidengansatuspesialislain(Tindakantumpangtindihpadaduadokterspesialis)
Tumpangtindihkompetensidenganduaspesialislain(Tindakantumpangtindihpadatigadokterspesialis)
Tumpangtindihkompetensidengantigaspesialislain(Tindakantumpangtindihpadaempatdokterspesialis)
18

28. NONAMATINDAKANICDIX-CMF1F2.1F2.2F3F4
TOTAL
SKOR
RVUJASA
HAND
1Jari,extradigit,amputasi84.01/86.26259015154018520,0003,700,000
2Jari,variouslesions,Rayamputasi(single)84.01259015154018520,0003,700,000
3Jari,variouslesions,amputasi(multiple)84.01259015154018520,0003,700,000
4Jari,polydactyly,amputasiwithrekonstruksi86.26259045454024520,0004,900,000
5Jari,various,amputation(single)**84.0125451551010020,0002,000,000
6AngkatK-Wirewithanestesiaregional97.88259015154018520,0003,700,000
7Sendi(wrist),variouslesions,arthrodesis81.25259045456026520,0005,300,000
8Nerve,VariousLesions,biopsy04.1259015156020520,0004,100,000
9Sendi(jari),contracture,capsulectomy/capsulotomy82.35259045156023520,0004,700,000
10Jari,injury,debridement79.64259045454024520,0004,900,000
11Jari,crushinjuries(complex)wounddebridement79.64259045454024520,0004,900,000
12Jari,crushinjury(simple),wounddebridement79.64259045454024520,0004,900,000
13Jari,macrodactyly,debulking82.83259045456026520,0005,300,000
14
Nerve(Ekstremitasatas),EntrapmentSyndrome(other),Decompression
(unilateral)
82.832590454545
250
20,0005,000,000
15
Nerve(ekstremitasatas),entrapmentsyndrome(other)decompression
(bilateral)
04.492590454560
265
20,0005,300,000
16
Nerve(ekstremitasatas),entrapmentsyndrome(other)decompressionwith
nervetransportation/endoneurolysis
04.492590454560
265
20,0005,300,000
17Tendonsheath(ekstremitasatas),tenosynovitis(multiple),drainage83.01259045456026520,0005,300,000
18TendonSheath(extremitasatas),tenosynovitis(single),drainage83.01259045456026520,0005,300,000
19Jari,superficialinfection,drainage82.09259045456026520,0005,300,000
20Jari,deepinfection,drainage82.09259045454024520,0004,900,000
21Jaringanlunak(palmarspace),abscess,drainage82.04259045454024520,0004,900,000
22Jari,jaringanlunaktumor,excision82.29259045456026520,0005,300,000
23Jari,wart/com/naevus,excision82.29259045456026520,0005,300,000
24Tendonsheath(extremitasatas)ganglion/villonodularsynovitis,excision82.21259045454024520,0004,900,000
TARIFJASAMEDISTINDAKANPEMBEDAHANDOKTERSPESIALISORTHOPAEDI&TRAUMATOLOGI
19

29. NONAMATINDAKANICDIX-CMF1F2.1F2.2F3F4
TOTAL
SKOR
RVUJASA
25TendonSheath&jaringanSubkutis,ganglion/smallbursa,excision82.21259045454024520,0004,900,000
26Elbow(medicalepicondyle),fracture,excisionbonyfragment79.32259045456026520,0005,300,000
27Jari,tumors,excisionwithdissectionofneurovasculerbundle82.29259045456026520,0005,300,000
28Kulitdanjaringansubkus,defect(deep)stageddistantflap(division)86.74259045456026520,0005,300,000
29Kulitdanjaringansubkultis,Defect(singledigit),freefullthicknessgraft86.63259045456026520,0005,300,000
30Nervedefect,peripheralgraft04.5259045456026520,0005,300,000
31Tendon-flexor(ekstremitasatas)injury,tendongraft83.81259045456026520,0005,300,000
32Tendon-flexor(ekstremitasatas),Defectgrafting(single)83.81259045456026520,0005,300,000
33Jari,ringconstruction(single),koreksi86.892513545454529520,0005,900,000
34Thumb,Deformitas,Koreksi82.62513545456031020,0006,200,000
35Jari,ringcnstriction(multiple),koreksi86.892513545456031020,0006,200,000
36Jari,swanneck/Boutonnieredeformity(single),koreksi86.892513545456031020,0006,200,000
37Jari,deformities,koreksi86.892513545456031020,0006,200,000
38Jari,Syndactyly(single)koreksi86.852513545454529520,0005,900,000
39Kulitdanjaringansubkutis,defect(multipledigits)stagedlocalflap(division)86.73259045456026520,0005,300,000
40Thumb,paralysis,oppnensplasty82.712518090456040020,0008,000,000
41Jari,deformities,osteotomy77.292518090456040020,0008,000,000
42Tendon(ekstremitasatas),Bowstringing/entrapment,pulleyrekonstruksi82.71/83.832518090456040020,0008,000,000
43Carpus,fracture/dislocation,reduksiterbukadanfiksasiinterna*79.33/79.84259090456031020,0006,200,000
44Jari,fracture/dislocation,reduksiterbukadanfiksasiinterna(multiple)*79.34/79.84259090456031020,0006,200,000
45Jari,ClosedTracture/dislocation,reduksiterbukadanfixation(single)79.34/79.84259090454029020,0005,800,000
46Jari,deformities,majorreconstructionprocedure82.62518090456040020,0008,000,000
47Jari,Defect/contracture(single)Rekonstruksi86.892518090454538520,0007,700,000
48Jari,defect/contracture(multiple)rekonstruksi86.892518090456040020,0008,000,000
49Carpus,delayed/nonunion,rekonstruksi86.892518090456040020,0008,000,000
50Nerve(Ekstremitasatas),Guyon'sTunnelSyndrome,Release(unilateral)04.43259045456026520,0005,300,000
51TendonSheath(ekstremitasatas),DeQuervain's(unilateral),Release82.01259045454525020,0005,000,000
52TendonSheath(Ekstremitasatas),TriggerJari(multiple),Release82.01259045456026520,0005,300,000
53Nerve(ekstremitasatas),carpaltunnelsyndorme,release(bilateralwith04.49259045456026520,0005,300,000
54
Nerve(ekstremitasatas),Guyon'stunnelsyndrome,release(bilateralwith
endoneurolysis)
04.492590454560
265
20,0005,300,000
20

30. NONAMATINDAKANICDIX-CMF1F2.1F2.2F3F4
TOTAL
SKOR
RVUJASA
55TendonSheath(ekstremitasatas),DeQuarvain's(bilateral),release82.01259045456026520,0005,300,000
56Jari,syndactyly(multiple)86.85259045456026520,0005,300,000
57Elbow,tenniselbow,release80.92259045456026520,0005,300,000
58Jari,deformity,instrinsicmusclerelease86.89259045456026520,0005,300,000
59Tendonsheath(extremitasatas),triggerjari(single)release82.01259045454525020,0005,000,000
60Jari,deformity,instrinsicmuscleextensorrelocation86.89259045456026520,0005,300,000
61Sendi(ExtremitasAtas)RushRods/Wires/ScrewRemoval78.6259045454024520,0004,900,000
62
Jari,foreignbody(superficial),removalwithmobilizationofneurovascular
bundle
86.052590454560
265
20,0005,300,000
63Tendon-extensor(extremitasatas)injury,repair(single)83.7/82.462513545454529520,0005,900,000
64Tendon-extensor(ekstremitasatas)injury,repair(multiple)83.7/82.462513545456031020,0006,200,000
65Nailbed,Laceration,repair(single)862513545454529520,0005,900,000
66Artery,large,injury,repairwithgrafting39.582513545456031020,0006,200,000
67Nervedigital,injury,primaryrepair04.742513545456031020,0006,200,000
68KulitdanJaringansubkutis,laceration(superficial)ofmorethan7cm,repair86.82513545456031020,0006,200,000
69Nerve-digital,injury,microsurgicalrepair(multiple)04.742518090456040020,0008,000,000
70NailBed,Laceration,Repair(multiple)86.272513590456035520,0007,100,000
71Nervedigital,Injury,microsurgical(single)04.742518090456040020,0008,000,000
72Nerve(ekstremitasatas),major,injury,microsurgical,repair(single)04.742518090456040020,0008,000,000
73Nervevariouslesions,primary/secondarysuture04.3259045456026520,0005,300,000
74Sendi(jari),variouslesions,replacementarthoplasty81.7259045456026520,0005,300,000
75Replantasi84.2225180909012050520,00010,100,000
76Jari/Digit,Stump,Revision86.842518090456040020,0008,000,000
77Jari,Scar,RevisionOsteotomy77.192518090456040020,0008,000,000
78Tendon-flexor(ekstremitasatas)adhesion,tenolysis(single)82.01259045454525020,0005,000,000
79Tendon-flexor(ekstremitasatas),adhesion,Tenolysis(multiple)82.01259045456026520,0005,300,000
80Tendon(wkstremitasatas),contracture,tenotomy82.11259045456026520,0005,300,000
81Jari,Trauma,Terminalisation(single)84.01259045454525020,0005,000,000
82Jari,trauma,terminalisation(multiple)84.01259045456026520,0005,300,000
83Jari,deformity,instrinsicmuscletransfer86.892518090456040020,0008,000,000
21

31. NONAMATINDAKANICDIX-CMF1F2.1F2.2F3F4
TOTAL
SKOR
RVUJASA
84Nerveulnar,entrapment,transposition04.74259045456026520,0005,300,000
SPINE
85Plasterapplicationofthespine84.59254545454020020,0004,000,000
86FacetBlockMultilevel03.96259090904033520,0006,700,000
87FacetBlock(1level)03.96259090902031520,0006,300,000
88ForaminalBlockMultilevel03.09259090904033520,0006,700,000
89ForaminalBlock(1level)03.09259090902031520,0006,300,000
90
Manipulation&Reductionofsimplefractureanddislocationwithgeneral
anaesthesia
04.8259090904033520,0006,700,000
91BiopsyVertebra(1level)*77.49259045904029020,0005,800,000
92AnteriorCervicalCorpectomy+Fusion(ACCF)*81.022590909012041520,0008,300,000
93Anteriorcervcaldiscetomy+Fusion(ACDF)*81.02+80.512590909012041520,0008,300,000
94
AnteriordanPosteriorSurgeryinSpinalDiseasewithStabilization/
Instrumentation.
032518090180120
595
20,00011,900,000
95
AnteriordanPosteriorSurgeryinDeformitywithStabilization/
Instrumentation.
03251809018012059520,00011,900,000
96Scoliosiskurvakurangdari70
o
CorrectiveSurgery*81.6251809018012059520,00011,900,000
97SpinalOsteotomyforAnkylossingSpondylitis*77.39251809018012059520,00011,900,000
98Scoliosiskurvalebihdari70
o
CorrectiveSurgery*81.6259018018021068520,00013,700,000
99
SpinalOsteotomyforAnkylossingSpondylitisdenganforwardgazekurang
dari3m*
77.392590180180210
685
20,00013,700,000
100Mayordesloughing,wounddebridementofthespine*77.692590909012041520,0008,300,000
101DebridementandanteriorfusioninTBSpine*86.28+81.02/81.042590909012041520,0008,300,000
102TotalDiscReplacement(Multilevel)*84.62590909012041520,0008,300,000
103Discograph(1level)*87.29259090902031520,0006,300,000
104DiscographMultilevel*87.29259090904033520,0006,700,000
105OpenDisestomy(1Level)-->AlatMedisKhusus*80.512590909012041520,0008,300,000
106MicroendoscopicDisectomy(1level)*80.512590909012041520,0008,300,000
107MicroscopicDisectomy(1Level)80.512590909012041520,0008,300,000
108OpenDisectomyMultilevel*80.512590909012041520,0008,300,000
109PosterolateralFusion*81.03/81.05/81.082590909012041520,0008,300,000
22

32. NONAMATINDAKANICDIX-CMF1F2.1F2.2F3F4
TOTAL
SKOR
RVUJASA
110Alartransversefusion*81.02590909012041520,0008,300,000
111Laminectomy(1Level)padasimplespinestenosis*03.092590909012041520,0008,300,000
112DecompressionLaminectomyforSpondilolisthesis+Stabilization*03.092590909012041520,0008,300,000
113DecompressionLaminectomyforTumorandSpinalStenosiswithStabilization03.092590909012041520,0008,300,000
114DecompressionLaminectomyforHNPwithStabilization*03.092590909012041520,0028,300,830
115OpenReductionandstabilisationofSpinalFracture*79.392590909012041520,0008,300,000
116PosteriorLumbarInterbodyFusion(FLIF)+Posteriorstabilisation*81.052590909012041520,0008,300,000
117PosteriorCervicalFusion*81.032590909012041520,0008,300,000
118Removalofimplants(Plate,Nail,Screw)*78.69259090904033520,0006,700,000
KNEE
119ArthroscopyDebridementKnee80.26259090456031020,0006,200,000
120ArthroscopyDiagnosticShoulder80.212513590456035520,0007,100,000
121ArthroscopyRemoveLooseBody80.2259090456031020,0006,200,000
122ArthroscopyDebridementShoulder80.212513590456035520,0007,100,000
123RotatorCuffRepairbyArthroscopy80.212513590456035520,0007,100,000
124ArthroscopyMeniscusRepair80.29259090456031020,0006,200,000
125ArthroscopyMinisectomy,ArthroscopySynevectomyKnee80.262513590456035520,0007,100,000
126ArthroscopyRemoveLooseBodyShoulder80.212513590454033520,0006,700,000
127ArthroscopyDiagnostic80.2259090456031020,0006,200,000
128OpenKneeDebridement86.22259045454024520,0004,900,000
129ShoulderHemiarthroplasty81.82513590456035520,0007,100,000
130AnteriorCruciateLigamentReconstruction81.45259090456031020,0006,200,000
131PosteriorCruciateLigamnetReconstruction81.45259090456031020,0006,200,000
132LateralCollateralLigamentReconstruction81.45259090456031020,0006,200,000
133MedialCollateralLigamentReconstruction81.45259090456031020,0006,200,000
134RecurrentShoulderDislocationRepairTUBSandAMBRI81.822513590456035520,0007,100,000
135RevisiTotalkneereplacement81.552513590458037520,0007,500,000
136RevisiTotalShoulderreplacement81.852513590456035520,0007,100,000
137TotalKneeReplacement81.54259090456031020,0006,200,000
138TotalShoulderReplacement81.80259090456031020,0006,200,000
23

33. NONAMATINDAKANICDIX-CMF1F2.1F2.2F3F4
TOTAL
SKOR
RVUJASA
ONCOLOGY
139RayAmputationJari84.01254545454020020,0004,000,000
140OpenBiopsy:SoftTissue86.11259090454029020,0005,800,000
141OpenBiopsyBoneTumor77.4259045454024520,0004,900,000
142Tumorjinaktulang(curettage+bonegraft)78.02545454512028020,0005,600,000
143MarginalmargineExcisionSoftTissueTumor86.325180904512046020,0009,200,000
144WideexcisionSoftTisueSarcoma/86.425180454512041520,0008,300,000
145ExcisionSoftTissueTumor<5cm(kecil)86.2259045454024520,0004,900,000
146Hemiartroplasty:MetastaticBoneDisease81.42518090458042020,0008,400,000
147Hemipelvectomy84.1925180904512046020,0009,200,000
148Limbablation:above/belowkneeamputationSoftTissueTumor/sarcoma84.172590454512032520,0006,500,000
149Limbablation:above/belowkneeamputationBoneTumor84.17259045456026520,0005,300,000
150Forequarteramputation84.0925180904512046020,0009,200,000
151LimbsalvageSurgeryTahap184.0/84.125180904512046020,0009,200,000
152LimbsalvageSurgeryTahap284.0/84.125180904512046020,0009,200,000
153
LimbsalvageSurgery:resectionadanrekonstruksidenganfibular
transfer/hemiartroplasty
81.4251809045120
460
20,0009,200,000
154LimbsalvageSurgery:TumorResectiononly84.125180904512046020,0009,200,000
155LimbsalvageSurgery:ScapularReconstruction84.125180904512046020,0009,200,000
156LimbsalvageSurgery:danrekonstruksidenganartrodesis84.125180904512046020,0009,200,000
157ORIF:MBD79.32518090458042020,0008,400,000
158TotalPatellectomydanrekonstruksi77.96259090456031020,0006,200,000
PAEDIATRIC
159BonybridgereleasepadakasusTarsalCoalition81.1259045456026520,0005,300,000
160Reposisitertutupdangipspadafrakturanakkecualifrakturfemur79.0209045454024020,0004,800,000
161Koreksicurlytoe77.58259045456026520,0005,300,000
162Koreksioverridingtoepolidactily77.58259045456026520,0005,300,000
163Koreksisyrdactylykaki86.85259045456026520,0005,300,000
164Debridementfrakturterbukapadaanak79.6209045454024020,0004,800,000
165Nekrotomy86.22209045454024020,0004,800,000
166InjeksiBotokspadakasusCerebralPalsy259045456026520,0005,300,000
24

34. NONAMATINDAKANICDIX-CMF1F2.1F2.2F3F4
TOTAL
SKOR
RVUJASA
167SkinGraft86.7259045456026520,0005,300,000
168PercutaneousTendonTenotomy83.13259045456026520,0005,300,000
169OpenAchillesTendonLengthening83.85259045456026520,0005,300,000
170Reposisitertutup,Arthrogram,danHemispicapadaDDH79.00259045456026520,0005,300,000
171ClosedReductiondanpemasangangipsfrakturfemurpadaanak79.05209045454024020,0004,800,000
172Synovectomyarthroscopypadapenderitahemoplili80.70259045456026520,0005,300,000
173FiksasiCannualtedScrewpadaSCFE78.1259045456026520,0005,300,000
174
SofttissuereleasepadakelainanCerebralPalsy,Arthrogryposis,SpinaBifida,
torticollis
78.12590454560
265
20,0005,300,000
175PosteromedialsofttissuereleaseCTEV83.84259045456026520,0005,300,000
176
SofttissuereleasedanEnhancementpadakasushabitualdislokasilututpada
anak
83.842590454560
265
20,0005,300,000
177Debridementdansofttissuereleasepadainfeksisendi86.28259045456026520,0005,300,000
178
ReposisitertutupdanPercutaneousPinningpadafrakturseputarsendisiku
padaanak
2590454560
265
20,0005,300,000
179Debridement,Nekrotomy,danSaucerizationpadaChronicOsteomyelits86.22259045456026520,0005,300,000
180Reposisiterbukadanfiksasiinternafrakturtulangpanjangpadaanak79.30259045908033020,0006,600,000
181TendontransferekstremitasbawahpadakasusNeuromuskularanak83.75259045908033020,0006,600,000
182ReposisiterbukadanfiksasiinternakasusfrakturintraArtikularpadaanak79.30259045908033020,0006,600,000
183Reposisiterbuka&FiksasiInternapadakasusfrakturSalterHarrisIII-IV79.5259045908033020,0006,600,000
184OperasirekonstruksiibujarikakipadaHalluxValgus77.51259045908033020,0006,600,000
185DoubleOsteotomypelvispadaexstrophybladder77.2925909018012050520,00010,100,000
186Arthrodesissendi(panggul,wrist,ankle,triplearthrodesis)81.22518090908046520,0009,300,000
187Acetabuloplasty(SalterInnominate,Pemberton,Dega)padakasuspanggul81.40251809018012059520,00011,900,000
188OpenReductiondislokasipanggultanpaAcetabuloplasty79.8525180901808055520,00011,100,000
189
OpenReductiondislokasipangguldenganAcetabuloplastydanFemoral
Osteomy
79.8525904590120
370
20,0007,400,000
190
BonyReconstructionpadaekstremitasatasanak(Misalnyamalunionfraktur
supracondylar,lateralcondyle)
251809090120
505
20,00010,100,000
191
BonyReconstructionpadaekstremitasbawahanak(MisalnyaCTEV,Blount
disease,kelainankongenital,malunionfraktur)
78.2525180909012050520,00010,100,000
25

35. NONAMATINDAKANICDIX-CMF1F2.1F2.2F3F4
TOTAL
SKOR
RVUJASA
192
LimbLengtheningatauoperasirekonstruksipadaanakyangmenggunakan
alatkhusus
25180909012050520,00010,100,000
TRAUMA
194JointKompleksDestruction/OAPostTrauma-TotalJointArthroplasty81.92513545908037520,0007,500,000
195NekrotikTissue>1Kompartemen-Debridement86.22259045454024520,0004,900,000
196NekrotikTissue-Debridement86.22259045454024520,0004,900,000
197JaringanGranulasi-STSG86.22259045454024520,0004,900,000
198NonUnion=Bonegraft81.20/78.42513545456031020,0006,200,000
199Frakturcollumfemurpadaorangtua79.352513545906035520,0007,100,000
200Frakturintertrochanterfemurpadaorangtua79.352513545906035520,0007,100,000
201JointStiffness-Liberation80.42513545458033020,0006,600,000
202MultipleFractureTulangPanjang-MIPO/ORIF&RemovalImplant>179.302513545456031020,0006,200,000
203FrakturTulangPanjang-MIPO/ORIF&ImplatRemoval(LongBone)79.30259045454024520,0004,900,000
204OpenFrakturshafttibiagrade379.362513545456031020,0006,200,000
205OpenFrakturshaftfemurgrade379.352513545456031020,0006,200,000
206OpenFrakturshaftradiusgrade379.322513545456031020,0006,200,000
207OpenFrakturshaftulnagrade379.322513545456031020,0006,200,000
208OpenFrakturshafthumerusgrade379.312513545456031020,0006,200,000
209osteomyelitis77.92513545456031020,0006,200,000
210FracturePelvisSimple-FiksasiEksternaPelvic/ORIFFracturePelvicSimple79.29/79.392513545456031020,0006,200,000
211FractureArtikuler->MIPO/ORIFArtikuler(Alatmedikkhusus)79.302513545456031020,0006,200,000
212ClosedFrakturshafttibia79.36259045454024520,0004,900,000
213ClosedFrakturdistaltibia79.362513545456031020,0006,200,000
214ClosedFrakturshaftfemur*79.35251545154014020,0002,800,000
215ClosedFrakturshaftradius79.32259045454024520,0004,900,000
216ClosedFrakturshaftulna79.32259045454024520,0004,900,000
217ClosedFrakturshafthumerus*79.31251545154014020,0002,800,000
218Fraktursubtrochanterfemurpadaorangtua(>60)79.352513545904033520,0006,700,000
219OpenFrakturshafttibiagrade1dan279.36259045454024520,0004,900,000
220OpenFrakturshaftfemurgrade1dan279.35259045454024520,0004,900,000
221OpenFrakturshaftradiusgrade1dan279.32259045454024520,0004,900,000
26

36. NONAMATINDAKANICDIX-CMF1F2.1F2.2F3F4
TOTAL
SKOR
RVUJASA
222OpenFrakturshaftulnagrade1dan279.32259045454024520,0004,900,000
223OpenFrakturshafthumerusgrade1dan279.3125123454540277.520,0005,550,000
224FrakturAcetabulum&Pelvic-ORIFAcetabulum&Pelvic79.392513545454029020,0005,800,000
225FractureAcetabulum1Collum-ORIF(TR.14)79.392513545454029020,0005,800,000
226ClosedFrakturproksimaltibiainvolveintraartikular79.362513545454029020,0005,800,000
227ClosedFraktursupracondylarfemur79.352513545454029020,0005,800,000
228ClosedFrakturintercondylarfemur79.352513545454029020,0005,800,000
229Frakturcollumfemurpadaanakmuda(<60)79.3525123454540277.520,0005,550,000
230Fraktursubtrochanterfemurpadaanakmuda(<60)79.3525123454540277.520,0005,550,000
231Frakturintertrochanterfemurpadaanakmuda(<60)79.3525123454540277.520,0005,550,000
232Frakturgaleazi79.3225123454540277.520,0005,550,000
233Frakturmontegia79.3225123454540277.520,0005,550,000
234Frakturneckhumeruspadaanakmuda(<60)79.3125123454540277.520,0005,550,000
235Frakturneckhumeruspadaorangtua(>60)79.312513545906035520,0007,100,000
236InstabilityJointInfection(TR.05)81.962513545456031020,0006,200,000
237LimbLegInequality-BoneLengtheningTransport78.35/78.372513545456031020,0006,200,000
238NeglectedCase-BoneReconstruction78.02513590456035520,0007,100,000
239KompartemenOtot81.54259045454024520,0004,900,000
240AcuteAnklejointdislocation79.87259045454024520,0004,900,000
241AcuteKneejointdislocation78.86259045454024520,0004,900,000
242AcuteHipjointdislocation79.85259045454024520,0004,900,000
243Acuteelbowjointdislocation79.82259045454024520,0004,900,000
244Acuteglenohumeraljointdislocation*81.822515155107020,0001,400,000
Keterangan:
*
**
***
Tumpangtindihkompetensidengansatuspesialislain(Tindakantumpangtindihpadaduadokterspesialis)
Tumpangtindihkompetensidenganduaspesialislain(Tindakantumpangtindihpadatigadokterspesialis)
Tumpangtindihkompetensidengantigaspesialislain(Tindakantumpangtindihpadaempatdokterspesialis)
27

37. 1ALVEOLARBONEGRAFTDENGANALLOGRAFT,GA*24.22515451520120200002,400,000
2AMPUTASIKOMPLEK,GA84.04254545515135200002,700,000
3AMPUTASISEDERHANA,GA**84.01251545510100200002,000,000
4ANGKATJAHITAN,LA97.392515155565200001,300,000
5ANKYLOSISRELEASE,GA76.952590454560265200005,300,000
6BEDAHMIKRO,GA86.89251804590130470200009,400,000
7BIOPSI,LA76.112515155565200001,300,000
8BOUTONNNIEREDEFORMITYREPAIR,LA82.712545155595200001,900,000
9BURIEDDERMALFLAP(THOMPSONPROCEDURE),GA86.72590454570275200005,500,000
10CHORDEEEXCISION+URETHROPLASTY1TAHAP,GA64.4225180454550345200006,900,000
11CHORDEEEXCISION,GA**64.422545451520150200003,000,000
12CIRCUMFERENTIALWIRING+ARCHBARR,GA24.72545451510140200002,800,000
13CIRCUMSISI,LA***64.00255155555200001,100,000
14CLOSEDRECUCTION+IMF(EYELET),GA76.7254545515135200002,700,000
15CLOSEDREDUCTION+ARCHBARR,GA76.7254545515135200002,700,000
16CLOSEDREDUCTION+BANDAGE,LA76.72515155565200001,300,000
17CLOSEDREDUCTIONWITHSPLINT,LA76.72515155565200001,300,000
18COMMISSUROPLASTY-COMPOSITEFLAP(MICROSURGERY),GA27.57251804590130470200009,400,000
19COMMISSUROPLASTY-DIRECTCLOSURE,LA27.512590154530205200004,100,000
20COMMISSUROPLASTY-EARCARTILAGEGRAFT,LA27.5725180154530295200005,900,000
21COMMISSUROPLASTY-GASTROOMENTALFREEFLAP(MICROSURGERY),GA27.57251804590130470200009,400,000
22COMMISSUROPLASTY-JEJUNALFREEAUTOGRAFT(MICROSURGERY),GA27.57251804590130470200009,400,000
23COMMISSUROPLASTY-REGIONALFLAP,LA27.5725180154580345200006,900,000
24COMMISSUROPLASTY-SKINFLAPLOKAL,LA27.5725180154520285200005,700,000
25COMMISSUROPLASTY-SKINGRAFT,GA27.552590451530205200004,100,000
26COMMISSUROPLASTY,LA27.52590151530175200003,500,000
27CROSS-FACIALVERVEGRAFT,GA04.5251804590130470200009,400,000
RVUJASA
TARIFJASAMEDISTINDAKANPEMBEDAHANDOKTERSPESIALISBEDAHPLASTIKREKONSTRUKSIDANESTETIK
NONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
28

38. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
28DEBRIDEMENDANNEKROTOMIDEKUBITUS,LA86.282515155565200001,300,000
29DEBRIDEMENTLUKABAKARFASEAKUT>30%,GA86.282545451520150200003,000,000
30DEBRIDEMENTLUKABAKARFASEAKUT15-30%,GA86.282545451520150200003,000,000
31DEBRIDEMENTLUKABAKARFASEAKUT<15%,GA*86.282515451510110200002,200,000
32DEBRIDEMENTLUKABAKARFASEAKUT<15%,LA86.28251515151080200001,600,000
33DISTANTFLAP,GA86.742545454540200200004,000,000
34DORSUMSISI,LA64.492515155565200001,300,000
35DOUBLEROTATIONSKINFLAP,GA86.742545454540200200004,000,000
36DOUBLEROTATIONSKINFLAP,LA86.742545151540140200002,800,000
37EKSISIBASALIOMADENGANSKINFLAP,LA86.425180154520285200005,700,000
38EKSISIFISTELPREAURIKULA,LA18.212545155595200001,900,000
39EKSISIGANGLION,LA82.212545151530130200002,600,000
40EKSISIHAEMANGIOMADENGANCOMPOSITEFLAP,GA38.62590454560265200005,300,000
41EKSISIHAEMANGIOMADENGANCOMPOSITEFLAP,LA38.62590151560205200004,100,000
42EKSISIHAEMANGIOMADENGANSIMPLEADVANCEMENTFLAP,GA38.62545451520150200003,000,000
43EKSISIHAEMANGIOMADENGANSIMPLEADVANCEMENTFLAP,LA**38.62545151540120200002,400,000
44EKSISIHAEMANGIOMADENGANSKINFLAPLOKAL,LA**38.62545151540120200002,400,000
45EKSISIHAEMANGIOMADENGANSKINFLAP,GA38.62545454540200200004,000,000
46EKSISIHAEMANGIOMADENGANSKINGRAFTING,GA38.62545454540200200004,000,000
47EKSISIHAEMANGIOMADENGANSKINGRAFTING,LA**38.62545151540120200002,400,000
48EKSISIINTRAKELOIDAL+JAHITPRIMER,LA**86.22545155595200001,900,000
49EKSISIINTRAKELOIDALDILUARWAJAH,LA86.22515155565200001,300,000
50EKSISIINTRAKELOIDALWAJAH,LA86.22545151540140200002,800,000
51EKSISIKELOID+SKINGRAFTING-KOMPLEK,GA86.22545454540200200004,000,000
52EKSISIKELOID+SKINGRAFTING-REVISIDENGANMULTIPLEZPLAST,GA70.14+86.622545151540140200002,800,000
53EKSISIKELOID+SKINGRAFTING-REVISIDENGANSIMPLEADVANCEMENT,GA70.14+86.622545451510140200002,800,000
54EKSISIKELOID+SKINGRAFTING-REVISIDENGANSINGLEZPLASTY,GA86.842545451510140200002,800,000
55EKSISIKELOID+SKINGRAFTING,GA70.14+86.622545451510140200002,800,000
56EKSISIKELOID+SKINGRAFTING,LA70.14+86.62254515510100200002,000,000
57EKSISIKELOIDDENGANFLAP,LA86.662545151540140200002,800,000
29

39. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
58EKSISIKISTADERMOID,LA*83.3925151551070200001,400,000
59EKSISINEVUSDILUARWAJAHSIMPLE,LA44.812515155565200001,300,000
60EKSISINEVUSDILUARWAJAHMULTIPLE,LA44.812545155595200001,900,000
61EKSISINEVUSWAJAHMULTIPLE,LA86.3254515540130200002,600,000
62EKSISINEVUSWAJAHSIMPLE,LA86.3254515510100200002,000,000
63EKSISIPOLIDAKTILISIMPLEDEWASA,LA82.392590151560205200004,100,000
64EKSISIPOLYDACTYLYCOMPLEX,GA80.92590454565270200005,400,000
65EKSISIPOYDACTYLYSIMPLE,GA82.392590454565270200005,400,000
66EKSISIRINOFIMA,GA21.32590454565270200005,400,000
67EKSISIRINOFIMA,LA21.32590151555200200004,000,000
68EKSISITRAGUSASESORIUS,LA18.22515155565200001,300,000
69EKSISIVERUKA,LA86.22515155565200001,300,000
70EKSTIRPASITUMORJINAK,DILUARWAJAH,LA*86.22515150560200001,200,000
71EKSTIRPASITUMORJINAKKULITDILUARWAJAH,GA86.22515455595200001,900,000
72EKSTIRPASITUMORJINAKKULITWAJAH,GA86.22545451510140200002,800,000
73EKSTIRPASITUMORJINAKKULITWAJAH,LA86.2254515510100200002,000,000
74EKSTRAKSICORPUSALIENUM,LA86.052545155595200001,900,000
75EKTIRPASIATEROMDILUARWAJAH,LA86.212515155565200001,300,000
76EKTIRPASIATEROMWAJAH,LA86.212545155595200001,900,000
77EKTIRPASILIPOMADILUARWAJAH,LA86.32515155565200001,300,000
78EKTIRPASILIPOMAWAJAH,LA86.32545155595200001,900,000
79ENDOSCOPICRECONSTRUCTIVESURGERY,GA17.49251804590130470200009,400,000
80ESCHARECTOMYDENGANTANGENSIALEKSISI,GA86.222515455595200001,900,000
81ESCHAROTOMY,LA86.222515155565200001,300,000
82FACIALSLINGDENGANALOGRAFT,GA86.2225904545130335200006,700,000
83FASCIOCUTANEUSFLAP,GA86.752590454570275200005,500,000
84FASCIOTOMYBURNEDCOMPARTEMENTSYNDROME,GA*83.142515451520120200002,400,000
85FINGERTIPINJURYREPAIR-COMPOSITEGRAFT,LA84.22251515540100200002,000,000
86FINGERTIPINJURYREPAIR-NEUROVASCULARISLAND/DISTANTFLAP,GA77.92590454570275200005,500,000
87FINGERTIPINJURYREPAIR-SKINFLAPLOKAL,LA77.925901545100275200005,500,000
88FINGERTIPINJURYREPAIR-SKINGRAFTING,LA86.622545151540140200002,800,000
30

40. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
89FINGERTIPINJURYREPAIR-TOETRANSFER,GA82251804590130470200009,400,000
90FRAKTURDANDISLOKASI-ORIFDENGANMINIPLATE,GA*79.842590454570275200005,500,000
91FRAKTURDANDISLOKASI-PEMASANGANINTRAMEDULARYWIRE,LA79.12545151540140200002,800,000
92FRAKTURDANDISLOKASI-PEMASANGANSPLINTTANGAN,LA79.74251515152090200001,800,000
93FREEFLAP,GA83.77251804590130470200009,400,000
94FREEGRACILLISTRANSFER,GA76.7251804590130470200009,400,000
95FRONTOZYGOMATICOMAXILLARYSUSPENSION,GA86.632590454570275200005,500,000
96FULLTHICKNESSSKINGRAFT(FTSG)DAERAHDILUARWAJAH,GA86.632545454540200200004,000,000
97FULLTHICKNESSSKINGRAFT(FTSG)DAERAHDILUARWAJAH,LA*86.632545151520120200002,400,000
98FULLTHICKNESSSKINGRAFT(FTSG)PADAWAJAH,GA86.632590454570275200005,500,000
99FULLTHICKNESSSKINGRAFT(FTSG)PADAWAJAH,LA86.632590151560205200004,100,000
100INSISIABSESPERIKONDRITIS,GA86.01255451530120100001,200,000
101INSISIABSESPERIKONDRITIS,LA*86.01255155106010000600,000
102INSISIABSCESS,LA86.01255155106010000600,000
103
INJEKSIHAEMANGIOMADENGANSKLEROTINGAGENTATAUTRIAMCINOLON
ACETONID,GA
99.232515455595200001,900,000
104
INJEKSIHAEMANGIOMADENGANSKLEROTINGAGENTATAUTRIAMCINOLON
ACETONID,LA
99.232515155565200001,300,000
105INJEKSISKLEROTINGAGENT,LA99.252515155565200001,300,000
106INSERSITULANGRAWANTELINGAAKIBATAVULSITELINGA,LA18.7125901555140200002,800,000
107IOID+ARCHBARRFRAKTUR1SISI,GA76.732515455595200001,900,000
108IOID+ARCHBARRFRAKTUR2SISI,GA76.732515455595200001,900,000
109IOID+IMF(EYELET)FRAKTUR1SISI,GA76.752515455595200001,900,000
110JAHITLUKADIWAJAHDAERAHESTETIKUNIT,GA86.592545454540200200004,000,000
111JAHITLUKADIWAJAHDAERAHESTETIKUNIT,LA86.592545151540140200002,800,000
112JAHITLUKADIWAJAHDENGANKERUSAKANKOMPLEK,GA86.592590454560265200005,300,000
113JAHITLUKADIWAJAHDENGANKERUSAKANKOMPLEK,LA86.592590151560205200004,100,000
114JAHITLUKADIWAJAHDENGANKERUSAKANSEDANG,GA86.592545454540200200004,000,000
115JAHITLUKADIWAJAHDENGANKERUSAKANSEDANG,LA86.592545151540140200002,800,000
116KAUTERISASILESIKULITJINAK,LA86.3255155555200001,100,000
117KAUTERISASIPAPILOMAKULIT,LA86.3255155555200001,100,000
31

41. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
118KONTRAKTURTANGANDANJARI,LA86.8425180151540275200005,500,000
119KONTRAKTURTANGANDANJARI,GA86.8425180454540335200006,700,000
120LABIOPLASTYBILATERAL,GA27.542545454540200200004,000,000
121LABIOPLASTYPADAMICROFORM,LA27.542590151560205200004,100,000
122LABIOPLASTYSUMBINGBIBIRUNILATERAL,GA*27.542515455595200001,900,000
123LABIOPLASTYUNILATERALDENGANNASOPLASTY,LA27.54+21.872545151540140200002,800,000
124LABIOPLASTYUNILATERALDENGANNASOPLASTY,GA27.54+21.872545454540200200004,000,000
125LEFORTIOSTEOTOMY,GA76.65251804590130470200009,400,000
126LOBULOPLASTY,LA18.712515155565200001,300,000
127MALLETFINGERREPAIR,LA82.84254515550140200002,800,000
128MANDIBULARDISTRACTION,GA76.43251804590130470200009,400,000
129MANDIBULARRECONSTWITHNONVASCULARIZEDBONEGRAFT,GA**76.912590451515190200003,800,000
130MANDIBULARRECONSTWITHTMJPLATEREKONSTRUCTION,GA76.95251804590130470200009,400,000
131
MANDIBULARRECONSTWITHVASCULARIZEDBONEGRAFT(MIKRO)-DEFEK
BOYDT,GA
76.99251804590130470200009,400,000
132MASTOPEXY,GA85.6251804590130470200009,400,000
133MAXILLARYRECONST.WITHNONVASCULARIZEDBONEGRAFT,GA*76.912590451515190200003,800,000
134MAXILLARYRECONST.WITHVASCULARIZEDBONEGRAFT(MIKRO),GA76.99251804590130470200009,400,000
135MEDIAL/LATERALCANTHOPLASTY,GA8.5925904545130335200006,700,000
136MELAKUKANNEKROTOMILUAS,GA86.222515455595200001,900,000
137MELAKUKANNEKROTOMISEDANG,LA86.222515155565200001,300,000
138MUSCULOCUTANEUSFLAP,GA83.02590454570275200005,500,000
139MYOCUTANEUSFLAP,GA83.02590454570275200005,500,000
140OMENTALFLAP,GA54.74251804590130470200009,400,000
141OPENREDUCTIONWITHIMPLANTANDSEPTOPLASTY,LA21.88251804590130470200009,400,000
142OPENREDUCTIONWITHWIRE/TITANIUMIMPLANT,GA76.74251804590130470200009,400,000
143OPERASIBEDAHMIKROYANGLAIN,GA86.89251804590130470200009,400,000
144OPERASIREKONSTRUKSI:HIDUNG,LA*21.872590151555200200004,000,000
145OPERASIREKONSTRUKSI:HIDUNG,GA21.8725180454550345200006,900,000
146OPERASIREKONSTRUKSI:PALPEBRA,LA*08.01+08.022590151560200200004,000,000
147OPERASIREKONSTRUKSI:PALPEBRA,GA08.01+08.0225180454550345200006,900,000
32

42. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
148OPERASIREKONSTRUKSI:TANGANDANJARIJARI,LA79.282590151560205200004,100,000
149OPERASIREKONSTRUKSI:TANGANDANJARIJARI,GA79.2825180454540335200006,700,000
150OPERASIREKONSTRUKSI:TELINGA,LA*18.4+18.712590151565210200004,200,000
151OPERASIREKONSTRUKSI:TELINGA,GA18.4+18.7125180454540335200006,700,000
152OPERASIREKONSTRUKSI:WAJAH,LA76.0+86.025901515130275200005,500,000
153OPERASIREKONSTRUKSI:WAJAH,GA76.0+86.025904545130335200006,700,000
154OPERASIREKONSTRUKSI:PAYUDARADANSEKITARNYA,GA85.725180454540335200006,700,000
155OPERASIREKONSTRUKSI:BOKONG,GA86.8925180454540335200006,700,000
156OPERASIREKONSTRUKSI:GENITALIAEKSTERNADANSEKITARNYA,GA64.425180454540335200006,700,000
157OPERASISKINFLAPYANGLAINYANGLEBIHKOMPLEK,GA86.7425180454540335200006,700,000
158OPERASISKINFLAPYANGLAINYANGLEBIHKOMPLEK,LA86.742590151560205200004,100,000
159OPS.REKONSTRUKSI:DEFEK/KELAINANMUKA,LA27.92590151560205200004,100,000
160OPS.REKONSTRUKSI:DEFEK/KELAINANMUKA,GA27.925180454540335200006,700,000
161OPS.REK.:DEFAK/KELAINANTUBUHYANGLAIN,LA86.82590151560205200004,100,000
162OPS.REK.:DEFAK/KELAINANTUBUHYANGLAIN,GA86.825180454540335200006,700,000
163ORBITALBONEANDEYESOCKETRECONSTRUCTION,GA16.09251804590130470200009,400,000
164ORIF+ORBITALWALLRECONSTRUCTIONDENGANRIBSBONEGRAFT,GA16.01251804590130470200009,400,000
165ORIF+ORBITALWALLRECONSTRUCTIONDENGANSILICONPLATE,GA16.2251804590130470200009,400,000
166ORIF+TITANIUMMINIPLATEAPPROACHEKTRAORAL1SISI,GA76.792545454550210200004,200,000
167ORIF+TITANIUMMINIPLATEAPPROACHEKTRAORAL2SISI,GA76.7925904545130335200006,700,000
168ORIFDENGAN1APPROACH,GA*76.742545451520150200003,000,000
169ORIFDENGAN2APPROACH,GA76.7925454545110270200005,400,000
170ORIFDENGAN3APPROACH,GA76.7925904545130335200006,700,000
171ORIFDENGANGINGGIVO-BUCALAPPROACH,GA76.792545454540200200004,000,000
172ORIFDENGANINFRACILIARAPPROACH,GA76.792545454540200200004,000,000
173ORIFDENGANTRANSCONJUNCTIVALAPPROACH,GA76.792545454540200200004,000,000
174ORIFUNTUKFRAKTURLEFORTI,GA76.742545454540200200004,000,000
175ORIFUNTUKFRAKTURLEFORTII,GA76.7425454545110270200005,400,000
176ORIFUNTUKFRAKTURLEFORTIIIBICORONALAPPROACH,GA76.74251804590130470200009,400,000
177ORIFUNTUKFRAKTURLEFORTIII,GA76.74251804590130470200009,400,000
178OSSEOINTEGRATEDMANDIBULARIMPLANT-CLOSEPRIMARY,GA76.7625904545130335200006,700,000
33

43. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
179OSSEOINTEGRATEDMANDIBULARIMPLANT-DISTANT/FREEFLAP,GA76.41251804590130470200009,400,000
180OSSEOINTEGRATEDMANDIBULARIMPLANT,GA76.7625454545110270200005,400,000
181PALATOPLASTYCOMPLETE,GA**27.62515451520120200002,400,000
182PALATOPLASTYINCOMPLETE,GA27.62545454540200200004,000,000
183PASANGARCHBARR1SISI,LA76.752590151560205200004,100,000
184PASANGARCHBARR2SISI,LA76.752590151560205200004,100,000
185PHARYNGOPLASTY,GA29.425904545130335200006,700,000
186PRIMARY/SECONDARYREPAIRNERVEINJURY(BEDAHMIKRO),GA4.7251804590130470200009,400,000
187RECONSTRUCTIONOFCENTRALRAYDEFICIENCY,GA82.92545454540200200004,000,000
188RECONSTRUCTIONOFRADIALRAYDEFICIENCY,GA82.92545454540200200004,000,000
189REKONSTRUKSIDENGANCOMPOSITEFLAP(MICROSURGERY),GA86.74251804590130470200009,400,000
190REKONSTRUKSIDENGANCOMPOSITEFLAP(MICROSURGERY),GA86.74251804590130470200009,400,000
191REKONSTRUKSIDENGANFREEVASCULARIZEDBONEGRAFT,GA86.74251804590130470200009,400,000
192REKONSTRUKSIDENGANMENGGUNAKANTISSUEEXPANSION,GA86.932590451530205200004,100,000
193REKONSTRUKSIDENGANMUSCLEFLAPDENGANSKINGRAFT,GA86.725904545130335200006,700,000
194REKONSTRUKSIDENGANMUSCULOCUTANEUSFLAP,GA86.725904545130335200006,700,000
195REKONSTRUKSIDENGANSKINFLAPKOMPLEK,GA86.725454545110270200005,400,000
196REKONSTRUKSIDENGANSKINFLAPKOMPLEK,LA86.725451515100200200004,000,000
197REKONSTRUKSIDENGANSKINFLAPLOKAL,GA86.725454545110270200005,400,000
198REKONSTRUKSIDENGANSKINFLAPLOKAL,LA86.725451515100200200004,000,000
199REKONSTRUKSIDENGANSKINGRAFTING,GA86.62545454540200200004,000,000
200REKONSTRUKSIDENGANSKINGRAFTING,LA86.62545151540140200002,800,000
201REKONSTRUKSIDENGANTISSUEEXPANTION+SKINFLAP,GA86.93+86.7025904545130335200006,700,000
202REKONSTRUKSIIBUJARI-BONEGRAFT+MYOCUTANEUSFREEFLAP,GA82.69251804590130470200009,400,000
203REKONSTRUKSIIBUJARI-BONEGRAFT+REGIONALFLAP,GA82.6925904545130335200006,700,000
204REKONSTRUKSIIBUJARI-DEEPENINGFIRSTDIGITALWEBSPACE,LA82.8925901545100275200005,500,000
205REKONSTRUKSIIBUJARI-POLICIZATION,GA82.6125904545130335200006,700,000
206REKONSTRUKSIIBUJARI-TOETOTHUMBTRANSFER,GA82.8125904545140345200006,900,000
207REKONSTRUKSIKELAINANGENITALIAEKSTERNAYANGLAIN,LA71.925901515130275200005,500,000
208REKONSTRUKSIKELAINANGENITALIAEKSTERNAYANGLAIN,GA71.925904545130335200006,700,000
209REKONSTRUKSIKELAINANTELINGAYANGLAIN,LA18.7925901515130275200005,500,000
34

44. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
210REKONSTRUKSIKELAINANTELINGAYANGLAIN,GA18.7925904545130335200006,700,000
211REKONSTRUKSIMANDIBULADENGANCOSTOCHONDRALGRAFT,GA76.43251804590130470200009,400,000
212REKONSTRUKSISOFTTISSUEDANTULANG,GA83.99251804590130470200009,400,000
213REKONSTRUKSISOFTTISSUEYANGLAIN,GA83.9925904545130335200006,700,000
214REKONSTRUKSISOFTTISSUEPADAHIPERTELORISM,GA16.9825904545130335200006,700,000
215REKONSTRUKSISOFTTISSUEPADAHIPERTELORISM,LA16.9825901515130275200005,500,000
216REKONSTRUKSITELINGA-ELEVASIFLAPDAUNTELINGA+SKINGRAFT,GA18.71251804590130470200009,400,000
217REKONSTRUKSITELINGA-OPERASIINSERSIGRAFTTULANGRAWAN,GA18.71251804590130470200009,400,000
218REKONSTRUKSITELINGA-REPAIRLOBULUSDANKELAINANPENYERTA,LA18.792590151560205200004,100,000
219REKONSTRUKSITELINGA-REPAIRLOBULUSDANKELAINANPENYERTA,GA18.792590454570275200005,500,000
220REKONSTRUKSIVERMILION,GA27.592545451510140200002,800,000
221REKOSTRUKSISOFTTISSUEDANTULANGPADAHIPERTELORISM,GA16.98251804590130470200009,400,000
222RELEASEBURIEDPENIS,LA64.442545154515145200002,900,000
223RELEASEBURIEDPENIS,GA*64.442545451515145200002,900,000
224RELEASEEKSTROPION,LA*08.442545151515115200002,300,000
225RELEASEEKSTROPION,GA08.442545451510140200002,800,000
226RELEASEKONTRAKTURDENGANDERMAGRAM,LA86.842545154510140200002,800,000
227RELEASEKONTRAKTURDENGANFREEFLAP,GA86.84+86.71+86.74251804590130470200009,400,000
228RELEASEKONTRAKTURDENGANSKINFLAP,GA86.84+86.71+86.7425904545130335200006,700,000
229RELEASEKONTRAKTURDENGANSKINFLAP,LA86.84+86.71+86.7425180151540275200005,500,000
230RELEASEKONTRAKTURDENGANSKINGRAFT,GA86.84+86.6325454545110270200005,400,000
231RELEASEKONTRAKTURDENGANSKINGRAFT,LA86.84+86.6325901545100275200005,500,000
232RELEASEKONTRAKTURDENGANZPLASTY,GA86.8425454545110270200005,400,000
233RELEASEKONTRAKTURDENGANZPLASTY,LA86.842590154590265200005,300,000
234RELEASEKONTRAKTURLEHER,LA86.8425901545130305200006,100,000
235RELEASEKONTRAKTURLEHER,GA86.8425904545130335200006,700,000
236RELEASEKONTRAKTURLINIER,LA86.8425901545100275200005,500,000
237RELEASEKONTRAKTURLINIER,GA86.8425454545110270200005,400,000
238RELEASEVAGINAACRETA,LA70.7625901545100275200005,500,000
239RELEASEVAGINAACRETA,GA70.7625454545110270200005,400,000
240REPAIRBLEPHAROPTOSIS,LA08.3325180154570335200006,700,000
35

45. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
241REPAIRBLEPHAROPTOSIS,GA08.3325904545130335200006,700,000
242REPAIRBIBIRDENGAN-ESTLANDERFLAP,GA27.5725904545130335200006,700,000
243REPAIRBIBIRDENGANBERNARD-BUROWSFLAP,GA27.5725904545130335200006,700,000
244REPAIRBIBIRDENGANKARAPANDZICMETHODE,GA27.5725904545130335200006,700,000
245REPAIRCAMPTODACTYLY,GA08.5125904545130335200006,700,000
246REPAIRCLEFTEARLOBE,LA18.392545155595200001,900,000
247REPAIRCLINODACTYLY,GA77.3425904545130335200006,700,000
248REPAIRCREEPLEHYPOSPADIA,GA58.4525904545130335200006,700,000
249REPAIRDUCTUSNASOLACRIMALIS,GA9.7325904545130335200006,700,000
250REPAIRDUCTUSPAROTIS,GA26.4251804590130470200009,400,000
251REPAIREPISPADIA,GA*58.4525904545135340200006,800,000
252REPAIRFISTELPALATUMDENGANBUCALATAULINGUALFLAP,GA27.5325904545130335200006,700,000
253REPAIRFISTELPALATUM,GA27.5325454545110270200005,400,000
254REPAIRFISTELURETHRACOMPLEX,GA58.4325904545130335200006,700,000
255REPAIRFISTELURETHRASEDERHANA,GA58.4325454545110270200005,400,000
256REPAIRINVOLUTIONALPTOSIS,LA08.362545151520120200002,400,000
257REPAIRINVOLUTIONALPTOSIS,GA*08.362545451520150200003,000,000
258REPAIRPALPEBRADENGANTARSOCONJUNCTIVALGRAFT,GA08.6125904545130335200006,700,000
259REPAIRPALPEBRADENGANHARDPALATEMUCOSALGRAFT,GA08.6225904545130335200006,700,000
260REPAIRPALPEBRADENGANLOCALSKINFLAP,LA08.6125901545100275200005,500,000
261REPAIRPALPEBRADENGANLOCALSKINFLAP,GA08.6125454545110270200005,400,000
262REPAIRPALPEBRADENGANORALMUCOSALGRAFT,GA08.622545454540200200004,000,000
263REPAIRPALPEBRADENGANPOSTERIORLAMELLARRECONSTRUCTION,GA08.702545454540200200004,000,000
264REPAIRPALPEBRADENGANSEPTALCHONDROMUCOSALGRAFT,GA08.7025904545130335200006,700,000
265REPAIRPALPEBRADENGANSKINFLAPREGIONAL,LA08.7125901545100275200005,500,000
266REPAIRPALPEBRADENGANSKINGRAFT,LA08.7225901545100275200005,500,000
267REPAIRPALPEBRADENGANSLIDINGTRANSCONJUNCTIVALFLAP,LA08.7125180154570335200006,700,000
268REPAIRPALPEBRAKOMPLEK,GA08.7325904545130335200006,700,000
269REPAIRPALPEBRASIMPLE,LA*08.712545151510110200002,200,000
270REPAIRPOLYSYNDACTYLY,GA86.8525454545110270200005,400,000
271REPAIRSOFTTISSUEKOMPLEK,LA86.592590151560205200004,100,000
36

46. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
272REPAIRSOFTTISUESIMPLE,LA86.592545151540140200002,800,000
273REPAIRSYARAFTEPI,GA04.74251804590130470200009,400,000
274REPAIRSYMBRACHYDACTYLY,GA86.8525454545110270200005,400,000
275REPAIRTENDONEKSTENSORTANGANMULTIPLE,GA82.4625904545130335200006,700,000
276REPAIRTENDONEKSTENSORTANGANTUNGGAL,LA82.4625901545100275200005,500,000
277REPAIRTENDONFLEKSORTANGANMULTIPEL+PULLEYRECONST,GA82.44251804590130470200009,400,000
278REPAIRTENDONFLEKSORTANGANMULTIPLE,GA82.4425904545130335200006,700,000
279REPAIRTENDONFLEKSORTANGANTUNGGAL+PULLEYRECONST,GA82.44251804590130470200009,400,000
280REPAIRTENDONFLEKSORTANGANTUNGGAL,LA82.4425901545100275200005,500,000
281REPAIRTRAUMATELINGAKOMPLEK,GA*18.72545454540200200004,000,000
282REPAIRTRAUMATELINGASIMPLE,LA18.42545151540140200002,800,000
283REPALATOPLASTY,GA27.625454545110270200005,400,000
284REPLANTASIJARIMULTIPLE,GA84.22251804590130470200009,400,000
285REPLANTASIJARITUNGGAL,GA84.22251804590130470200009,400,000
286REPOSISIDISLOKASITMJ,GA*76.932515451510110200002,200,000
287RESEKSIRAHANG,GA76.425454545110270200005,400,000
288
RESTORASIDANREKONSTRUKSISOFTISSUE+BONEDENGANMULTIPLE
APPROACH,GA
84.9251804590130470200009,400,000
289REVASKULARISASIJARIMULTIPLE,GA84.22251804590130470200009,400,000
290REVASKULARISASIJARITUNGGAL,GA84.22251804590130470200009,400,000
291REVISIDENGANMULTIPLEZPLASTY/WPLASTY,GA86.8425904545130335200006,700,000
292REVISIDENGANMULTIPLEZPLASTY/WPLASTY,LA86.8425901545100275200005,500,000
293REVISIDENGANFLAPJAUH,GA86.7425904545130335200006,700,000
294REVISIDENGANFLAPLOKAL,GA86.7425454545110270200005,400,000
295REVISIDENGANFLAPLOKAL,LA86.742590151560205200004,100,000
296REVISIDENGANSIMPLEZPLASTY,GA86.84254545520140200002,800,000
297REVISIDENGANSIMPLEZPLASTY,LA86.84254515510100200002,000,000
298REVISILABIOPLASTY,LA27.542545151540140200002,800,000
299REVISIPARUTDENGANSIMPLEADVANCEMENTFLAP,GA86.74254545520140200002,800,000
300REVISIPARUTDENGANSIMPLEADVANCEMENTFLAP,LA86.74254515510100200002,000,000
301REVISIPARUTWAJAH,LA86.842590151560205200004,100,000
37

47. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
302REVISIPARUT,GA86.84251545540130200002,600,000
303REVISIPARUT,LA86.8425151553090200001,800,000
304REVISISTUMP,LA86.842545151540140200002,800,000
305REVISISPARUTDILUARWAJAH,LA86.842545151540140200002,800,000
306RHYNOPHYMAREPAIR,LA21.89+21.425901545100275200005,500,000
307ROUZERPLASTY,LA86.86+86.232515155565200001,300,000
308NAILBEDRECONSTRUCTION,GA86.86254545520140200002,800,000
309SECONDARYLIPREPAIR,GA27.5259045540205200004,100,000
310SECONDARYHECHTING,LA86.89251515556510000650,000
311SECONDARYREPAIRLABIOPLASTY,LA27.542590151560205200004,100,000
312SECONDARYRHYNOPLASTY,LA21.87+21.8425180154570335200006,700,000
313SEMIOPENREDUCTION(GILLIESPROCEDURE),GA21.87254545520140200002,800,000
314SEPARASICOMPLETESYNDACTTLY,GA86.852545454550210200004,200,000
315SEPARASICOMPLEXSYNDACTYLY,GA86.8525454545110270200005,400,000
316SEPARASISYNDACTYLY,GA86.852545454550210200004,200,000
317SIMPLEADVANCEMENTFLAP(FLAPKULITSEDERHANA),LA86.725151551070200001,400,000
318SIMPLEADVANCEMENTFLAP,LA86.725151553090200001,800,000
319SINGLEROTATION/TRANSPOSITIONSKINFLAP,GA86.72545451515145200002,900,000
320SINGLEROTATION/TRANSPOSITIONSKINFLAP,LA86.72545151530130200002,600,000
321SKINANDFASCIALGRAFTS,LA86.72590151560205200004,100,000
322SKINFLAPKOMPLEKLEBIHDARISATUFLAP,GA86.725454545110270200005,400,000
323SKINFLAPKOMPLEK,GA86.725454545110270200005,400,000
324SKINFLAPLOKALKOMPLEK,GA86.71+86.74259045540205200004,100,000
325SKINFLAPLOKALKOMPLEK,LA86.71+86.74259015570205200004,100,000
326SKINFLAPLOKALSEDERHANA,GA86.71+86.74254545520140200002,800,000
327SKINFLAPLOKALSEDERHANA,LA86.71+86.74254515550140200002,800,000
328SKINFLAPSEDERHANA,LA86.71+86.742590151560205200004,100,000
329SKINGRAFTINGYANGLUAS,GA86.6925904545130335200006,700,000
330SKINGRAFTINGDENGANLUASSEDANG,GA86.692590454570275200005,500,000
331SKINGRAFTINGYANGSEDERHANA,GA86.692545451570200200004,000,000
332SOFTTISSUEREKONSTRUKSI,LA86.82590151560205200004,100,000
38

48. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
333SPLITTHICKNESSSKINGRAFT(STSG)LUASDENGANPERAWATANKHUSUS,GA86.6925454545110270200005,400,000
334SPLITTHICKNESSSKINGRAFT(STSG)LUAS,GA86.692545451570200200004,000,000
335SPLITTHICKNESSSKINGRAFT(STSG)SEDERHANA,GA86.69251545550140200002,800,000
336SPLITTHICKNESSSKINGRAFT(STSG)SEDERHANA,LA86.69254515550140200002,800,000
337STAGEDSUBCUTANEOUSEXCISIONUNDERNEATHFLAPS,GA86.7525904545130335200006,700,000
338STIFFFINGERJOINT-FINGERARTHOPLASTYWITHSILICONEIMPLANT,GA81.71251804590130470200009,400,000
339STIFFFINGERJOINT-CAPSULOYOMY-TENOLYSIS,LA81.7225180154570335200006,700,000
340STIFFFINGERJOINT-FINGERARTHOPLASTYWITHTITANIUMIMPLANT,GA81.71251804590130470200009,400,000
341STIFFFINGERJOINT-VOLARPLATERELEASE,LA81.7925180154570335200006,700,000
342SUPRAORBITALBONERECONSTRUCTION,GA76.46251804590130470200009,400,000
343SURGICALDEBRIDEMENT/SHARPDEBRIDEMENT,GA86.222515455595200001,900,000
344TANGENSIALEKSISIDINIDENGANSKINGRAFTING,LA86.32590151560205200004,100,000
345TANGENSIALEKSISIDINIDENGANSKINGRAFTING,GA86.222590451530205200004,100,000
346TEMPORALISMUSCLEFASCIATRANSFER,GA83.8925904545130335200006,700,000
347TENDONREPAIR,LA83.622590151560205200004,100,000
348TENDONTRANSFERMULTIPLE,GA82.9251804590130470200009,400,000
349TENDONTRANSFERTUNGGAL,GA82.9251804590130470200009,400,000
350TENDOPLASTY,GA82.925904545130335200006,700,000
351TISSUEEXPANTION,GA86.9325904545130335200006,700,000
352TMJARTHROSCOPYANDTREATMENT,GA80.29251804590130470200009,400,000
353TMJARTHROTOMY,GA80.10251804590130470200009,400,000
354TMJLAVAGEDENGANC-ARM,GA87.13251804590130470200009,400,000
355TOTALCRANIALVAULTRECONSTRUCTION,GA02.06251804590130470200009,400,000
356TOTALJOINTREPLWITHVASCULARIZEDBONEGRAFT,GA86.73251804590130470200009,400,000
357TOTALJOINTREPLACEMENTWITHIMPLANT,GA81.71251804590130470200009,400,000
358
TOTALSKINANDSUBCUTANEOUSTISSUEEXCISIONDGSKINGRAFT
(CHARLES),GA
86.6125904545130335200006,700,000
359TRANSEKSUALFEMALETOMALE,GA64.5251804590130470200009,400,000
360TRANSEKSUALMALETOFEMALE,GA64.5251804590130470200009,400,000
361TRANSPLATATIONPENIS,GA64.45251804590130470200009,400,000
39

49. RVUJASANONAMATINDAKANF1F2.1F2.2F3F4
TOTAL
SKOR
ICDIX-CM
362URETHROPLASTY,GA*58.452590451525200200004,000,000
363FACIALBONECOUNTOURING-ANGLERESHAPING,GA76.09251804590130470200009,400,000
364FACIALBONECOUNTOURING-GENIOPLASTYWITHSILICONEIMPLANT,GA76.92251804590130470200009,400,000
365FACIALBONECOUNTOURING-MALARPLASTYWITHSILICONEIMPLANT,GA76.92251804590130470200009,400,000
366FACIALBONECOUNTOURING-OSSEOUSGENIOPLASTY,GA76.68251804590130470200009,400,000
367FACIALBONECOUNTOURING-OSSEOUSMALARPLASTY,GA76.65251804590130470200009,400,000
368FACIALBONECOUNTOURING-SPLITMANDIBLEOSTEOTOMY,GA76.64251804590130470200009,400,000
Keterangan:
*
**
***
Tumpangtindihkompetensidengansatuspesialislain(Tindakantumpangtindihpadaduadokterspesialis)
Tumpangtindihkompetensidenganduaspesialislain(Tindakantumpangtindihpadatigadokterspesialis)
Tumpangtindihkompetensidengantigaspesialislain(Tindakantumpangtindihpadaempatdokterspesialis)
40

50. NONAMATINDAKANICDIX-CMF1F2.1F2.2F3F4
TOTAL
SKOR
RVUJASA
1KRANIOTOMI/TREPANASIKONVENSIONAL
Neoplasma/prosesdesakruang
2a.lamaoperasilebihdari4jam01.242590180901205052000010,100,000
3b.lamaoperasikurangdari4jam01.2425901809040425200008,500,000
4Koreksilikworhoe01.242590904530280200005,600,000
5Penyakitvaskuler01.242518018090405152000010,300,000
6Epidural/Subduralhematoma01.242545909020270200005,400,000
KRANIOTOMI/TREPANASIBEDAHMIKRO
Neoplasmabasiskranium
7a.lamaoperasilebihdari4jam01.24251801801801206852000013,700,000
8b.lamaoperasikurangdari4jam01.2425180180180406052000012,100,000
AVM/Aneurisma
9a.lamaoperasilebihdari4jam01.2425180180180806452000012,900,000
10b.lamaoperasikurangdari4jam01.2425180180180406052000012,100,000
11Transphenoidalapproach01.242590909040335200006,700,000
OPERASIENDOSKOPI
12a.lamaoperasilebihdari4jam02.9925901809080465200009,300,000
13b.lamaoperasikurangdari4jam02.9925901809040425200008,500,000
OPERASIENDOVASKULAR
Diagnostik
14a.Angiograficerebral88.4125901555140200002,800,000
15b.Angiografispinal88.41259015510145200002,900,000
16c.BalloonOcclusionTest259015510145200002,900,000
17d.WADATes89.10259015510145200002,900,000
Terapi
a.Aneurysma
TARIFJASAMEDISTINDAKANPEMBEDAHANDOKTERSPESIALISBEDAHSARAF
41