The medical service price item initiation guideline (hereinafter referred to as the item initiation guideline) is not only a standardized integration of the current medical service price items oriented towards service output, but also a comprehensive update of the medical service pricing rules. Based on a review of the national policy requirements for medical charging rules, this study analyzed the pricing rule settings and their changes in the pricing explanations and usage instructions of the item initiation guidelines. The study found that the item initiation guidelines clearly defined the charging boundaries through positive and negative lists, and put forward new requirements for the top-level design and application scenarios of medical charging rules. Policy suggestions for making full and effective use of charging rules in item initiation guidelines include updating the national and provincial versions of medical charge regulation and supervision rule databases according to significant changes in the elements of item initiation guidelines, establishing a matching relationship between medical orders and price items, embedding charging rules into information systems, and strengthening the supervision line of defense.