The release of the guide for project approval of medical service pricing is an important measure to promote the deepening of medical service pricing reform. It is also a major measure to standardize medical service price items at the national level for the first time since the establishment of the National Healthcare Security Administration in2018. This article briefly describes the background, significance of the release of guide for project approval of medical service pricing, takes the actual medical service pricing items as a case, compares, analyzes the content differences before, after the implementation of guide for project approval of medical service pricing, discusses the difficulties, countermeasures of the implementation, to provide patients, hospitals, pharmaceutical companies, medical industry authorities with a multi-angle understanding, thinking